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babs17 08-31-2007 08:32 PM

Anyone ever gone to ER when Pain gets BEYOND CONTROLLABLE?
I was wondering if anyone who is a PM patient ever goes to the ER during times of uncontrollable pain? 2 days ago, I felt like I was being tortured....slowly and severly. I have Chronic pain, so YES, it hurts badly many times a day. I'm on LA meds and take SA for BT Pain. But, what I felt actually made me act a bit nutty to my caretakers....this happens about once every 2 months. I never know if I should go to an ER....or just ride it out. It usually lasts a good 2 hrs. Lots of screaming and crying. My sister was here for this last one, and she does not think that it's normal to go through that and not see a Doctor. I was just getting anyone else's opinions. Thanks.

matri956 08-31-2007 08:48 PM

Re: Anyone ever gone to ER when Pain gets BEYOND CONTROLLABLE?
I'm new to these boards so I'm not used to abbreviations.....what does "LA meds" mean and what is "SA for BT pain".....I ask because pain management can cover a lot and if I had a really bad episode of pain and couldn't reach my doctor I definitely would go to the ER.

neurowreck 08-31-2007 09:32 PM

Re: Anyone ever gone to ER when Pain gets BEYOND CONTROLLABLE?
Do you have someone on call that you can get ahold of when the meds aren't working? You shouldn't have to put up with that sort of pain. I've got fibromyalgia, seizures (pain after those), and a recent knee replacement (did go to the ER to tell them to cut the leg off before surgery, since it hurt so bad- had a torn meniscus, and the joint was at an angle with no cartilage left- so replacement at 43 was only option- it still hurts in the muscles in my thigh). Headaches are another problem. I avoid the ER at all costs due to being labeled a 'frequent flier' and 'drug seeker', but if you have a doc on call who can refer you to the ER, and call them ahead of time, you will be treated better...... just an idea :)

IZZY'SMOM 08-31-2007 09:52 PM

Re: Anyone ever gone to ER when Pain gets BEYOND CONTROLLABLE?
Hi Babs~
Sorry you had to go thru that...I hope you are feeling better.:angel:

Can you talk to your doc or even call and leave a message to tell him what has been going on? Maybe your b/t meds arent strong enough, OR maybe he could write you for just a few of something stronger when this happens so you dont have to pay for the ER costs, as well as the pain and inconvenience.

I strongly suggest you call your doc. And you have the ER records to back you up, and tell him you have gone thru this before.

Will he allow you to take more of your b/t meds, or does that not help? Everyone has times that are worse than others, and you shouldnt have to suffer thru those and go to the ER.

I hope your doc is understanding and will help you out. It would be nice to have even a script for 20 tabs to fall back on if you needed it. But its hard to even get what we need, so I understand not wanting to push it...
Let us know what happens...I havent had to do this, and Im on the road alot for my golf, and I do worry about it. i dont know what I would do if it happened to me.

Fabrashamx 08-31-2007 11:13 PM

Re: Anyone ever gone to ER when Pain gets BEYOND CONTROLLABLE?
Hi Babs,

I agree, you need to ask your doctor what you should do when this happens.
Do you have a pain contract? I was allowed with my old doctor to go in to ER for an injection, usually morphine or demerol. and she would allow the ER to give me some Percocet to take instead of my hydrocodone until my pain and nausea were back under control.
If you do go to the ER, make sure you call your doctors office very first thing in the morning, so they know what happened. (Tuesday in this case, with the monday holiday, unless your doc has saturday hours)
Also, every pain patient needs to have some anti nausea suppositorys on hand, sometimes thats all it takes to keep us out of the ER when the pain gets bad and we start to lose our meds along with our lunch.:(

Everyone needs to find out what their pain doctor wants them to do incase of emergency, some of them want you to bend over backwards to only see them and no one else, some like to call the ER and request you be given a specific med, etc.

I think emergency plans should be written into every PM contract, No one likes to be in agony, throwing up meds, and scared if they go to ER they will be dropped from their PMs practice. forwarned is forearmed.

I need to ask my new doctor about this too, I'd rather do it before its a middle of the night emergency.

Best of luck, I hope you get relief soon!

erfan 09-01-2007 12:12 AM

Re: Anyone ever gone to ER when Pain gets BEYOND CONTROLLABLE?
LT is long term meds like Fentanyl Patch, OxyContin, MS Contin or any oher time released med that allows for dosing greater than eery 4-8 hours.

ST is short term med like Roxicodone, oxycodone, percocet, icodin, norco, etc. that is used for BT or breakthrough pain. ST meds are usually dosed at eery 4-8 hours or when needed.

BT pain is a pain that occurs despite having an LT med in your system. It often is pain that goes above above and beyond the usual pain you have. It is often sharp and severe pain.

