back pain

CodeteamB · Mar 4, 2014

Is your chief resident perhaps trying to direct this patient to an appropriate level of care (which weekly ER visits and toradol shots is not)?

Surely this patient would be better served by seeing a service that can address the underlying reasons for pain, and help to manage it in an appropriate way.

In my experience such a patient would be referred to a chronic pain management specialist/clinic.

dsherman · Mar 4, 2014

the patient goes to pain management weekly for epidural injections. pt. refuses narcotics as pt. does not want to get addicted.

zmansc, ASN, RN · Mar 4, 2014

Has the patient discussed her need for additional relief with her provider at the pain management clinic? Why are the epidural injections not meeting her needs? This situation seems like it needs further indepth assessment of the proper course for the patients long term care.

dsherman · Mar 4, 2014

I agree but she comes in after the injections due to breakthrough pain. I am wondering if I should refer her to someone else I wrote her an rx for diclofenac to help with her pain and she seemed satisfied maybe it will help. but I will most likely see her next Tuesday back in the er. she also only comes on the days I work

Altra, BSN, RN · Mar 4, 2014

I've not ever seen an academic hospitalchain of command in which a midlevel provider reported to a resident.

1fastRN · Mar 4, 2014

Weird, I've only heard of those "frequent fliers" for narcotics. Sounds like that patient needs to find somewhere else to go!

Trauma Columnist · Mar 4, 2014

May I ask what state your practice in?

dsherman · Mar 4, 2014

ohio and northern kentucky

wheeliesurfer · Mar 6, 2014

Are her PM injections also on Tuesdays? If indeed they are, then I suspect that this "breakthrough" pain she is experiencing is not actually BT, but post procedure pain after the local wears off and she is again feeling the effect of the epidural. If she is in fact seeing you on the same day she has seen her pain mgt. physician for the other injection, than perhaps you could suggest that she talk to her PM doc about doing the toradol injection in office at the same time.

If she is seeing you on a different day, perhaps you could recommend that she still follow up with her PM doc, even if it means twice weekly appts for injections. The first for the epidural and the second for the Toradol. I imagine that her insurance would much prefer the extra specialty visit than a weekly ER visit for a chronic condition that could be cared for on an outpatient basis.

I would absolutely recommend that she follow up with PM about this "breakthrough" pain, and you stop caring for her chronic pain. She could have already signed a pain contract with the PM doc about not getting treated for the pain elsewhere (definitely no narcs from another provider without PM approval). Tell her that her pain doc should be the one who deals with ALL aspects of her chronic pain management, and that if she is going to expect you to treat her pain as well, then you need a letter (or phone conference) with her PM doc outlining what she would like done in a true pain exacerbation if her office is unable to see the patient on said day. That way, all providers are on the same page, and it will hopefully get this "frequent flyer" out of your ER and into her PM office where she belongs in the first place, unless it is a true EMERGENCY.

dsherman · Mar 6, 2014

I will tell her to talk with her pain management doctor and I will call the clinic as it is in the facility I don't mid seeing her but it's just crazy every Tuesday. Thank you so much