Treating pain in ER

Specialties Emergency

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Do you nurses typically see patients undermedicated in the ER for pain? I had the worst experience this past weekend. I have suffered chronic pain for about 10 years and at one time was on 600mg of oxycontin a day for about 5 years. I have weaned myself off of the oxycontin and now am on 120mg of roxycondone. I recently learned I have spinal stenosis in my lumbar, along with chronic kidney stones and neuropathy. So early sunday morning, after waiting over 8 hours for the pain to let up, I finally went to the ER. The ER doctor would only give me toradol and phenergan for nausea/vomiting ( I was also vomiting blood ). Finally he agreed to give me 1 ml of dilaudid (what a nice man. gag) which literally only took the edge off of my pain for about 15 minutes. Worst experence ever. I left in about the same pain I arrived in, only not vomiting. I made it a point to tell the Dr that I unfortunatelly have a high tolerance to pain meds, but he didn't care. Said chronic pain isn't treated in the ER. I thought if someone comes into the ER in chronic pain it must be treated, regardless of the cause. I wasn't asking or and RX or narcs, as I already had that at home, just wasn't working with this severe pain. Now I know the addicts probably mess things up for us who really need the relief, but shouldn't the doctor be able to tell the difference? Just curious about what you ER nurses see with regards to the subject. Thanks

Specializes in future OB/L&D nurse(I hope) or hospice.
Although this has nothing to do with your original post, this is important.

You have to know, you will be in intractable pain pretty often when you are a nurse. Standing all day with no chance to even take a pee until your shift is over and no dream of sitting for 10 minutes to eat something. If your back is that bad, you need to think seriously about your entering nursing school. That and the fact you will be expected to pass with clear urine, not opiate containing urine even with a prescription. Just the way it is in the real world of medicine.

As far as your pain goes, Maybe Monday morning you could go to your PM doctors office and try to get seen? I have no suggestions for how to handle pain. It is your demon to fight with.

I do hear you loud and clear and can't even begin to tell you how many tears have been shed once I learned of my back issue. I am puting serious thought into other options. Thank you for the insight. I do have an appointment today at 2:00pm with my PM doctor. Thanks again for your advice.:)

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Specializes in future OB/L&D nurse(I hope) or hospice.

Also, I do realize the issue with the drug testing and thus the reason for weaning me off the oxycontin ( I do realize that oxycontin and roxy are the same, one being extended release and one be immediate release)with the intention of moving to the immediate release and slowly weaning off that also. The injections/nerve blocks etc are, I am praying, will releave enough of the pain. I am also going to look into yoga and meditation as an alternative way of managing my pain . My goal is to be off all narcs within the next 4-6 months.

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Specializes in CT ,ICU,CCU,Tele,ED,Hospice.

first ,i am very sorry that you are in such pain.i have several conditions that also leave me in pain all the time severe cervical stenosis,spinal stenosis and disc disease also.but each person is different and it sounds like you are doing all you can.i am glad you are seeing a pain specialist.but when you went to the ed what did you expect to happen ?what did you expect to receive?for most people toradol,phenergan and dilaudid would provide some pain relief.agreed you probably needed more second to your tolerance.but ed is for emergencies .you were not going to leave the ed 100% painfree.that would not be a realistic expectation.but hopefully in less pain then when you came in.most likely you were told to followup with your pcp and pain specialist also.good luck feel better .

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As a family nurse practitioner with many years as an ER and ICU nurse, I think I have an understanding of both sides of the story. Chronic non-cancer pain is one of the toughest things we deal with. If you are not a prescriber you may not have a complete understanding of the entire picture. There has been an increase in deaths from people prescribed opioids. That is a fact, and it's not from overdoses or suicides. I have several patients whom I treat with opioids. I've been "fooled" a few times. I don't like it, but it happens. I'd rather get fooled a few times than avoid treating someone effectively. I also use hypnosis to help people. Chronic pain patients need to ideally be willing to do whatever is necessary to help themselves. Sorry if I rambled.

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Specializes in future OB/L&D nurse(I hope) or hospice.

I absolutely didn't expect to leave pain free, but I have been told by my PM doctor that if the pain flares to the point where it is intolerable to go to the ER so I can recieve some temporary relief at most. I was vomiting so badly do to the pain I was unable to keep down anything, including my pain meds perscribed to me. Instead I was treated like a common criminal seeking my next fix, and that is NOT who I am. I am also sorry to hear about your back issues and wish you the best of luck.

