[I love my cat!]

Here is an EXCELLENT article regarding PAIN:

PAIN

Chronic pain seen altering how brain works By Julie Steenhuysen
Tue Feb 5, 5:50 PM ET

CHICAGO (Reuters) - Brain scans of people in chronic pain show a state of constant activity in areas that should be at rest, U.S. researchers said on Tuesday, a finding that could help explain why pain patients have higher rates of depression, anxiety and other disorders.

They said chronic pain seems to alter the way people process information that is unrelated to pain.

"It seems that enduring pain for a long time affects brain function in response to even minimally demanding attention tasks completely unrelated to pain," the researchers wrote in the Journal of Neuroscience.



To study this activity, Chialvo did a type of brain scan known as functional magnetic resonance imaging on 15 people with chronic back pain and 15 healthy people.

They gave their volunteers a simple attention task -- tracking a moving bar on a computer screen -- to observe the brain shifting out of default mode to handle the task.

Both groups performed the task well but when they measured areas of the brain activated, differences emerged.

EDITED

They said disruptions in this default network could explain why pain patients have problems with attention, sleep disturbances and even depression.

"These findings suggest that the brain of a chronic pain patient is not simply a healthy brain processing pain information but rather it is altered by the persistent pain in a manner reminiscent of other neurological conditions associated with cognitive impairments," they wrote.

(Editing by Maggie Fox and Bill Trott)

__________________________________________________ ____________
Any educated and qualified Medical Professional will admit, we don't know A LOT about the brain! I find research and articles like this very encouraging!

[mmutk]

I have edited to withhold my personal opinion

[Malanya]

I'm a long-term lurker, but this is my first post. I'd like to give a bit of background, and then ask a question that I hope won't be laughed at.

I'm 28 years old. I'm working in the computer industry while finishing my degree, hopefully to be a psych nurse (I couldn't handle an ER after being married to a resident who was in an ER rotation while waiting for an opening for OB-GYN.) At age 19, after my mother was dxed with FMS, she wanted me to go to her rheumatologist to investigate the muscle pain and poor sleep I'd had for years. Sure enough, with 13 of the 18 tender points, I was dxed with FMS as well. (Those ones at the point of the collarbone REALLY hurt.) I was given a ton of Flexeril, which just made me sleepy, and then given Zanaflex, which actually worked without making me horribly drowsy. But at that time, I was also very overweight, on BCP, and also on thyroid meds. After I was single, I quit the BCP and my weight dropped off almost as if my magic (scared my PCP actually). Losing the weight made a huge difference in my pain levels, as apparently I also have some disc issues and you know how weight loss helps those. Anyway, have not taken any meds for FMS for six years, and while I have an occasional bad spell they're not nearly as bad as they used to be.

I'm also allergic to aspirin and etodolac. (Also allergic to erythromycin, clindamycin, and a now apparently withdrawn quinolone called Raxar, but those are antibiotics.) Having five medication allergies, apparently, is a red flag for an ER. I've stopped mentioning the old FMS dx because it seems like every time I do I get really bad treatment from anywhere.

My question is this. I had to go to the ER for the first time in 3 years (the last time was for an asthma attack at work, they take workplace health incidents very seriously and insisted on calling an ambulance) for a broken tooth. I mentioned my allergies. The doctor could see it was a freshly broken tooth, and did give me a prescription for eight pain pills and a referral to an oral surgeon. However, he was very abrupt with me and said that if I came back in with pain of any sort they would not treat it. I didn't mention the FMS dx from years back.

Was this doctor just afraid of the DEA, or did my allergy list combined with the fact it was a toothache make him think I was a seeker? Yeah, I was seeking pain relief after the ibuprofen didn't work, but I really don't feel I was a "drug seeker" as the term is commonly used. I've never been to an ER for the pain that may be related to FMS -- the only time I've went to an ER for pain was when I sprained (and later re-sprained) an ankle and right after a car accident. The original sprain, from falling down stairs, was while I was first in college and that was when I found out I was allergic to etodolac. The resprain was five years ago. But essentially every time I've went to an ER for acute pain, I've been treated badly (in my opinion). I was never one of those patients who said 10/10, or was abusive to the nurses or doctors. What the doctor wrote, I accepted without comment and tried it to see if it worked.

If the ER docs think I'm a seeker, what is the red flag they're seeing? The FMS is hardly ever mentioned, I've usually had higher than normal for me BP when I present, and I've done my best to be cooperative with any tests, etc. Or is it just standard practice to treat patients rudely who present with pain? Maybe I've had a run of bad luck with doctors, but ... I'm wondering if it's my allergy list.

