I'm an ER Doc with Pain: September 24, 2016



  • My son developed cluster migraines 1 year ago, suffice to say he was prescribed OXYCodone and now is addicted. He has lost everything since (his GF and daughter have left because of the KAOS around prescription renewal and withdrawl). Question: What if anything is an effective pain management for cluster migraines that are not addictive?



  • @Forum_Moderator [QUESTION FROM FACEBOOK] Combining a few similar questions together: What can I do to convince ER professionals that I am not just seeking drugs, but that my pain is legitimate and real? If I had to present to my local ER with pain, how should I describe it in order to receive good treatment? What are the words/phrases that will make the staff pay attention and distinguish me from a 'drug seeker?' How can I express myself with the ER doctors in a way that they will be understanding and empathetic?

    Great questions, and I’m guessing this is the no. 1 thing chronic pain patients are interested about. The answer is already in some of my other answers, but the main thing is your behaviour. How you come across to staff and what preparation you have done beforehand? You do not want to fit that stereotype I mentioned before if you can possibly help it!!

    Do's:

    1. Be polite, cooperative and non-demanding, especially about opiates.
    2. Have a diagnosis and label the problem as a flare-up ( ER staff are used to this in other chronic diseases).
    3. Have a family Dr and a flare-up plan..explain what steps you have taken on that plan.
    4. Bring a letter from your Dr with this plan included in it.
    5. Bring a medication list.
    6. Be straightforward in your description of the pain without exaggerating. Concentrate on how it feels, where it is etc., rather than always answering every question with the pain intensity to get them to understand. This and exaggerating the pain features is very tempting to do and natural because you think it help them understand better, but it will backfire as it pushes you towards that stereotype I’ve been talking about.
    7. Let staff know if you have any new or different features of your pain. If this new feature is the main problem then it might be a new, possibly very important, problem unrelated to your chronic pain. Chronic pain can mask other important diseases so new features is an important thing to tell ER staff.

    Don't's:

    1. Be the opposite of no 1 above.
    2. Try to avoid the ER when it is very likely to be extremely busy. This would be late on weekend days or evenings and public holidays. You want staff that are at their most understanding, not when they are up to their ears with life-threatening cases other than you. The best time to go, if you really have to, is mid-morning to mid-'afternoon. Seems kind of crazy, an emergency doesn’t have a clock, but those are the least busy times.


  • [QUESTION FROM FACEBOOK] Combining a few similar questions together: What can I do to convince ER professionals that I am not just seeking drugs, but that my pain is legitimate and real? If I had to present to my local ER with pain, how should I describe it in order to receive good treatment? What are the words/phrases that will make the staff pay attention and distinguish me from a 'drug seeker?' How can I express myself with the ER doctors in a way that they will be understanding and empathetic?



  • @Forum_Moderator [QUESTION FROM FACEBOOK] What do I do when I can't stand the pain, and my doctor just isn't hearing me and or doesn't have the time to deal with things. Should I be going to the over-filled hospital for pain relief?

    Great question. The answer is never finding yourself in that situation in the first place, if you can. By this I mean, talk to your Doctor about flare-ups when he or she does have the time, and come up with a plan. The best time to talk to a Dr about your pain is when you are NOT writhing around in agony! The plan can have lots in it and a visit to the ER might be in it as a last resort, but at least if you do end up having to go, you can show that you have a plan and have tried a few things first. Trust me on this, being able to show a plan and what you've done gets you a long way to being understood and listened to in the ED. The Pain Tool box gives you suggestions of other techniques and places to help you with coping mechanisms when things are bad. Certainly the ER is there for people who are overwhelmed with pain, it’s just not the first option and if you go, there are some things you can do beforehand. You can also call the “nurse hotline” at 8-1-1 for free-of-charge provincial health information.



  • My GP prescribes me meds which, for the most part, aer sufficient at controlling my daily pain. During a flare, my GP told me to go to the ER and provided me with a note that said (among other things), "this patient suffers chronic pain, she is not a drug addict". I had never been so mistreated by healthcare professionals as I had been that day at the ER. Why, when a patient is documented as having a chronic pain condition, and is obviously being followed and prescribed pain meds, is she then treated/mistreated at the ER for flair ups?



  • @Drahuber This group of patients who are stable on opioids are certainly being recognized by people who are involved with pain care and there is increasing discussion at the planning and care levels on how best to treat these patients.



  • [QUESTION FROM FACEBOOK] What do I do when I can't stand the pain, and my doctor just isn't hearing me and or doesn't have the time to deal with things. Should I be going to the over-filled hospital for pain relief?



