A rant on pain management, in this country.

[Gagafritz]

What is the picture of a drug seeker? Someone who needs pain medication becomes labeled as a drug seeker. It is a nice label to toss about until you or someone you loved is in pain. But, if you are tossing that label at me, then you are pretty ignorant.

 

[Gagafritz]

As for pain, my mom cries every night over severe diabetic neuropathy of her feet. SHe has tried everything, advil, ASA, tylenol, lyrica, gabapentin. The only thing that helped take the edge off a bit was Darvocet which they took off the market. She is 80 years old. Does it really matter if she gets "addicted"to opioids? Why can't she be made to be comfortable. Sheesh.

 

[mskafka]

So all I needed was about 10 pain pills. I was given exactly 10....or 3-days supply. I still have 2 left, and these were written....what.....3-4 days ago? Haven't needed it today.

Now again...had I asked for 90 oxycontin, it would have been a different matter altogether. I don't generally ask for narcotics. I guess so many practitioners have been burned, they are gun shy.

 

[Gagafritz]

How much pain medicine someone else needs really isnt' anyone's business. I know people on Fentanyl patches or take oral morphine for cancer pain and on and on. They aren't Addicts and to make such implications is extremely rude and ignorant.

 

[mskafka]

You may well be underinsured in which case the medical insurance people could be saying no.

Are these pain controllers expensive?

Pain management can be expensive as well.

Do you have full 24/7 medical insurance coverage no co-pays/no deductibles etc etc etc.

This may be where the problem lies?

If it is a insurance coverage situation going to the ER may be the option. If I were experiencing your level of pain the ER would be my choice STAT!

Me? Underinsured? No. I have excellent insurance. I pay a pretty penny for it through work, but I can't complain. The diagnosis alone has been over $10,000. So far, all I've been responsible for has been $500.

I'm sure there's more to come, but that's it, thus far. I've been blessed. It makes you think-how many times you thought of just walking out of that job and telling the boss to go to hell. How THANKFUL I am that I never did that.

 

[mskafka]

Florida's definition of a "Pain Management" doctor is someone that's 60-75 miles away that has a higher co-pay.
No refills, so you get to make the trip every month.

And someone that won't treat a patient that doesn't have insurance. I know, because then the people come to our hospital desperate for pain control after they have lost their insurance and gotten dumped.

Classy.

That's where the drug-seeking-addict label comes from, tho....

My daughter has Fybro and no insurance.
She has share-cost medicaid but no income.
Sometimes the only way she can meet her share of cost is to go to the ER.

Because she's an attractive 35 yr old blonde, there's the assumption that she can't have "chronic" pain.

I just find myself wondering if she's had everything ruled out. My doctor first suspected either MS or Lupus in 2003. They were right on the money. It just took until 2011 to confirm it. If she hasn't had autoimmune diseases ruled out, she definitely needs to. Especially if you have a family history, or if she's had mono, for one.

Of course, Geaux will tell you that no one knows for certain what the cause of MS is; but Epstein-Barr has been implicated...possibly.

 

[Montrovant]

Did it ever occur to you that the reason triage exists so that people that have actual emergent medical conditions go straight back and jump over the people who are just there for pain control and other trivial complaints that clog up the system? (I once saw someone wait for 8 hours to be seen for "insomnia".

Why is the word emergent used that way by the medical community? My understanding of the definition was that it would be describing something as emerging, and that you should say 'people that have actual emergency medical conditions'. The couple I live with both work in hospitals (he on the clerical side, she as an ER nurse) and their use of the word was the first I had heard it used in such a way. It just seems so unnecessary to me.

/end unrelated rant

Maybe because it's the correct word to use at the time:

e·mer·gent (-mûrjnt)
adj.
1.
a. Coming into view, existence, or notice: emergent spring shoots; an emergent political leader.
b. Emerging: emergent nations.
2. Rising above a surrounding medium, especially a fluid.
3.
a. Arising or occurring unexpectedly: money laid aside for emergent contingencies.
b. Demanding prompt action; urgent.4. Occurring as a consequence; resultant: economic problems emergent from the restriction of credit.
n.
One that is coming into view or existence: "The giant redwoods . . . outstrip the emergents of the rain forest, which rarely reach two hundred feet" (Catherine Caulfield).

emergent - definition of emergent by the Free Online Dictionary, Thesaurus and Encyclopedia.