Any suggestions or red flags that show up in my history to you more experienced ER nurses?

I appreciate you listening to such a long post.

Take care,

Malanya

[CritterLover]

Originally Posted by Malanya

I'm a long-term lurker, but this is my first post. I'd like to give a bit of background, and then ask a question that I hope won't be laughed at.

I'm 28 years old. I'm working in the computer industry while finishing my degree, hopefully to be a psych nurse (I couldn't handle an ER after being married to a resident who was in an ER rotation while waiting for an opening for OB-GYN.) At age 19, after my mother was dxed with FMS, she wanted me to go to her rheumatologist to investigate the muscle pain and poor sleep I'd had for years. Sure enough, with 13 of the 18 tender points, I was dxed with FMS as well. (Those ones at the point of the collarbone REALLY hurt.) I was given a ton of Flexeril, which just made me sleepy, and then given Zanaflex, which actually worked without making me horribly drowsy. But at that time, I was also very overweight, on BCP, and also on thyroid meds. After I was single, I quit the BCP and my weight dropped off almost as if my magic (scared my PCP actually). Losing the weight made a huge difference in my pain levels, as apparently I also have some disc issues and you know how weight loss helps those. Anyway, have not taken any meds for FMS for six years, and while I have an occasional bad spell they're not nearly as bad as they used to be.

I'm also allergic to aspirin and etodolac. (Also allergic to erythromycin, clindamycin, and a now apparently withdrawn quinolone called Raxar, but those are antibiotics.) Having five medication allergies, apparently, is a red flag for an ER. I've stopped mentioning the old FMS dx because it seems like every time I do I get really bad treatment from anywhere.

My question is this. I had to go to the ER for the first time in 3 years (the last time was for an asthma attack at work, they take workplace health incidents very seriously and insisted on calling an ambulance) for a broken tooth. I mentioned my allergies. The doctor could see it was a freshly broken tooth, and did give me a prescription for eight pain pills and a referral to an oral surgeon. However, he was very abrupt with me and said that if I came back in with pain of any sort they would not treat it. I didn't mention the FMS dx from years back.

Was this doctor just afraid of the DEA, or did my allergy list combined with the fact it was a toothache make him think I was a seeker? Yeah, I was seeking pain relief after the ibuprofen didn't work, but I really don't feel I was a "drug seeker" as the term is commonly used. I've never been to an ER for the pain that may be related to FMS -- the only time I've went to an ER for pain was when I sprained (and later re-sprained) an ankle and right after a car accident. The original sprain, from falling down stairs, was while I was first in college and that was when I found out I was allergic to etodolac. The resprain was five years ago. But essentially every time I've went to an ER for acute pain, I've been treated badly (in my opinion). I was never one of those patients who said 10/10, or was abusive to the nurses or doctors. What the doctor wrote, I accepted without comment and tried it to see if it worked.

If the ER docs think I'm a seeker, what is the red flag they're seeing? The FMS is hardly ever mentioned, I've usually had higher than normal for me BP when I present, and I've done my best to be cooperative with any tests, etc. Or is it just standard practice to treat patients rudely who present with pain? Maybe I've had a run of bad luck with doctors, but ... I'm wondering if it's my allergy list.

Any suggestions or red flags that show up in my history to you more experienced ER nurses?

I appreciate you listening to such a long post.

Take care,

Malanya

ERs tend to get saturated with dental pain patients.

While most are happy to give an initial Rx for pain meds, they can't fix the problem, and it isn't going to go away.

You need a dentist, not an ER doc, right?

The ERs where I have worked don't have that policy (only give an Rx for tooth pain x1), but they have all limited the number of pain pills to 6-10.

And, to me, that isn't such a bad idea (limiting the number of Rxs to one). We have such a hard time getting people to follow up. They'd rather just come back to the ER, for some reason.

As for the docs attitude, some just arn't very friendly. I wouldn't read too much into it.

[caroladybelle]

Originally Posted by CritterLover

ERs tend to get saturated with dental pain patients.

While most are happy to give an initial Rx for pain meds, they can't fix the problem, and it isn't going to go away.

You need a dentist, not an ER doc, right?

The ERs where I have worked don't have that policy (only give an Rx for tooth pain x1), but they have all limited the number of pain pills to 6-10.

