Chronic Pain (as an RN)

[fitzfan82]

I'm an RN who works in Pre-Op/PACU and floats to the ER as needed. I'm currently on medical leave for a sacral meningeal cyst (Tarlov cyst) on my s2-s4 that is 7cm x 4cm, with bone erosion. Tonight when my husband gets home, I'm having him take me to the ER for symptoms. I normally would never, ever dream of going to the ER for chronic pain related issues, but its come to a head and I can't even sit in a chair for more than 20 minutes without stabbing pain. My legs are numb and tingly and my hands are shaky. The pain has left me unable to sleep well for 3 days and last night I didn't sleep at all. I feel like I have a rock shoved into my bone. I'd say the pain is about a 7. I'm worried mostly that it has grown and that the nerves are being damaged based on the hands and legs, and I also need something to let me sleep- my home meds aren't cutting it and my doctor won't prescribe anything higher (Norco 10 and gabapentin is what I'm on).

ANYWAY, the point here is not to bore you with my story, but to comment on that fact that even as an RN, a surgical RN, I am scared to death to go to the ER for my symptoms. I've been in the ER as a patient twice that I can recall- once, for DKA (type 1 diabetes) and once when I was diagnosed with this monstrosity. That's a sad state that even medical professionals, who know what is serious and what is not, are afraid of being labeled or dismissed. When I was diagnosed, the PA that I initially saw told me I had sciatica and to take ibuprofen (I quickly asked for a real MD).

Do those who work in the ER more often have any insights on this? I never really tell them I'm a nurse because I don't think it should matter, but do patients who are medical professionals get taken more seriously in the ER? I'm just very nervous and would like some insight.

PS: The hospital I'm going to is the one my PCP and my neurosurgeon are out of, not the hospital I work at.

[scottaprn]

I try to avoid telling anyone at the ER I am a nurse and when I worked at the ER I never treated any healthcare provider differently than someone else.

The ER is still not the place for pain management. If your neurosurgeon isn't willing to fix the problem it is probably worth a second opinion. If you continue with conservative treatment and your physician won't go higher with your pain medication then a referral to pain management is in order.

I hope you get relief from your symptoms

[Lunah, MSN, RN]

As the poster above said, the ER isn't a great place to manage your breakthrough pain. If your home meds aren't doing it, revisit your management plan with your PCP and neuro. Definitely a referral to pain management. When were you last seen?

Personally I give everyone the benefit of the doubt. Many patients with chronic pain do experience acute exacerbation of their issues. I hope you find some relief.

[Anna Flaxis, BSN, RN]

I don't triage based upon whether you are a nurse or not. I assign acuity based upon chief compliant, VS, presence or absence of high risk situation, etc.

As described, your chief complaint would be "back pain" and your ESI acuity level would be 4 (1 is a resuscitation, 5 is the very lowest acuity).

That means you will wait until everyone with a higher acuity level has been roomed.

You might sense a lack of urgency- not necessarily due to lack of compassion, but because your condition is not emergent, and you've already been living with it for some time, so you can wait.

As others have stated, the ER is not a good place to manage chronic pain. You need to follow up with your pain management specialist, and if you're not satisfied with their response, seek a second opinion.

Most likely, we would give you something IM and send you on your way (after a potentially very long wait, when you could be at home in your own bed taking your ibuprofen and Norco and alternating heat and ice instead of waiting in the ER lobby), but since you already have a script for Norco, we wouldn't be prescribing anything except maybe a muscle relaxer (in a very limited quantity), and advising you follow up with your PCP.

[Anna Flaxis, BSN, RN]

Just wanted to add that if the ER you go to has a dedicated Fast Track, or is not very busy at the time you go, you could get in and out pretty quickly. But this would have nothing to do with your being an RN. Patients are triaged and seen based on acuity and the needs of the department.

[fitzfan82]

I jdischargeant that it was sad an RN has to be scared to go to the ER because of the staff attitudes. I don't expect to get in faster because I'm a nurse, I never even told them that I was.

Actually when I went I was given a stat MRI due to the fact that the cyst on my spinal cord is filled with CSF and the intensity of the pain combined with the loss of sensation on one leg made them weary of a potential rupture or need for immediate surged on it. I was put in the main ER (not fast track) and given IV fluids as I had eaten in over a day, and am diabetic, along with IV Dilaudid after they reviewed the previous and new MRIs.

As i said, I would never go to the ER for just pain, but with the type of condition I have, combined with being diabetic, they told me I was smart to go in. If CSF leaks into your body, it can become very serious, even life threatening. The sudden onset of new, intractable pain with other symptoms signal to me that something has changed. After paging my doctor through his office more than once. I had to do something. Not to mention that as a diabetic, my blood sugar levels were all over the place.

On discharge, my dx was not 'back pain' but symptomatic sacral meningeal cyst.

[fitzfan82]

I also can only take Tylenol, not NSAIDS because I take another medication that interacts. They also did give me some valium IV.

[scottaprn]

We cant give medical advice but consider a second opinion. Based on the size and symptoms you describe a second set of eyes wouldn't hurt.

[fitzfan82]

Thanks. The flareup is subsiding slowly, and I am on the list to schedule surgery with one of three top Drs in the nation who treat this rare condition, I just got really scared that night when the pain intensified so sharply and I lost feeling in my thigh. But I was afraid to go to the ER even though I was really scared. But it turned out. Pray that I get my surgery scheduled within the month!