What I wonder is how it became the right word. Emergent seems to be a derivation of the word emerge, rather than a derivation of emergency. More, it seems to be simply replacing the word emergency without any change in meaning; is there a difference between saying 'emergent medical condition' and 'emergency medical condition'?

I wonder how and why it came to be defined so that it means emergency.

 

[mskafka]

Sorry to hear that Muskafa.
Tennessee huh ? Isn't that where Jesus was born ?
It's the heart of murka and drugs is only fer them thar pussies and demoNrats.
Try another state or better yet, go to a country where you'll be treated like an adult. I can walk in a farmacia and get you a basket full of goodies for 1/10 of what your "Chosen" are charging you. The only "permission' I need is a wallet and be tall enough to see over the counter.

LMAO! Yes, Tennessee is where I've lived most of my life. I've lived in KY and MI. Not much difference, but a little bit of diversity.

Not everyone in TN is shallow and ignorant. You know that you're going to find that anywhere you go, my man. I'm just trying to figure out if it's that my dr. is afraid to prescribe, if the medical assistant isn't conveying what I'm saying, clearly, or if doc likes my PPO and wanted to add botox injections to my tab.

At that moment, I was in so much pain, that I probably would have kicked one of them, had they been in the same room with me, and said the same thing. You know....that's what the stuff's there for! I was basically told-" Well, hang in there. We're going to send a home health nurse over there, tomorrow, for solu-medrol infusions.". WOW! And all the while, I'm almost screaming....."It hurts!".

 

[mskafka]

Has it occurred to anyone that someone who is actually willing to sit in an ER for hours for a pain shot probably truly does have pain in order to even endure that?

Good point, Gaga. At my level, we're told to treat pain; no questions asked. If they hurt, you treat.

 

[mskafka]

Has it occurred to anyone that someone who is actually willing to sit in an ER for hours for a pain shot probably truly does have pain in order to even endure that?

The part I hate is that the only medically trained person in this thread is arguing that people who want pain meds are usually addicts. Even if they are addicts they should get whatever meds they need. I used to have a standing prescription for Tylenol 3 because of neuralgia from shingles. I got lucky there because it was never severe enough for me to actually need the pills, but try convincing a doctor who wants to believe you are an addict before he believes that you need help that you suffer from pain when there are absolutely no physical symptoms, especially of that doctor then argues that pain meds are the last thing you need.

Only medically trained? Are you speaking at a physician level? I'm a paramedic, and I treat (or used to treat before the MS) many people with narcotics.

 

[mskafka]

Look up the DSM-IV criteria for Somatoform Pain Disorder.

I know what it is. I don't think that is the issue for most people with FM.

Not for MS. But the symptoms of FM sound a lot like it. It is a neurosis.

Yes, no somatoform here. I've never in my life (minus nights after too much alcohol) not walked to bed from the bathroom. My fiance was screaming "This is ridiculous! I'm calling 911!!!" And me being the hard-headed paramedic that I am, "DON'T YOU DARE CALL 911!"

I thought that I'd broken my hip. I couldn't imagine anything else hurting that badly.

 

[Againsheila]

I would just like to rant about the current status of pain management in the USA!

Some of you know....care....don't care... (and who cares?) that I was diagnosed with multiple sclerosis on Dec. 29, 2011. I'm not looking for pity; and this is totally not the point of this thread.

What I am PISSED about, is the the quality of pain management that we as patients receive.

For those of you who are unfamiliar with many autoimmune disorders....in autoimmune disorders, we have what are called "flares". Basically these are flare-ups of the wonderful, MULTITUDE of symptoms that go along with these diseases.

I recently had a flare that lasted for 7 days. My left hip began to spasm on New Year's night. I mean VIOLENTLY spasm-with fasciculations so bad, that it looked like an alien was going to pop out of my leg. I couldn't walk when they would start. I found myself on the bathroom floor three nights in a row, unable to walk back to bed. The pain was excruciating, that I thought I'd fractured my hip, spontaneously. Worse than any kidney stone, or ovarian cyst that I've had....and I've had a few. (TMI? Okay....I'll get to the point.)