And, to me, that isn't such a bad idea (limiting the number of Rxs to one). We have such a hard time getting people to follow up. They'd rather just come back to the ER, for some reason.

As for the docs attitude, some just arn't very friendly. I wouldn't read too much into it.

Ditto!

The issue that you presented with is one that should be followed up with your MD or Dentist......not with the ER.

ERs are places for treating immediate problems or life threatening emergencies. Many patients see them on the weekends when they cannot go elsewhere, but they are not appropriate for continuity of care.

One way to insure that people followup appropriately is to provide only enough meds to cover until they can see the correct practitioner that can provide continued care.

And as far as attitude, ERs are generally very busy places, and if you can walk and talk on your own, the MD is probably more worried about those cases that can't. Open rudeness is an issue, a bit of of brusqueness though is understandable.

[Malanya]

Originally Posted by CritterLover

ERs tend to get saturated with dental pain patients.

While most are happy to give an initial Rx for pain meds, they can't fix the problem, and it isn't going to go away.

You need a dentist, not an ER doc, right?

The ERs where I have worked don't have that policy (only give an Rx for tooth pain x1), but they have all limited the number of pain pills to 6-10.

And, to me, that isn't such a bad idea (limiting the number of Rxs to one). We have such a hard time getting people to follow up. They'd rather just come back to the ER, for some reason.

As for the docs attitude, some just arn't very friendly. I wouldn't read too much into it.

I appreciate the reassurance. I was able to work with my PCP to get enough pain relief until the dental office could get me an appointment, so I was okay. Too bad it took a month to get scheduled for the root canal! At least they were able to save the tooth...

Mainly I was just wondering if the allergy list was what was causing it. I didn't even bother going to an ER when I dislocated my kneecap last year -- well, I was able to walk on it after putting it back in place immediately after, so it didn't quite qualify as an emergency. (It was when my man saw me limping that he insisted I go to the doc -- I'd torn my MCL slightly.)

I know especially ER docs have to walk a fine line between being "Dr. Feelgood" and treating legitimate pain. But when I've gone in to the ER for acute injury, it's felt like the docs thought I was being a wimp. (My PCP actually lodged a complaint with the ER after my fall down the stairs, saying that "no doctor in his right mind would give etodolac for an asthmatic patient with an allergy to aspirin" -- but that was in college in another state.)

What bothered me about the way that particular ER doc handled it, though, wasn't that he said "Don't come back in here for a toothache" -- he said that if I came in for any pain, he wouldn't treat it and had marked it in my chart. I felt like he saw me as a "seeker". And I couldn't for the life of me figure out why, until I started reading this board more thoroughly and saw that "long allergy list" was a sign. Oh well.

I *am* grateful for the small script that got me through until I could see my PCP. And I realize that's what an ER is for. I just wish he'd been a bit more ... oh, I don't know.... nice. "It's my policy not to give multiple prescriptions for toothaches because it doesn't fix the problem" would have went over better than "Don't come in here again for pain, we won't treat you."

The nursing staff, I must say, was exceptional at that hospital.

Take care, and again, I don't envy any of you ER nurses. I would much prefer to deal with crazies than with vegetables in every orifice.

[CritterLover]

Originally Posted by Malanya

Mainly I was just wondering if the allergy list was what was causing it. I didn't even bother going to an ER when I dislocated my kneecap last year -- well, I was able to walk on it after putting it back in place immediately after, so it didn't quite qualify as an emergency. (It was when my man saw me limping that he insisted I go to the doc -- I'd torn my MCL slightly.)

A long list of antibiotic allergies does not tend to make me think "seeker."

Drug seekers tend to be allergic to non-narcotic pain medictions, and pain-medication alternatives.

I'm going to be honest, though -- I do wonder about some people that have long allergy lists, even if it doesn't incule toradol, ibuprofen, naprosyn, neurontin, elavil, flexeril, nubain and codeine.

I know it is possible to have multiple antibiotic allergies, but sometimes I wonder if all of the allergies are "real." Sometimes I think the patients just have a low tolerance for the adverse effects of some antibiotics.

Others seem to get some weird sort of "thrill" out of being difficult to treat. "Oh, you can't give me that . Or X,Y,Z...."Kind of like patients that seem to be oddly proud that they are a "hard stick."

Anyway, enough off-topic. I doubt your allergy list was the reason for the "no more pain meds" flag in your chart. More than likely, it was the dental pain. Even though you had a visible sign (the chipped tooth) there are people out there that will walk around with something like that, just to get the pain meds. Sometimes it is for self consumption, sometimes it is to sell. Some ER docs are very wary of that.

