Chronic Pain and the ER Visit

By Mary L. Meyer, Manager and Knox H. Todd, MD, MPH, Director
Pain and Emergency Medicine Institute

Emergency Departments (EDs) are designed to respond to the most obvious and urgent medical needs. Assessment, prioritizing, and treatment happen quickly. This is the opposite of what is needed to treat chronic pain. Chronic pain is a complex phenomenon and it is often not amenable to a straightforward, standardized treatment approach. Nonetheless, when severe pain hits, the ED may be the only option available.The purpose of this article is to help chronic pain sufferers understand better the unique environment of the ED and how that might affect the care they are given, and to suggest some ways that this encounter can be made more productive.

Barriers to effective Treatment – A relationship of strangers

The patient-physician relationship in the emergency department is frequently one between strangers. There is no shared history or understanding of the complexity of the patient’s situation

Most physicians receive very little training in pain management, so it is not surprising that emergency physicians may not be skilled in the management of a complex chronic pain condition, such as reflex sympathetic dystrophy. If they have no experience or skill in dealing with the condition that is presented to them, they may tend to minimize the seriousness of the condition, and unconsciously shield themselves from the patient’s distress.

Many patients with chronic pain might know more than the treating physician about the medications needed for effective treatment of their conditions. However, if patients are too adamant in their demands for particular drugs, it can cause physicians to become suspicious of their motives.

Emergency physicians are very concerned that patients might use the ED to obtain controlled substances because of addiction or for criminal purposes. Physicians may fear prescribing large doses of opioids (narcotics) to control pain they do not understand. Recent activities of the Drug Enforcement Administration to control illicit prescribing by physicians also contributes to this climate of fear.

What can a patient do?

If you have a primary care provider who knows your situation, it will be enormously reassuring to the ED physician if he or she is aware that you are seeking care in the ED and your PCP can be contacted. It might help to ask your physician for a letter that states you are under care, a description of the pain condition, and how it is being managed. You should take this document with you when you go to the ED. The letter should contain contact information for your physician.

Always keep handy a list of the medications and dosages you are taking to bring with you to the ED. This will help the physician know what additional drugs can be prescribed safely.

Be patient with the caregivers. Remember, you are a stranger to them. When you are in pain this is a hard thing to ask, but becoming angry with your caregivers may alienate them, increase their suspicions of your motives, and lessen the chances that your treatment will be successful.

If you have a less than optimal experience in the ED, write a follow-up letter to the hospital patient advocate describing your treatment. If it was not accomplished during the visit, ask your physician to communicate with the ED. This will be very helpful in establishing a relationship should you need emergency services in the future.

Mary L. Meyer, Manager
Knox H. Todd, MD, MPH, Director
Pain and Emergency Medicine Institute
The Pain and Emergency Medicine Institute
Department of Emergency Medicine
Beth Israel Medical Center
Albert Einstein College of Medicine
First Avenue at 16th Street
New York, NY 10003
Tel: 212 420 2813
Email:
ktodd@chpnet.org

Resource: Entire Article at RSDSA

http://rsds.org/Resources/chronic_pain_ER_.html

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9 comments on “Chronic Pain and the ER Visit

  1. This was so helpful, Paulette! Thank you. My mom has chronic pain and she stays away from the ED, just thinking that there is nothing they can do. But sometimes it gets so bad for her . . .well, you know about that. This gives me hope that there could be another option than just to suffer through the night or day, if we were prepared.
    God bless you and all the ways He works through you to bless others.

    • Debbie,

      Thank you so much for your support! I’m really glad you found the information helpful. I definitely understand your mother’s point of view. When I’m going through an extreme flare up of the RSD, I just ride it out at home. I know that I would only be made even worse if I would go to the emergency room at a hospital. As the article states, I would know more than the doctors know about what I’m dealing with, and they certainly would not understand the symptoms that I exhibit when I am in a full flare up. It’s really sad, but unfortunately true.

      God bless,

      Paulette

  2. Thank you, Minister Paulette

    “The patient-physician relationship in the emergency department is frequently one between strangers. There is no shared history or understanding of the complexity of the patient’s situation”
    You educate, even through your painful experiences…. I am thinking of how much the Great Physician knows about me and yet He still loves me. I can go to Him and not say a word and He would know exactly how to ‘fix’ me. How cool is that!

    I will not stop praying. I am asking Him to hold you in the palm of His hands as You walk through each day. He is so faithful!

    Blessings much,
    ann

    • Hi Ann,

      Thank you for the encouraging comment. I truly hope posting about RSD is educational, and helpful, especially to those who are newly experiencing the symptoms of this syndrome! It can be a terrifying experience.

      “I am thinking of how much the Great Physician knows about me and yet He still loves me. I can go to Him and not say a word and He would know exactly how to ‘fix’ me. How cool is that!” I enjoyed this part of your comment. Thanks for sharing! Yes, our God is truly faithful!

      Blessings to you,

      Paulette

  3. Again I wonder why I am the only healthy one in my family. I am the “baby” of the family who is statistically the least healthy.

    On a personal level I cannot relate to someone who has chronic pain, like you and others I know, but I spend some time helping my sister who is a medical marvel. She has 13 incurable problems and she (and you and others) are a constant challenge to me and I admire you greatly. My sister is one of the happiest people I know and is an example to all.

    I am sure your blog will help many as they face their problems.

    • Angela.

      You are blessed, indeed! Thank you much for sharing your thoughts with us! “My sister is one of the happiest people I know and is an example to all.” Absolutely wonderful! May the Lord continue to bless you and keep you, today and every day!

      Paulette

  4. Hi Paulette,this is some good and helpful advice I hope many take notice,I sure could use one of those good shots I remember getting from the ER Doctors whew it was good.I’m having more pain today but I’m sure it’s because of the cold and damp weather . Have a good one my Twin and we’ll talk later.
    Love ya 😀

    • Hi Pat,

      Thanks for the encouraging comment. Sorry to hear that your pain is up today. The cold and damp weather are definitely not helpful when it comes to managing your pain levels. You know I’ll keep you in my prayers Twin!

      Love you too.

  5. Pingback: Getting Rid Of Chronic Pain Through Hypnosis | The Back Pain Shoulder And Neck Pain Blog

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