3 days into this, I finally contacted my neurologist. Pain medication? No. Even though I was biting my lip not to scream on the phone. I got to talk to her "nurse" (medical assistant.....hey....no offense guys, but there is a huge difference between the two) and was basically told to hang in there. And a day passes, I'm still basically flat on my back, unable to stand for more than 15 seconds without having to sit down, due to the monstrous fasiculations. I get a call that home health will be to my house the next day for 5 days of solu-medrol IV infusions; and to make sure that I take TUMS between infusions for the gastrointestinal discomfort. Nothing for pain...for the muscle soreness that accompanied my involuntary muscle contractions in the above-mentioned. Gee thanks, doc.

I received the infusions, which stopped the contractures. And now, it feels like I've spent a week hiking and rock climbing. And I've done this many times my friends, so I know that there is going to be some amino acid buildup afterward for several days. I was in fantastic shape before all this began. Also, rheumatoid arthritis hasn't been ruled out, yet. We're just trying to halt the (MS) disease process, right now. One lesion on my cervical spinal cord is enough.

And finally down to the point of this entire thread:
The significant dosage of neurontin was not helping (what I thought was probably muscle soreness secondary to the contractions). I explained to this...medical assistant, that I was ingesting approximately 3200mg ibuprofen daily-to the point that I was beginning to get gastrointestinal symptoms as well. This didn't even strike a c-major in this woman. "Well......Dr. (no giving name) wants to try botox injections."

I asked these people if I could have 10 pain pills....would have settled for tylenol 3, tramadol...whatever. Nope. SOL and JWF!

I had to go to my PCP who seemed to understand that I was in a lot of discomfort, and gave me what I asked for. Nothing more. Nothing less. I wasn't asking for 90 oxycontin, or 50 fentanyl patches. This is the FIRST time I have asked for something narcotic-wise since this disease process began. And now, I feel like a criminal. I have been referred to a "pain clinic". I find that very insulting. All I want to do, is to be able to return to work, and walk with full range-of-motion of my extremities. I'm getting physical therapy, trying to exercise...doing all the right things.

I want to thank all of the dope dealers out there who go to these establishments, and get these pills to sell. Has it ever crossed your minds to get off your duff and get a job.....do something with yourself? You make me sick to my stomach.

What do I do? Write my representative. My fiance being a pharmacist, told me that doing so might be cathartic, it's probably a waste of time.

So what if you have bulging disks in your lower back. I have 2, and have managed to work...FOR YEARS....without pain medication or disability. Now, I have a true disability, with occasional disabling pain, and I can't get the help I need. Life is not fair...but this is BEYOND UNFAIR. Just 10 pills please, doc. That's all I'm asking.

Thanks for listening; and I'm open for any suggestions, rebuttals, etc... Bring them on.

One of the reasons my sister picks up large amounts of tylenol 3 whenever she visits Canada, you can get it up there without a prescription.

I have pain issues too and when my muscle spasms are at their worst, I can't beleive that it's against the law for the local clinic to give me a shot which doesn't even get rid of the pain, but at least gets it to a leval I can handle..

 

[Sunshine]

Has it occurred to anyone that someone who is actually willing to sit in an ER for hours for a pain shot probably truly does have pain in order to even endure that?

Good point, Gaga. At my level, we're told to treat pain; no questions asked. If they hurt, you treat.

That's the good thing about emergency work as opposed to clinic work. The drug addicts drive us up the wall!

 

[Sunshine]

Why is the word emergent used that way by the medical community? My understanding of the definition was that it would be describing something as emerging, and that you should say 'people that have actual emergency medical conditions'. The couple I live with both work in hospitals (he on the clerical side, she as an ER nurse) and their use of the word was the first I had heard it used in such a way. It just seems so unnecessary to me.

/end unrelated rant

Maybe because it's the correct word to use at the time:

e·mer·gent (-mûrjnt)
adj.
1.
a. Coming into view, existence, or notice: emergent spring shoots; an emergent political leader.
b. Emerging: emergent nations.
2. Rising above a surrounding medium, especially a fluid.
3.
a. Arising or occurring unexpectedly: money laid aside for emergent contingencies.
b. Demanding prompt action; urgent.4. Occurring as a consequence; resultant: economic problems emergent from the restriction of credit.
n.
One that is coming into view or existence: "The giant redwoods . . . outstrip the emergents of the rain forest, which rarely reach two hundred feet" (Catherine Caulfield).

emergent - definition of emergent by the Free Online Dictionary, Thesaurus and Encyclopedia.