Most-but not all-Pain Management Doctors (PM) will rx both a LT and ST med.

babs17 09-01-2007 08:50 AM

Re: Anyone ever gone to ER when Pain gets BEYOND CONTROLLABLE?
Hey....let me CLARIFY my Question :)

Thanks for the replies so far. I should have explained a bit further. I have NEVER gone to the ER for the pain. It was always my impression that the ER leaves us Pain People at the end of the line, so, EVERYBODY else gets treated before us, and I have never wanted to wait in a ER and be in pain like that. I'd rather be in the comfort of my own home.

BUT, it got me thinking, [I]should I be going to the ER[/I]? That's where my question to this board originated. Just for documentation, or just for comfort's sake. ????

To answer the question about Contracts...YES, I DO have one and I OBEY IT LIKE it's God's law. I'm under the impression that here in the USA, pain patients get the brunt of some ugly press and stereotypes. Therefore, I DO NOT bend any of the rules at my Pain Management office. As bad as my daily pain is, I would NOT want to even imagine getting tossed out of any Pain Management Office for breaking any rules. My body would never forgive my me for that.

Sorry for the Abbreviations there, Matri956. I can see that someone was kind enough to answer your Q's regarding that. And WELCOME!

[I]So, my Q is[/I], [B]Even though I have not gone to the ER for pain, should I be going on the really really horrible episodes? [/B]And Yes, I will let my Pain Management doctor know about these episodes. I'm sure that some people will understand, but, when my doctor enters the room when I am there for my appointment, I get lost in other Q's , and forget that particular one. :-) Thanks fabby, Neurowreck, and Izzy for the suggestions!!!! And Neurowrck, I love your name on here...LOL.

I'm still feeling the ripple effect in my muscles from that horrible pain episode from 3 days ago. It usually takes a good week or so, for the knawing , stabbing pain that follows an episode like that, to go away. Have to lay low for the next week. I'm a very energetic person, so I hate when this happens. But, you have to do what you have to do in order to survive this chronic pain life, right?

Shoreline 09-01-2007 09:38 AM

Re: Anyone ever gone to ER when Pain gets BEYOND CONTROLLABLE?
Hey babs, I doubt your sister will ever understand unless she develops chronic pain. To a CP patient, pain is something we live with every day. To a normal person pain is a warning sign that something is wrong, usually the worse the pain the worse the problem. However, that's not true for chronic pain and is something people that live with CP need to learn, except or understand. Even though we may experience more pain from one day to the next or one hour to the next, our bodies is no longer using pain as a warning signal that we need immediate attn.

Other than spending 6+ hours in an ER at the very bottom of a triage list because waiting isn't going to cause any additional harm. I don't see the benefit of a shot of any med that only lasts 4 hours and may leave you in the exact same spot as soon as it wears off an hour after you get home.

I've never gone to the ER for CP. They have saved my life during a heart attack, patched me up or stiched me up after breaking bones or being in an MVA, but these things are actual emergencies that a doc isn't going to question why you are even there.

It's not a matter of not being allowed to go to the ER or some rule in a contract. It's a matter of is the ER the right place to go and is a doc whos specialty is trauma or emergency medecine the right doc to see for BT pain. Especially when our PM doc has already given us stronger meds for BT pain than any ER doc will ever send us home with.

That being said, or that side of the coin having been examined, If it were my wife screaming in pain and crying and acting irrational, I would take her to the ER. There is no right or wrong answer.

However when CP patients see the ER as an alternative to being uncomfortable untill they can be seen by their PM doc, what's the right answer as far as how many times is it OK to go to the ER? Once every 2 months, once a month, Once a week? How many times is the same ER going to treat us when the only treatment we seem interested in is a shot of morphine or dilaudid. This can get us labeled and actually cost us our PM doc if he's tired of being called at midnight about another patients BT pain when he prescribes meds specifically for BT pain and flairs like this to avoid those trips to the ER.

We aren't our docs only patient, so the same things we do are being done by every other patient he sees and by every drug seeker that sees the ER as a quick fix. I know we aren't thinking about our docs other 500 patients in the middle of a flair, but maybe we should give it some thought before we decide the ER is a reasonable source for additinal pain meds when our pain spikes.

I'm not telling people what they should do or how they should act, I'm just offering another perspective.
Take care, Dave

neurowreck 09-01-2007 10:16 AM

Re: Anyone ever gone to ER when Pain gets BEYOND CONTROLLABLE?
One way to get in to the ER sooner, is if your pain is too bad to sit in the car, or you become dizzy, and need an ambulance to take you- straight to a may still be waiting, but at least it wont be in the chair area. And, hospitals are supposed to deal with pain per the Joint Commision for the Accredidation of Hospitals....if they don't you can notify them that you were left in pain when that's the reason you went there.

