Pain Will Not Kill You

[trailerparkmedic]

Guy came in with abdominal pain and was (correctly) sent to the souped up urgent care section. Guy got some morphine while he was there, and then was sent to the OMG You're Dying!!! section as his heart rate went down to the upper 30s and his rectal temp went down to 95. He got warmed up, maintained an appropriate temp without the Bair Hugger and had a slightly less horrific heart rate and so he came to hang with me in the you're probably getting admitted section while he waited for a bed upstairs.

Me: Hi, I'm TPM, I'm your nurse, how are you doing?
Guy: I'm in PAIN and I need something NOW! Moan moan moan.
Me: I'm sorry you're in so much pain. Would you like some Motrin?
Guy: I'm in REAL PAIN and I need something stronger.
Me: No. You almost died when we gave you morphine so you won't be getting any more narcotics at this point.
Guy: <Insert typical threats, such as I'm a racist, I'm just trying to make him suffer, I'm discriminating against him because he's poor> I'm just going to leave then and go to Other Local Hospital.
Me: That's certainly within your rights, though I would strongly advise against it as you almost died earlier and you need close monitoring. If you'd like to leave, please sign this paper and you'll be free to go.
Guy: I need to talk to your supervisor!

I grabbed the charge nurse, who is a no-nonsense 20 year Army vet.

Charge Nurse: Hi! Remember me? I came and helped move you when you started trying to die. I understand you are unhappy with the current pain management plan?
Guy: Blarghle blah blah threat blah blah GIMME DILALALA NOW
Charge Nurse: No. None of us will risk killing you or losing our licenses by giving you medication that almost killed you earlier. You can either accept that or leave. There will be no negotiations, as pain won't kill you but pain medicine will.

Guy ended up AMA'ing a few hours later anyways (for a different reason) but he did shut up about pain medicine.

[Eisa]

I know pain sucks, and it sucks when you have to just suffer through it, but yeah, you're clearly not gonna be giving him any more pain meds when he almost died from them before!

[PepperElf]

i always find it interesting when people try waiving their "patient's rights" around as it it somehow means "you have to give me the drugs I demand!"

i mean sure he can refuse treatment at the risk of his own life
but that doesn't mean he'll get what he wants drug-wise.

brings "cutting off your nose to spite your face" to a whole new level right there

[AmbrosiaWriter]

Too bad you couldn't give him the dose then resuscitate him again and go "Told you so." I know you couldn't, but it would've been pretty vindicating. I wouldn't play around with a patient's health like that though, talk about law suit waiting to happen.

I don't get how he doesn't understand "PAIN MEDS WILL KILL YOU."

[kpzra]

i will admit, I yelled at another patient when I was in the hospital "The pain may not kill you, but I WILL if you don't SHUT UP!". My daughter has been cut out 5 hours before, I was tired after 30 hours of labor and an OD and just wanted to sleep. She kept wailing that it huuurt and her boywhatever was in the hallway talking on the phone outside my door about it to someone. I had my husband open the door to chase him off (6'3" hubby vs 5'6" boy) and I hollered. My nurse even rolled her eyes when the call button cell went off and it was her. She though having a baby would get her drugs (wish I was kidding). I had an 8-inch incision and was on oral Motrin. You had a very normal delivery with no tearing even (heard that from phone boy). I know everyones pain levels are different, but STFU so others don't have to hear you through the thick walls. You had pain meds an hour ago.

[malmalthekiller]

My mom had weight loss surgery, and woke up complaining like one of those people. She usually is extremely strong, mentally, and I've never heard her complain so much in her life.

In her defense, pain medication in general messes with her, she has to be given less potent medication. I think most of the moaning was a reaction to what she was already getting

Still, poor other lady in the room.

[Seshat]

TPM: what about some of the non-opiate/opiod pain meds, like Lyrica?

I know you weren't the treating doctor, but they certainly come to mind for me...

[Sapphire Silk]

TPM: what about some of the non-opiate/opiod pain meds, like Lyrica?

I know you weren't the treating doctor, but they certainly come to mind for me...

Lyrica is not a pain medication. It is an adjunct therapy; used to treat long term chronic pain for a very specific list of conditions.