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Specializes in future OB/L&D nurse(I hope) or hospice.
As a family nurse practitioner with many years as an ER and ICU nurse, I think I have an understanding of both sides of the story. Chronic non-cancer pain is one of the toughest things we deal with. If you are not a prescriber you may not have a complete understanding of the entire picture. There has been an increase in deaths from people prescribed opioids. That is a fact, and it's not from overdoses or suicides. I have several patients whom I treat with opioids. I've been "fooled" a few times. I don't like it, but it happens. I'd rather get fooled a few times than avoid treating someone effectively. I also use hypnosis to help people. Chronic pain patients need to ideally be willing to do whatever is necessary to help themselves. Sorry if I rambled.

Great Idea. I will look into the hypnosis. I am looking at ALL avenues to control my pain without the need for narcs. I HATE being dependent on them. And thanks for caring about your patients.

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The difference is you had a NEW acute injury that required intrvention and pain relief........not a flare of a chronic condition requiring an increase and or change in prescrbed meds. ER's are for acute issues not fine tuning chronic pain.

If the OP is having a change in her medical condition she needs to seek the care of her PCP. This site cannot offer medical advice or make judgments about medical care without the appropriate informantion about the contirbuting factors. 600mg of oxycotin is a lot of a narcotic and roxicodone is oxycontin.

I hope you feel better....

the comment in bold is not correct!

I once had a patient on 1000mg of oxycontin daily divided into three doses....

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Specializes in ER, Med-surg, ICU.

I just returned from a CALS class and many of the providers were discussing treating their chronic pain patients. Many of them stated that they do not use pain clinics due tot he fact that they feel the pain clinic use too many narcotics and create addicts or jhust patients whose narcotic tolerance is so high it is really very difficult to treat them in the ER. An interesting thing was a provider whose hospital is sending her to accupuncture training and to use this to treat her pain patients. Of course I believe acute pain needs to be treated but hopefully another avenue for you to go down in the treatment of your chronic issues.

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Specializes in ER.

butterfly-

I would have been happy to medicate you until you were comfortable- though that doesn't help you a bit now.

We have PCP's that write letters to our ER docs so they are aware of pain control plans for patients that might otherwise be treated as seekers. The ERP's aren't under any obligation to do exactly as the PCP says, but they usually will understand the difference between acute on chronic pain patients, and those looking for a high.

In the situation you described once the doc decided you weren't getting the high test drugs it was unlikely he would change his mind. Go for the IV rehydration, nausea control...and antiemetic to take home with you, and then once you can keep down your own pills you might be able to manage til your own doc returns your call.

I'm sorry you had to deal with that.

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Specializes in future OB/L&D nurse(I hope) or hospice.
the comment in bold is not correct!

I once had a patient on 1000mg of oxycontin daily divided into three doses....

If you look at my post #13 just above you will see that I did infact state that I know Oxycontin and Oxycodone are the same, with Oxycontin being the extended release and the oxycodone I am now taking ( and slowly weaning off of ) being the immediate release. I do know that taking 600mg a day of oxycontin for over 6 years is not an easy thing to wean off of on your own. However, I have done that. I am now on 120 mg of oxycodone IR and every month dropping down 30 mg. Have had 4 back procedures and and feeling so much better. I am very hopeful as I HATE being on the stuff.

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Specializes in future OB/L&D nurse(I hope) or hospice.
butterfly-

I would have been happy to medicate you until you were comfortable- though that doesn't help you a bit now.

We have PCP's that write letters to our ER docs so they are aware of pain control plans for patients that might otherwise be treated as seekers. The ERP's aren't under any obligation to do exactly as the PCP says, but they usually will understand the difference between acute on chronic pain patients, and those looking for a high.

In the situation you described once the doc decided you weren't getting the high test drugs it was unlikely he would change his mind. Go for the IV rehydration, nausea control...and antiemetic to take home with you, and then once you can keep down your own pills you might be able to manage til your own doc returns your call.

I'm sorry you had to deal with that.

Thank you so much for understanding. I just hate it so bad when I am labeled as an addict. I have never even taken one hit off a cigarette, nor have I ever even been drunk in my life, and I am 42. I am just simply someone who has had to deal with chronic pain. This is the first time I have had to visit the ET for this reason. Usually it is for kidney stones. But, none the less. I do understand the other points of view with the ER doctors to a certain degree because of there are so many just seeking the high. Thanks again for your kind works. :)

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If you look at my post #13 just above you will see that I did infact state that I know Oxycontin and Oxycodone are the same, with Oxycontin being the extended release and the oxycodone I am now taking ( and slowly weaning off of ) being the immediate release. I do know that taking 600mg a day of oxycontin for over 6 years is not an easy thing to wean off of on your own. However, I have done that. I am now on 120 mg of oxycodone IR and every month dropping down 30 mg. Have had 4 back procedures and and feeling so much better. I am very hopeful as I HATE being on the stuff.

same med, different formulation, therefore NOT the same thing.

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