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  • When is it Ok to go to Emergency Room for pain??

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    Old 09-18-2005, 06:24 AM   #1
    Blasterboy
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    When is it Ok to go to Emergency Room for pain??

    Hi all. I'm having an awful day, my pain meds just don't seem to be working and I feel sick and on edge because of the pain. I just can't face this right now, it's pulling me down!

    I've taken two doses of my meds as perscribed today and they don't seem to be touching the pain; they usually do, so why not today, it doesn't make sense!!?

    I've another hour before I can take my next dose, but I'm not confident it will help, so my question is at what stage in pain suffering is it reasonable to visit the ER for some sort of treatment??? I know that my pain is far from being as bad as many of you suffer on this board, but it's wreaking my sanity right now, I feel like I'm going to collapse inwards (if that makes any sense!)

     
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    Old 09-18-2005, 10:21 AM   #2
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    Re: When is it Ok to go to Emergency Room for pain??

    Do you have a long acting med and a rescue med? This is what the rescue (or breakthrough) meds are for, to take when things are so bad that you need to make a trip to the ER.

    If you don't mind me asking, what is your Dx and what are you taking?

    Before you decide to embark on the long journey to ER, just some things to keep in mind:

    1) ER trips usually last 4-16 hours
    2) Pain patients are usually not met with the red carpet treatment. Make sure you bring prescription bottles and any MRI or CT scan reports to verify the things you say.
    3) You will be viewed as a "seeker", so keep that in mind.

    FEEL BETTER

    Alan

     
    Old 09-18-2005, 10:37 AM   #3
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    Re: When is it Ok to go to Emergency Room for pain??

    Hi Wolf

    Thanks for your feedback. I've only had this pain for 5 months since stomach surgery. I thinks it's some sort of nerve pain and I've just been referred to a Pain Specialist at last! I'm in the UK so I think the drugs I use here our a little different from USA.

    Anyhow what I have for now is Tramadol 50mg and I can take up to 8 a day max 100mg a time. I rarely take more than 6 in a day as it makes me feel sick. I mix each Tramadol dose with two 500/30 actemin/codeine phosphate and when the pains worse I can mix the Tramadol with two 30mg Dihydrocodeine (DF118's, I don't think you have these in the US, but it's my understanding that they are nothing like as strong as Hydrocodeine, although I'm not really sure.)

    So that's my lot, I don't have a breakthrough pain med at present as I presume my case isn't normally that bad, although at times recently it's becoming worse. I presume that's because I cut back my Amitriptyline dose from 50mg or 75mg before bed down to 25mg (it was causing too much drowsyness at work, I kept nodding off!) Because of the stomach surgery I can't take Nsaids either, but if the pain's real bad I will take 400mg Ibuprofen, it seems to offer a tiny extra relief, but I can only take that occassionally.

    I'm expecting my Pain doctor to do nerve blocks for me and I'm really hopefull that that will work, as I'm not prepared to be perscribed any stronger painkillers unless it's absolutly absolutly nessasery.

    I'm still feeling like crap right now, but it's eased a little since my last post as I managed to meditate a little and that calmed me down some. I guess I'll just grin and bear it as I'm not prepared for the hassles of ER that you kindly pointed out. Any further advice or opinions would be appreacaited.

    Thanks in advance

    Last edited by Blasterboy; 09-18-2005 at 10:48 AM.

     
    Old 09-18-2005, 11:39 AM   #4
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    Re: When is it Ok to go to Emergency Room for pain??

    Basically, we have tramadol--the rest are the equivalent of codeine )longer acting) and (short acting) "Norco or Lorotab or Vicodan or Hydrocodone" (in quotes all the same med). That's one step down from the morphine family where you would REALLY get relief: MsContin (long acting), and (short acting)"Percocet or Endocet or Oxycontin" (all the same).

    Last edited by dango; 09-18-2005 at 11:42 AM.

     
    Old 09-18-2005, 01:02 PM   #5
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    Re: When is it Ok to go to Emergency Room for pain??

    Well, now that I know that you've had fairly recent surgery, I WOULD get on over to the ER.

    This is much different than a chronic pain flare up. I'd have it checked out.

    Regards,
    Alan

     
    Old 09-18-2005, 02:52 PM   #6
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    Re: When is it Ok to go to Emergency Room for pain??