What I wonder is how it became the right word. Emergent seems to be a derivation of the word emerge, rather than a derivation of emergency. More, it seems to be simply replacing the word emergency without any change in meaning; is there a difference between saying 'emergent medical condition' and 'emergency medical condition'?

I wonder how and why it came to be defined so that it means emergency.

Well, when a patient goes bad we say they 'crapped out' or 'crashed' or other some such. I don't really think people, like me, who use medical jargon in our workday lives really cares how the words evolved. There is a certain Tao to them. The just ARE.

 

[Quantum Windbag]

Has it occurred to anyone that someone who is actually willing to sit in an ER for hours for a pain shot probably truly does have pain in order to even endure that?

The part I hate is that the only medically trained person in this thread is arguing that people who want pain meds are usually addicts. Even if they are addicts they should get whatever meds they need. I used to have a standing prescription for Tylenol 3 because of neuralgia from shingles. I got lucky there because it was never severe enough for me to actually need the pills, but try convincing a doctor who wants to believe you are an addict before he believes that you need help that you suffer from pain when there are absolutely no physical symptoms, especially of that doctor then argues that pain meds are the last thing you need.

Only medically trained? Are you speaking at a physician level? I'm a paramedic, and I treat (or used to treat before the MS) many people with narcotics.

Geaux has made it clear that he is on his way to being a doctor. You may have emntioned being a paramedic, but I have not read all your posts.

 

[geauxtohell]

Did it ever occur to you that the reason triage exists so that people that have actual emergent medical conditions go straight back and jump over the people who are just there for pain control and other trivial complaints that clog up the system? (I once saw someone wait for 8 hours to be seen for "insomnia".

Why is the word emergent used that way by the medical community? My understanding of the definition was that it would be describing something as emerging, and that you should say 'people that have actual emergency medical conditions'. The couple I live with both work in hospitals (he on the clerical side, she as an ER nurse) and their use of the word was the first I had heard it used in such a way. It just seems so unnecessary to me.

/end unrelated rant

emergent
[ih-mur-juhnt]   Origin
e·mer·gent
   [ih-mur-juhnt] Show IPA
adjective
1.
coming into view or notice; issuing.
2.
emerging; rising from a liquid or other surrounding medium.
3.
coming into existence, especially with political independence: the emergent nations of Africa.
4.
arising casually or unexpectedly.
5.
calling for immediate action; urgent.

Emergent | Define Emergent at Dictionary.com

 

[OohPooPahDoo]

I would just like to rant about the current status of pain management in the USA!

Some of you know....care....don't care... (and who cares?) that I was diagnosed with multiple sclerosis on Dec. 29, 2011. I'm not looking for pity; and this is totally not the point of this thread.

What I am PISSED about, is the the quality of pain management that we as patients receive.

For those of you who are unfamiliar with many autoimmune disorders....in autoimmune disorders, we have what are called "flares". Basically these are flare-ups of the wonderful, MULTITUDE of symptoms that go along with these diseases.

I recently had a flare that lasted for 7 days. My left hip began to spasm on New Year's night. I mean VIOLENTLY spasm-with fasciculations so bad, that it looked like an alien was going to pop out of my leg. I couldn't walk when they would start. I found myself on the bathroom floor three nights in a row, unable to walk back to bed. The pain was excruciating, that I thought I'd fractured my hip, spontaneously. Worse than any kidney stone, or ovarian cyst that I've had....and I've had a few. (TMI? Okay....I'll get to the point.)

3 days into this, I finally contacted my neurologist. Pain medication? No. Even though I was biting my lip not to scream on the phone. I got to talk to her "nurse" (medical assistant.....hey....no offense guys, but there is a huge difference between the two) and was basically told to hang in there. And a day passes, I'm still basically flat on my back, unable to stand for more than 15 seconds without having to sit down, due to the monstrous fasiculations. I get a call that home health will be to my house the next day for 5 days of solu-medrol IV infusions; and to make sure that I take TUMS between infusions for the gastrointestinal discomfort. Nothing for pain...for the muscle soreness that accompanied my involuntary muscle contractions in the above-mentioned. Gee thanks, doc.