[Malanya]

Originally Posted by CritterLover

I know it is possible to have multiple antibiotic allergies, but sometimes I wonder if all of the allergies are "real." Sometimes I think the patients just have a low tolerance for the adverse effects of some antibiotics.

I truly wish that for the mycin family it was just the standard "stomach issues" that apparently a lot of people have with erythromycin -- it's hives, and it really limits what a doctor can do. He's never even tried a Z-pack with me getting hives from two different mycins. My mom can have a bad respiratory infection and take six pills and be done with it -- and I really envy her that.

[quote]Others seem to get some weird sort of "thrill" out of being difficult to treat. "Oh, you can't give me that . Or X,Y,Z...."Kind of like patients that seem to be oddly proud that they are a "hard stick."[quote]

I just don't get how that would give someone a thrill. Do they like having black and blue arms or something? Oh well, crazy is crazy... and the first thing I learned in ab psych is not to try to understand crazy, just to deal with it without becoming crazy yourself.

Anyway, enough off-topic. I doubt your allergy list was the reason for the "no more pain meds" flag in your chart. More than likely, it was the dental pain. Even though you had a visible sign (the chipped tooth) there are people out there that will walk around with something like that, just to get the pain meds. Sometimes it is for self consumption, sometimes it is to sell. Some ER docs are very wary of that.

Anyone who walks around with a cracked tooth is a much more pain-tolerant soul than I am, I guess, unless the nerve is already dead or something. Everyone told me that a root canal was a painful procedure -- BS! Once he had me numbed up, all I noticed was pressure, and you never saw a happier soul than I was after that dental appointment. He gave me a script for Vicoprofen for "after pain" that I gave back to him when they put the permanent crown on it. I knew it'd been hurting some before it finally broke (then it was exquisite), but I didn't realize just how bad it was really hurting until they root-canaled it and I woke up after the numb wore off, pain free. (Feel free to pass on my story to anyone you know who has a dental phobia -- I wanted to kiss that dentist, and I'm happily attached!)

[I love my cat!]

Originally Posted by mmutk

I have edited to withhold my personal opinion

Why? I think a difference in opinion makes a good discussion!

[I love my cat!]

Interesting about the allergies. Allergies, specifically Multiple Chemical Sensitivities (MCS) is common is people with Fibromyalgia.
I suffer from a lot of allergies. Environmental, food, medications, animals, etc.
When I have gone into the MD/ER and they ask for my allergies, I tell them. If I am met with eye-rolling, heavy sighs and sarcastic, "Anything else?", I then take out the paperwork from all of my Allergy tests and present them. They can see for themselves, the results from the 4 days of skin testing and blood work. They can read the Allergists notes on my reactions to medications. They can see the skin-prrick reactions and the IgE levels in my blood work.
Boy, do their attitudes change fast!!!!!
All I can say is THANK GOODNESS there are allergy tests! I can only imagine the judgmental attitudes towards a person suffering from Fibromyalgia Pain AND Allergies and not having anything on paper to "prove" that their allergies are legitimate. So, not only are they making up their pain, but now they are making up their allergies and their reactions?

To add. I feel Dental Pain is severely undermedicated. I had a temp Inlay placed over my back tooth. As I was leaving the office, I could feel the pain and my mouth was still numb! They told me to take Ibuprofen. I told them that I would need something stronger because if the pain is this bad now, it will only get worse. I know my body. Nope. Take Ibuprofen. Well, about 12 hours later, I was in excruciating pain. The side of my face felt as though it was going to explode. I called the after hours number and got through to the Dentist and explained my situation. She called in 20 Vicodin. That saved my LIFE. Had she not called in the medication, I would have gone to the ER.
When the permanent inlay was ready (about 3 days later) I went back. When they were removing the temp inlay, they could see that a flap of skin/gum had been folded over and pinched with the temp inlay.....hence the EXCRUCIATING pain.
I told them so, but apparently at this office, pain isn't what the patient says it is.
They left the room and I saw my chart open on the table, so I looked at it. The Secretary had written in big, red letters PATIENT SEEKING VICODIN. I was so angered by this and I mentioned it, too. I told them that am not a drug seeker, but a patient seeking pain relief and if I was a drug seeker, would I really be spending $1000 on dental work for 20 lousy Vicodin? Please, give me a break.
I never went back to that Dentist again.