    I'm going to have a chat to my surgeon again tomorrow, I spoke to his sectractery earlier and she's emailed him. I can certainly wait until then..

     
    Old 09-18-2005, 06:18 PM   #7
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    Re: When is it Ok to go to Emergency Room for pain??

    Blasterboy, when you have endured surgery to your stomach AND have pain that is utterly intolerable--I, as a peer pain patient, believe you should get yourself to the ER to be treated. Pain tells your body something is amiss, so don't ignore it!

    It is probably just me, but it doesn't seem that you have very good (potent) medication for pain. Tramadol is not much of a pain reliever--particularly after surgery.

    Just in case you are not aware, tramadol (the generic form of Ultram) can cause seizures. This has happened to me.

    My lay opinion is GET TO THE ER IF YOU STILL HAVE TREMENDOUS PAIN.

    Furthermore, I get more and more irked when I am considered a "drug seeker" simply because I approach an ER for pain relief.

    I could go into a lengthy diatribe concerning my experiences. I will explain one item, however. My pain doctor, who worked in the pain unit at the local hospital, told me to go to the ER (it was after hours). At this hospital, the Pain unit is part of the ER department. My Pain doctor called the physician on duty, and the physician on duty refused to follow this colleague's orders. My Pain doctor instructed the ER to administer an injection of Dilaudid to help my pain. The doctor on duty told me that the ER experienced too many "drug seekers". Therefore, he could not comply with the instructions given by the Pain doctor who worked at that very same hospital (in the Pain unit that is part of the very same ER).

    What I don't understand is that all of my records were there. Also, my Pain doctor, who was head of the Pain Center, specifically called there. As well, I had rarely even been to the ER for any reason. With all of my records there, as well as my Pain doctor's "OK"--I have an increasingly difficult time dealing with this so-called treatment. The physician on duty said the only thing he could do was offer medication that could "potentiate" the medications I already took. He said he could give me an injection of Stadol. Since I use the Duragesic Patch 75 mcg, the agonist-antagonist action of Stadol was not an option. When I pointed this out to the doctor, he became belligerent.

    SO...My Pain doctor prescribed me medication and instructed me on how to make my own injection should the need arise. Of course, this is not a great idea for most people. However, I have only made approximately 5 injections in the last 3 or 4 years. LET ME MAKE IT CLEAR THAT I WOULD NOT RECOMMEND THIS PROCEDURE TO ANYONE AS A PEER PAIN PATIENT. All suggestions of treatment should be made by your physician.

    Sorry...I didn't mean to travel to a completely different tangent.

    If you, Blasterboy, still have this cruddy pain--please get to your doctor and have the situation rectified. You should not be forced to endure this agony.

    I wish you well!

     
    Old 09-19-2005, 07:45 AM   #8
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    Re: When is it Ok to go to Emergency Room for pain??

    FYI: The pain management clinic I go to here in the U.S. says that pain is not an emergency.

    They post signs in the clinic that says to never to go the ER for the pain they are treating us for.

    I have basically ruled that out as an option.
    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

    You are under different circumstances than I am though. I hope you are feeling better.

     
    Old 09-19-2005, 11:53 AM   #9
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    Re: When is it Ok to go to Emergency Room for pain??

    Dear Drewtn,

    Boy...that sounds awfully harsh to deny pain patients relief from their pain. It also sounds like they suffer from a severe lack of compassion. Is that your only Pain Clinic option in your area? Do they supply you with enough appropriate medication for emergencies?

    That just seems cruel to me. Don't misunderstand me. I do realize that many people abuse the pain system. A stubbed toe doesn't warrant a trip to the ER, but there are many legitimate reasons to have pain resolved.

    That is very disturbing to me. I shouldn't be so irked. After all, the last time I went to the ER for pain was in 1999. But, I feel better just knowing that I can get relief if I need it.

    Thanks!
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    Old 09-19-2005, 12:39 PM   #10
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    Re: When is it Ok to go to Emergency Room for pain??

    Hi Blaster...

    As you may have read, I'm having all sorts of problems obtaining my pain meds since I moved to the east coast.

    I too suffer abdominal pain. I've had four or five surgies, still have pain and doc's think it's nerve pain (someone's scalpel got away with them and nicked something during one of the proceedures)....