I received the infusions, which stopped the contractures. And now, it feels like I've spent a week hiking and rock climbing. And I've done this many times my friends, so I know that there is going to be some amino acid buildup afterward for several days. I was in fantastic shape before all this began. Also, rheumatoid arthritis hasn't been ruled out, yet. We're just trying to halt the (MS) disease process, right now. One lesion on my cervical spinal cord is enough.

And finally down to the point of this entire thread:
The significant dosage of neurontin was not helping (what I thought was probably muscle soreness secondary to the contractions). I explained to this...medical assistant, that I was ingesting approximately 3200mg ibuprofen daily-to the point that I was beginning to get gastrointestinal symptoms as well. This didn't even strike a c-major in this woman. "Well......Dr. (no giving name) wants to try botox injections."

I asked these people if I could have 10 pain pills....would have settled for tylenol 3, tramadol...whatever. Nope. SOL and JWF!

I had to go to my PCP who seemed to understand that I was in a lot of discomfort, and gave me what I asked for. Nothing more. Nothing less. I wasn't asking for 90 oxycontin, or 50 fentanyl patches. This is the FIRST time I have asked for something narcotic-wise since this disease process began. And now, I feel like a criminal. I have been referred to a "pain clinic". I find that very insulting. All I want to do, is to be able to return to work, and walk with full range-of-motion of my extremities. I'm getting physical therapy, trying to exercise...doing all the right things.

I want to thank all of the dope dealers out there who go to these establishments, and get these pills to sell. Has it ever crossed your minds to get off your duff and get a job.....do something with yourself? You make me sick to my stomach.

What do I do? Write my representative. My fiance being a pharmacist, told me that doing so might be cathartic, it's probably a waste of time.

So what if you have bulging disks in your lower back. I have 2, and have managed to work...FOR YEARS....without pain medication or disability. Now, I have a true disability, with occasional disabling pain, and I can't get the help I need. Life is not fair...but this is BEYOND UNFAIR. Just 10 pills please, doc. That's all I'm asking.

Thanks for listening; and I'm open for any suggestions, rebuttals, etc... Bring them on.

Doctors are reluctant to prescribe opiate pain relievers because they are extremely easy to get addicted to - and in fact many many many addicts of opiates started off as legal users of them as a result of a disease or accident.

Not saying its right, just giving you their logic.

But I'm surprised its still that hard for you. I have a busted disc in my back but its not really that severe (yet), and about 4 years ago I was able to get refills of Lortab over the phone, 30 pills at a time, for a year. I decided to not go in for the yearly re-script because I thought i was over depending on them, so its a good thing that had that stop-gap measure in there. But I can't imagine my pain is anything close to yours so that's not really even a good comparison.


Have you thought of trying marijuana? Its a miracle drug. Not saying it will work, but if it does, it will work really well.

 

[Gagafritz]

Well, it is very simple. Those who don't want pain medication or prefer to take Tylenol for pain conditions that warrant opioids, don't take them. But, don't prevent others from taking them who do need them. ANd, i find it a little disturbing that an ER provider on this board takes the "patient as addict" attitude right off the bat.

 

[OohPooPahDoo]

Well, it is very simple. Those who don't want pain medication or prefer to take Tylenol for pain conditions that warrant opioids, don't take them. But, don't prevent others from taking them who do need them. ANd, i find it a little disturbing that an ER provider on this board takes the "patient as addict" attitude right off the bat.

Unfortunately the law only allows physicians to prescribe substances - like opiates - that have an extreme potential for addiction even in patients who have previously never had problems with addiction to anything. The law will not all physicians, in most states, to prescribe pot. While marijuana certainly isn't going to work for all pain, it works a lot better the ibuprofen and tylenol

 

[geauxtohell]

Well, it is very simple. Those who don't want pain medication or prefer to take Tylenol for pain conditions that warrant opioids, don't take them. But, don't prevent others from taking them who do need them. ANd, i find it a little disturbing that an ER provider on this board takes the "patient as addict" attitude right off the bat.

I find it a little disturbing that you and your cohorts keep attributing sentiments to me that I never said and don't believe.

Then again, you guys continue to miss the ball on this matter. If you really knew what you were talking about, you'd understand why the ED is not the appropriate place for people to try and manage their chronic pain.