I'd bring the pain contract, so they know you're seeing someone, and not just hanging out there looking for drugs (you're right about the stereotypes, unfortunately). Chronic pain patients generally have fairly normal vital signs since they've acclimated to the pain, where 'normal' patients have elevated Blood pressure and pulse UNTIL they decompensate, and it goes down from the body not being able to handle it anymore.

You might ask your PM doc to add to the contract when to go to the ER= that would legitimize it for YOU. You still might get some attitude- write to patient relations about it, and remind them of JCAHO's emphasis on pain management (and write to them- I have about other issues). Nobody deserves to be in pain like that. When I told the ER doc to cut my leg off, I was serious- I couldn't take it anymore. Now I've got pain from the knee replacement- not as bad as before, but it's still enough to limit activities and require meds at times. I could justify more meds, but I don't want to ask for them.

Get your PM doc to support any ER visits as a last resort when you can't get ahold of him/her, and add it to your PM contract. That will at least let the ER know you are doing what the doc says. :)

babs17 09-01-2007 06:38 PM

Re: Anyone ever gone to ER when Pain gets BEYOND CONTROLLABLE?
Trust me...I HATE going to the ER. For many reasons....some being obvious, others being that I have been the caregiver on the receiving end of the patient/caregiver exchange. And I know that when you are running around saving lives...literally...someone in pain does not make it to your "first things to do" list. And, if it were me having a heart attack, I'd want to be looked at before the person next to me in pain. I'm quite fair on those accounts.

My big fear is that I am damaging my health otherwise. MEANING: the last 2 times I have had these episodes, my health deterioarted overnight. About a month and a half ago, I had a really bad episode of pain that lasted for 4-5 just wouldn't go away. I stuck it out, BUT, developed SHINGLES 2 days after that due to the stress of it. This past episode, I ended up with a horrible bout of Gastroenteritis b/c of the stress of the pain. It just seems that this "wait it out" avenue has been damaging me. I plan on telling my PM MD about this new found connection I have unveiled about how my body has been responding to bad episodes of pain. I was just fishing around here for some thanks, and please, keep them coming.

madhatter 09-01-2007 09:47 PM

Re: Anyone ever gone to ER when Pain gets BEYOND CONTROLLABLE?
With the medication I take for pain[oxycontin] and due to the contract I agreed to,I can't and won't go to the E.R. Even if I didn't have a contract,the E.R won't do any good for pain control. I don't even believe theres anyone there that is educated about pain. They either won't give you anything because[and this is understandable] in 99.9 percent of people being treated for chronic pain,they are taking sched.II narcotics. oxycontin,ms.contin, fetnyol ,etc. and the E.R in most cases will say your on heavy narcotics as it is,and won't give anything stronger.They give hydrocodone ,or IB. 800's and what is that going to do for most of us? Or,when going to the E.R and your just looking for something to control your pain,they think your drug seeking. It is very rare[ with my experiences,and talking to other people] for a doc. in the E.R to prescribe something that will help,to a chronic pain person.

neurowreck 09-02-2007 10:33 AM

Re: Anyone ever gone to ER when Pain gets BEYOND CONTROLLABLE?
ERs are notorious for being unsympathetic about pain- they're required to ask about it, yet they do nothing about it. They definitely don't understand chronic pain. I have found some help with patient relations, and they've passed on my letters to the ER medical director (mine is in reference to seizures, an autonomic disorder, and EMS calling me psycho because they picked me up after a seizure- not my choice- at a rape crisis center where I was getting help with a parole protest letter....if that makes me nuts, then nuts I am....EMS announced throughout the triage area, where other patients were that I was a psych's the ones who don't get help who are scary...).

But patient relations did pass on the info. I've since been going to another ER, which picked up nearly lethal pulmonary emboli, possible TIA, and increased headaches and seizures (admitted for all 3). They've never been nasty, and took me seriously. The pain meds they gave me for the headaches weren't all that helpful- yet they also needed to know about my neuro status, so I sort of understood that, but now, I'm in pain all the time, and need to talk to my doc about it.

But I know what you mean about going to the ER for pain. You end up at the bottom of the barrel, and get your name put on a little index card for the 'drug seekers''s so unfair.

sandollar 09-10-2007 11:09 AM

Re: Anyone ever gone to ER when Pain gets BEYOND CONTROLLABLE?
I think I can answer your question.

I was working full time most of this year in severe pain in my back, I was refered to a new PM in town for back pain. I had not seen him as of yet, and [B]before [/B]my first appt with him my knee gave out, I couldn't walk on it and I was dragging my leg in severe pain. Hubby took me to the ER and they gave me 12 lortabs and told me to check up with my Ortho Doc in the morning, Which i did. They asked me what I had for pain and hubby told them I was given 12 lortabs at the ER until I could see my new PM and let him know about my knee as well. They took x-rays and put a brace on it and ALSO gave me 12 lortabs. [B][U]BUT[/U][/B]I did not fill the Ortho Doctors Lortabs since I figured 12 was enough till I saw my new PM.