    Anyhow, to address your question. It sounds like you don't live in the US. All my experience in here in the US. The last time I was in the hospital (when I had a tube inserted into my stomach) I had the WORST pain of my life...even worse than childbirth. I was screaming in pain and the nurses basically told me to "be quiet)....while I was in the hospital.

    At least my doc was sympathetic to my pain issues. He and I tried lots of things till we found what worked. Then I moved to the east coast.

    Here, I've had nothing but trouble. So much so that (and here is my point to your post), I tried to wean myself off my 30mg methadone twice daily and mg 2 5/500 vics as needed for breakthrough.

    IT WAS HELL. I could NOT stand the pain. My goal is to be gainfully employed...the reason I moved here. I could not even get out of bed. I had the same question as you...at what point do you go to the ER? Well, here on the east coast of the US I have been treated like nothing but an addict seeking drugs. I never did go to the ER...I ended up just taking my normal dose of pain meds and hoping that I'd find a doc to prescribe my regular dose in time before I ran out.

    During the time I was trying to get off the meds I really think I should have gone to the ER. My teenaged daughter really urged me to go to the ER as I was in so much pain and withdrawls to boot.

    I do think it really depends on your pain tolerance, circumstances, relationship with your doc, where you are in your titration (is that a word? I mean the stage in which you are finding out how much you need to control the pain), and how long have you had the pain, what helps if anything, what meds you currently take and what is different about the pain at the time you are thinking of going to the ER.

    If you do decide to go to the ER you do as others have posted you'll want to take all your meds with you and any paperwork, diagnoses, or anything else you have from your doctor. You also want to be sure your regular doc gets a copy of whatever they treated you with if you do go. It may be that you need to increase the dose or change your pain meds...I don't know but, I just think there is that "something" within us all that just knows when we need to seek extra help. I don't know, call it a sixth sense or whatever, but being a chronic pain patient, I know when my pain is intolerable when or if I may need to seek additional help....especially since I recently tried to go off my meds because I was having such a hard time getting them.

    Good luck to you.....please let us know how you fare.

    Angela

    Last edited by RubySlippers; 09-19-2005 at 12:47 PM. Reason: spelling....where's the spell check :-)

     
    Old 09-19-2005, 01:16 PM   #11
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    Re: When is it Ok to go to Emergency Room for pain??

    Thanks everyone for the kind and informative feedback, I guess this is an issue that has plagued many of us. I think I was just freaking a little yesterday as I had some acute pain that was worse than usual, it did pass somewhat though and today I've felt almost human and my meds are working again. Strange how one day they work and yet another they don't even seem to help. The body sure is a special work of art that is beyond my understanding.

    Maybe I need more patience at times when the pains hit like that. My mind get racing though and I start to worry whilst the pain is increasing and I believe that in itself is not helpful for easing my situation. When I finially found the mindset to meditate yesterday that's when I found the most relief. I sort of centered on the pain been a ball of energy and that allowed my some peace on the matter; hard to explain that type of stuff really, I guess it's quite personal, but I remember Shoreline encouraging me to meditate on a post a few weeks back and that came to mind.

    I spoke to my surgeon today and he also reassured me that I wasn't going to fall to bits, lol and he had his secratery expediate the referral to the Pain clinic, hopefully I'll see someone with the week.

    Thanks again friends, I wish you a managable day filled with at least a little peace

     
    Old 09-20-2005, 05:46 AM   #12
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    Re: When is it Ok to go to Emergency Room for pain??

    Hi conductor,and welcome to the boards.I was just wondering about something you mentioned in your last post.when you stated that the Dr Rxed you meds to 'make your own injection"?Just exactly what did you do there?Do you do your own injections of pain meds or did you kind of mean that he 'created a kind of special mix of meds specifically geared for you and injects them for you?i am just a little confused about what exactly that statement ment.could you clarify it for me?i am just curious about the self injection part there.thanks,Marcia
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    Old 09-20-2005, 06:53 AM   #13
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    Re: When is it Ok to go to Emergency Room for pain??

    BlasterBoy I am glad you are feeling a bit better. Good to hear that your surgeon is speeding up your appointment. I know stress makes my pain MUCH MUCH worse!! Just being able to relax helps a lot! Take care!!