  • @Forum_Moderator

    [QUESTION FROM FACEBOOK] When you go to the ER in BC, do they have access to ALL your medical records and ALL your prescriptions? Or just access to when you are at that particular hospital? If it is well documented that you have a particular illness, why is so hard for the ER doc to believe you are pain?

    Great question from Facebook. In answer to your first question, almost all ERs have access to all your prescriptions in your Province very quickly online. This is very important as it sifts out the abusers who used to Dr shop to get lots of pills to use or sell ..it also corroborates a patient’s story when it comes to medication use.

    Access to your medical record isn't as slick. Certainly, your record in the hospital you usually go to will be readily available. However, if you have been to other hospitals it probably isn't. In bigger centres, there is increasing access between hospitals in the the same Region, e.g. Vancouver Coastal Health has some degree of hospital record sharing. As an Emerg Doc, if it’s important, we get the hospital to send over your ER record there or a discharge summary, but often that takes time.

    As for the second part about getting the ER doc believing you are in pain, thats a tough one. Like a lot of things in life there are some things you can control and some you can’t. You can’t control what the ER Dr believes or doesn’t. You can only control what you do. If you feel you are not being believed, you need to think about why that might be. As in normal life when you are talking to a friend, it might be something to do with your delivery and attitude that you are bringing to the interaction. I will tell you that there is a drug abuser stereotype in the eyes of ER staff and it has to do with the fact that there are a group of people who come to the ER looking for ways of getting drugs to abuse or sell. Like all stereotypes, it’s probably a myth but if it would help if you didn’t come across like this stereotype! The stereotype is a loud, aggressive patient saying they have 10/10 pain while they are walking around angrily demanding a specific opiate. They have no Dr, no letter, no plan and usually say they are allergic to all kinds of meds except their specific opiate. Now unfortunately, being a chronic pain patient can make you a bit like this for sure!! Angry at the all the appointments, waiting rooms, being misunderstood and being fed up.

    There is a growing awareness and educational activities at helping ER staff to be more up to date about chronic pain and what it means to the patient in terms of having flare-ups and needing help. Hopefully this will translate in more understanding when we say we have severe pain. In my own experience, most of my colleagues tried their very best to listen and understand chronic pain patients and continue to do an excellent job.



  • @seahawks85 I certainly agree with you that chronic pain patients who are stable on opioids are feeling threatened at the moment by the BC opioid guidelines. It’s to be remembered that most physicians view these guidelines as only suggestions on how to treat patients and that patients’ needs can be individualized on a case by case basis. Certainly this anti-opioid climate is going to carry over to other institutions like the ER and I fear that opioid access is going to be increasingly difficult.



  • @seahawks85 Sorry, that is really not my area of expertise, but I do know that Pain BC has already started and partially completed an educational package for doctors across the province on how to assess and treat chronic pain. There is increasing pressure to include chronic pain more in the curriculum of medical students and family medicine residents in their specialty training.



  • @Drahuber It seems that family doctors are limited by the college in supporting patients with chronic pain. They are worried about consequences faced by prescribing to patients, addictions,etc. These patients are running out of options. Thoughts?



  • As a follow up to that question, I am wondering what can be done so that family physicians have the ability to appropriately care for their patients at the family clinic ( prescribing, pain management,etc) in order to avoid ER visits.



  • [QUESTION FROM FACEBOOK] When you go to the ER in BC, do they have access to ALL your medical records and ALL your prescriptions? Or just access to when you are at that particular hospital? If it is well documented that you have a particular illness, why is it so hard for the ER doc to believe you are pain?



  • @rabird Hello everyone, great to be here. Great question. Patients have a right to be seen and assessed by an ER doctor in the Emergency Room. The ER doctor may suggest a line of treatment. If a patient doesn’t agree with that treatment then it can be further discussed, but a patient’s right is to be seen and assessed. If you disagree with what the ER doc is saying you have to go see another doctor. We haven’t lost the right to treatment, the doctor decides what treatment, in discussion with the patient, but they may disagree.

    As for your last question, the main thing is to go back to your family doctor or the clinic and to go and discuss it with them, and go from there. If it is still bad, then to go back to ER and discuss with them. Remember, your rights are that you can always go back and be assessed.



  • @rabird The forum event starts at 9AM today, so sit tight! Your question will be answered shortly.



  • what are the rights of people with chronic pain in the emergency room ? or have we lost the right to treatment ? what are people with chronic pain who are turned away at emergency to do ?


Log in to reply