It is not suitable as a substitute for narcotics for drug seekers. It's not even as useful as Tylenol for that.

Some of the anti-depressants or other pysch type meds are very useful for treating fibro pain, but what it is really doing is affecting how the pain impulse is generated (reducing the generation of the signal) rather than blocking pain at specific receptor sites in the brain as true analgesics do.

The patient in question symptoms are typical withdrawal symptoms. A benzodiazapine is useful to mitigate the symptoms until the body adjusts to the withdrawal. . . but there seems to have been a question that he was abusing those, too.

The ER is not the place to treat withdrawal unless the patient is requesting detox. Simply giving more opiates is counter productive. Usually these patients need to be referred to a pain management specialist to investigate and treat any real pain they have, and a detox center for detox if needed.

[Seshat]

Panacea: thank you!

That explains why stuff like Lyrica may be suitable for me, but isn't useful in ER situations. Gotcha.

And yeah, it's just no help for the drug-seeker type (as far as I know. IANApharmacist)


And you're right. Withdrawal is a chronic (or at least multi-week) situation, not a 'save the person's life/senses/limbs' ER situation. Much as I value ERs and think they're an absolute necessity; they have a specific purpose!

[trailerparkmedic]

The patient actually had something legit wrong with him, which is why he got the morphine initially. His behavior was very drug seeking and his reports of pain were way beyond we'd expect with that diagnosis so our best guess was that he was in some pain but was just using that to further aid in his seeking.

[bainsidhe]

When I've had surgery, I've become a whiney little baby, whimpering and crying cause it hurts. And that's after they've already given me something, but it hasn't completely kicked in yet. Wince, whimper, sniffle. Yep, that's me.

[Seshat]

Bainsidhe,

I completely understand. When my pain levels exceed what my pain meds & management techniques can handle, I end up curled up in a little ball around a stuffed tiger, begging my husband to make it stoooopppppp.

Pain won't kill you, but it can sure as hell make you want to escape your body!

(I've told my family that as soon as someone comes up with a way to upload me into cyberspace so I can still be with them, but not be in my broken body... I'm on it!)

[Shalom]

(I've told my family that as soon as someone comes up with a way to upload me into cyberspace so I can still be with them, but not be in my broken body... I'm on it!)

There's someone named Robinette Broadhead on the phone for you...

[EvilEmpryss]

Bainsidhe,

I completely understand. When my pain levels exceed what my pain meds & management techniques can handle, I end up curled up in a little ball around a stuffed tiger, begging my husband to make it stoooopppppp.

Pain won't kill you, but it can sure as hell make you want to escape your body!

I live with chronic pain, so when I hear people say "pain won't kill you" it makes me want to kill them. They just don't get it. Sometimes you *want* to die, just to make the pain stop (fortunately my days that are like that are very very rare). Panacea can verify that I am the BIGGEST pansy in the world when it comes to needles, but when I get a major flare-up on, I will BEG for anything, even if it has to be delivered with a needle the size of a ten-penny nail.

On the other hand, the drug-seekers only make it harder for legitimate patients to get the meds they need. Douches like the patient in the OP are so totally off-base that I support the nurse's response to him.

[Mytical]

I live with chronic pain, so when I hear people say "pain won't kill you" it makes me want to kill them. They just don't get it. Sometimes you *want* to die, just to make the pain stop (fortunately my days that are like that are very very rare). Panacea can verify that I am the BIGGEST pansy in the world when it comes to needles, but when I get a major flare-up on, I will BEG for anything, even if it has to be delivered with a needle the size of a ten-penny nail.

On the other hand, the drug-seekers only make it harder for legitimate patients to get the meds they need. Douches like the patient in the OP are so totally off-base that I support the nurse's response to him.

I've been balled up bawling like a baby because of pain..and the OP is right..pain doesn't kill you..even though sometimes you wish it would. When a pain medicine will kill you though, it is a good idea NOT to take it. Drug seekers make it hard for those of us with chronic pain. /end off topic.

Back on topic. Op knows meds = death, Op says no..I fully support that. My doctor has told me no to several types of pain meds. ANYTHING in the tylenol or Nsaid line. Which SUCKS..but they can seriously damage me..so guess what..I listen to the docs..surprising concept huh?