I saw him the following week and told him about the ER and the lortabs and how they sent me to the Ortho Doctor who did X-rays.
He filled a script for 90 lortabs and as soon as I got to the pharmacy, a bunch of red flags went up!!!

He called [B]ALL[/B] my Doctors and told them I was a drug seeker because I forgot to tell him I schredded the Ortho docs script. It didn't make any sense to me since I never had it filled.
But the pharmacy told him I had seen my GP [U]4 months earlier [/U]for pain meds.

Being depressed, I almost gave up on everyone. I began getting registered letters from all my doctors telling me to find another doctor and they would no longer see me. I spoke to the managers in all my Doctors offices that he called (on advice from my Therapist for Depression) and I explained what happened, they all agreed to see me without any problems.

I told this guy this all happend [B]BEFORE[/B] I met him. but it didn't make any difference. He almost ruined my life.
I went to my shrink for emergency advice due to my depression getting out of control.

He said this guy is new and actually didn't have any patients yet and I was his first one and when the pharmacy called him about the ER Script, he automatically told everyone on my pharmacy records (which I took in to him), that I was a high risk drug seeker.

I therefore took my Shrinks advice and called and told him that if he didn't fix this mess he made he would be talking to my lawyers for slander.

Everything was fixed and I told the Ortho Doc I needed a different PM and they sent me to the one I have now. Who rents an office from them, I told him what happened and he laughed at how paranoid this new guy was and put me on Duragesic Patches (50).

I told him If I ever had to go to the ER, I would let him know the next morning. He told me not to worry about it, cause they wouldn't give anyone enough pain meds to help anything anyway.

Shortly after, My Ortho Doc asked him if he would take over my knee's as well, and he did, however the Bakers Cyst in the back of my knee burst and they found bone fragments and loose kneecaps and will be scoping both knee's.
But he is in charge of any pain meds. I did not have to sign a contract with this guy either. Shore, should remember him, he is the one who is concerned about the DEA and is really careful about what he does.

BTW= Even though I didn't sign any contract, he still did a urine test while I was there and it came back that I was addicted to Heroin, Maraguana (SP?), and Cocaine and about 6 other illegal things.
But he said it was a combo of the meds I was on. And I was also taking [B]HOODIA[/B] to loose about 15 pounds and believe it or not, That's what came back as mariguana (SP?) So be careful on this Hoodia stuff guys!!

But to answer your question, NO, I would NEVER go to the ER again, it nearly ruined my life!!

trowftd3 09-10-2007 11:57 AM

Re: Anyone ever gone to ER when Pain gets BEYOND CONTROLLABLE?
I, too, try to avoid the er at all cost. Two years ago I had severe(I mean severe)stomach pain with vomiting. Way, way worse than the 11 on the scale! When I went to the er I told them the meds I take and they put me on a gurney behind a curtain. I was moaning in pain....and I usually hold it together pretty well...and they ignored me. The girl behind the curtain next to me said"My stomach hurts" in a calm quiet voice and they immediately said "Oh, lets get you a shot of some pain meds." They finally (45 mins later) gave me a 50mg shot of Demerol...which they had to repeat twice before I could tolerate the pain. They acted shocked when the tests results came back that I had a "rip-roaring" bladder infection. I was soooo mad and frustrated.

This is why I stay away from the er....I'll just moan in pain at home. My husband's always trying to take me but I'd rather try to get into see my doc or go to the walk in clinic. The wait is not as long. I know they can't give you any pain killers at the walk-in...actually the doctor gave me one oxycontin when I broke my arm. I just called my doc the next day and told her what happened and she wrote me a new prescription. She's the best.

Sorry to ramble.~Mush

Fabrashamx 09-10-2007 12:55 PM

Re: Anyone ever gone to ER when Pain gets BEYOND CONTROLLABLE?
ER has been able to help me in the past, and they have always been very kind, even though I have had some long waits.
But everyone is right about the meds. I'm on pretty weenie meds as far as pain management, Tramadol and Lortab, so if I get a shot of demerol and some percocet it really make a difference. But those are the strongest meds they will give anyone from an ER, so if I were on the patch and roxicet for breakthrough, going would be pointless, as everyone said.

They couldnt give me anything strong enough to make much of a difference.
But as far as SHOULD you go? I think everyone has a right to seek attention when they are writhing in pain, I have known people to be admitted to the hospital for a time where they certainly can give you stronger meds, until the pain is under control.

I was in the hospital once for a week with shots of demerol every 2 hours, and I came in through the ER.

HTH, Fabby

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