Pain Management in the ER

[KYARNP]

I think we seriously under treat pain in the ER. I have a doctor who I work with that orders Phenergan and Benadryl for any complaint of pain and it snows every patient. It is a pet peeve of mine that we undertreat pain. If the patient says they are in pain,then they are in pain. Who am I to say any differently. I just had to get that off of my chest.

Any thoughts?

Ky ARNP

[danggirl16]

Always a touchy subject. This caught my eye because the last place I worked one doctor's answer to ANY c/o pain was benadryl and zofran. Then if that didn't work, he would order Haldol!! The benadryl/phenergan/toradol thing works great for many of the migraine patients. I don't get the Haldol though...I read one study about it being effective for a small percentage of migraine patients BUT NOT for anything else. I think it may have been more to knock people out but I think it's unethical.

It's really a shame that we DON'T have any way to tell and it's a shame that so many people have abused the system that people in true need are undertreated. I have this perspective as both an ER nurse and as a patient. I had gone to the ER with pains like an intestinal obstruction (have had in the past). It was my second visit in two days because it was not going away. The ER doctor stated "I don't have time to treat chronic pain patients"...my response "have you seen the CT?"..."Um...yes...but I'll have the radiologist go over it again" In other words, no she hadn't looked and just assumed. Lo and behold I was obstructed in TWO different places!!

But, I get it totally.

I'm wondering if there is some other sort of assessment scale that could be developed. For example, psychologically people have different associations with color. The trick would be to keep the results of the scale secret so no one can "beat" it. Wishful thinking but no worse than answers of "20" on a 1-10 scale!! The person who can come up with the solution to this will be a millionaire no doubt!

[Gabby-RN]

That is certainly not the case everywhere. I feel like we over treat pain. Sometimes it seems like everyone except migraine sufferers get morphine or dilaudid.