    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~
    Jon,
    I know it sounds harsh. The first time I read the sign I was surprised. I assume they feel like they provide adequate care for their patients. I am given long acting and breakthrough medicine. They do have an on call person 24 hours a day. Although they say they donít prescribe anything at night. They also say you have to make an appointment to make any change in your medicines. All of my meds say they MUST last 30 days.

    What was really shocking to me was the list of rules they have. Although they are just trying to make sure they abide by what the DEA wants. Things like if someone in your family gets kicked out of the clinic and they live with you then you will automatically be kicked out too. They can send you a letter and not ever see you again. They donít necessarily give you meds to wean off either. Drug tests are a part of their treatment plan. Even the elderly lady that was blind and in a wheel chair got drug tested. All patients will. You canít have alcohol in your test either. They basically say you canít drink alcohol at all while a patient there because they can call you anytime for a drug test or medicine count. These are just a few things that were surprising to me. Just the fact that they can drop you as a patient at any time for no reason shocked me. I used to think I had some rights as a patient. But not anymore. I am at their mercy. The DEA has changed the way things are looked at. BIGTIME!!

    I am not saying I like any of this or agree. I just donít have a choice right now. I will play their game as long as they keep my pain reasonable. The thought of my pain going back to the level it was is just horrifying to me. I used to go to the ER with migraines. I havenít been there once since going to this clinic. I am not saying that people shouldnít go I am just saying that is the policy at my clinic. That is all. Sorry it sounds so harsh.

    Also sorry to get off topic here. I just wanted to explain my post.

     
    Old 09-20-2005, 05:58 PM   #14
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    Re: When is it Ok to go to Emergency Room for pain??

    Dear Marcia,

    Yes, I need to clarify what my Pain Management doctor instructed me to do. Before I go on, I want to make it clear that this Pain Doctor (that I loved dearly because he brought me back to life with adequate pain relief) moved out of the area. I am still sad, but my current Internist that I see (due to the fact that I have Lupus) allows me to continue utilizing the same procedure. I must say, though, that this Internist would die if it was known I divulged any of this--so, I am going to be as vague as possible.

    I am hesitant in explaining this because I don't want anyone to get in trouble, but I will tell you the basics. The Pain Doctor prescribed me Dilaudid pills to take orally for break through pain. However, he knew that I have the occasional need for an injection. Under his strict guidance, he taught me how to dissolve (crush and "cook") the Dilaudid pill in water. I would draw this into a syringe, using cotton to strain any large particles. He prescribed me several injection needles to use. I would inject the solution into my thigh muscle.

    PLEASE, PLEASE understand that he knew my family well--and he made it clear that this was not appropriate except for severe emergencies. In fact, I had to call his service to get his "OK" before each administration. The generic form of Dilaudid is relatively cheap, and this saved me a great deal in medical expenses. This was all under his explicit guidance and supervision!

    Because I fear a severe backlash from people who might read more into this than there actually was--I want EVERYONE to know that this is not a recommended treatment for most people. Frankly, I am a trustworthy patient, and he knew that. In fact, he made sure that I understood his own RIOT act!

    Just to recap--he taught me how to "make" the shot solution, and he taught me how to inject it into the large muscle in my upper leg because he said the shot would absorb best in a large muscle (as if I have any sort of muscular physique). Furthermore, he was safe with me because I am not a fan of needles! HERE'S THE DANGEROUS STATEMENT...I think the process is practically the same as the process drug addicts use to cook up their stuff. The only difference is that they inject their stuff in their veins.

    Marcia, I will be glad to answer any further questions. This is not something I like to discuss because most people want to condemn a person for "injecting". HOWEVER, this treatment--WHICH IS COMPLETELY OK'D BY MY PHYSICIAN--is no different than receiving a Dilaudid injection in an ER. The good part--the cost for the entire procedure is approximately $10. versus the outrageous amount it would cost to go to an ER. Furthermore, a visit to the ER does not guarantee that you'll receive the injection you need for pain since we all seem to be classified as drug seekers. OK...That's it for now!
    Sincerely,
    Jon

     
    Old 09-21-2005, 02:12 AM   #15
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    Re: When is it Ok to go to Emergency Room for pain??

    That's very brave of you to share that Jon. I wouldn't worry too much about others opinion unless you are somewhat uncomortable with this your self.

     
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