Take out your heating pad

http://well.blogs.nytimes.com/2016/03/25/seeking-painkillers-in-the-emergency-room/

(3/25/2016) Seeking Painkillers in the Emergency Room, by Helen Ouyang, M.D.

Helen Ouyang is an emergency physician at NewYork-Presbyterian Hospital and an assistant professor of medicine at Columbia University.

Physicians need to know that if they don’t prescribe a narcotic because it’s not clinically indicated, or worse yet, because the patient already has an addiction problem, that they have the backing of administrators at every level, from their own department to the head of the hospital all the way up to state officials. If patients are seeking narcotics and have a documented history of doing so — and become combative or refuse to leave after discharge — they may need to be escorted out of the emergency room by security and their treatment terminated to avoid interrupting the care of other patients…

I’m guessing that every patient who has been diagnosed with — and given the label of –“chronic pain,” has a “documented history” of “seeking narcotics.” When someone is in enough pain to seek medical attention, what do you think they’re looking for? A heating pad?

Will this include any patient who asks for painkillers any time in their lives? If you ask your dentist for some Vicodin after you have a cavity filled, will he write that in your electronic health record? “Patient was seeking narcotics.”

This is what I want pain patients to know: If you go to the emergency room for any reason, keep in mind that you will no longer be able to complain about doctors refusing to treat your pain. No one in the administration of the hospital will help you (unless you have connections).

For those patients who don’t suffer from chronic pain, you will face the same problems. A doctor refuses to treat your pain? Too bad. A doctor refuses to treat your pain for hours and hours, so that she can determine your addiction potential before giving you an opiate? Well, the pain didn’t kill you, did it? Shall we depend on our legal system to put a price on your suffering?

Under comments:

Joe Snyder, Houston
Cartilage in both knees are gone from jogging in early ’70s. Synvisc (hyaluronic acid) injections had limited effectiveness in quelling pain, and less so, as time went by. I have high pain tolerance (I.e., hobbled about with ruptured Achilles’ tendon for several weeks before diagnosis). I was able to tolerate knee pain during the day at work, but at bedtime I became more conscious of the pain and had trouble sleeping. All I required was a small, occasional dose (1-2 times a week….maybe) to allow a semblance of proper sleep time. The two “pain management” docs I saw were glade to take my personal info and charge Medicare (>$600) for a single office visit; and, then deny further “treatment”. Frustrated and sensing few options I had Total Knee Replacement a year ago. Not much improvement. I feel that if I was prescribed a small quantity of (in my case hydrocodone/ acetaminophen) I could have avoided a very risky surgery. I am a 75 years old semi-retired pharmacist.

Mary DeForest, New Mexico
I guess this is a Prebyterian problem. I can’t get anything for pain for obvious trauma, like being attacked by dogs. I had part of my nose-including bone-removed, a section of my lip, and tissue between those 2 places removed. I was in agony, and I had nothing for the pain. Presbyterian is cruel. I’m told that it is because I’m a senior citizen and they don’t want me addicted at this age. I don’t even take NSAIDs because of stomach problems and gastroentology keeps telling other doctors to tell 60+ patients to take NSAIDs, because of internal bleeding.

rebecca
Sometimes those of us in chronic pain end up in the ER because our pain spikes and the meds we *have* are no longer sufficient to keep it under control. Chronic pain isn’t a steady state, it has peaks and valleys. Sometimes my migraines are worse than others. Sometimes I can get rid of them with the meds I have, sometimes it gets bad enough that I need stronger medication, and the only place for that is the ER. I do get meds from my pain specialist, but he tells me to go to the ER when those stop working, so what should I do?

Your doctor tells you to go to the ER because he doesn’t want you calling him when you’re in a flare. Because he won’t help you, just like the ER will no longer help you. You asked what you should do, when the answer is obvious to me:  All these “experts” are telling you to suffer. And to stop asking for help, because they refuse to give it.

Samer, Illinois
Government agencies played a huge role in creating the problem during my medical school years and residency “pain is the fifth vital” was pounded in…

Many doctors blame the fifth-vital-sign procedure for drug abuse and addiction, as if that makes any sense at all. And, pray tell, what’s the alternative? Doctors should stop asking patients to rate their pain? Just like Medicare should stop asking patients to rate their doctors, right?

Health Nut, Minnesota
Working in the medical field, I disagree that the fault of opioid abuse falls into the hands of physicians. I remember our hospital being “written up” by the insurance companies for not providing total pain care of our patients as our ER physicians said this was going to happen if we complied with federal government in management of pain. We offered non narcotic pain relief and counseling instead. But the government forced our hand on this issue. We are, once again, acknowledged for our low patient satisfaction scores for our decreased opioid use in our ER. Its been a lose-lose situation for us, and I can imagine, most hospitals!

An insurance company writing up a hospital for not following federal guidelines for the management of pain? Huh? I’m too tired to look up the specifics of these guidelines, but as far as I know, it’s mostly about doctors rating patients’ pain as the fifth vital sign. But that’s not only a requirement of the federal government, it’s also followed by international organizations, too.

I’m sure there are a small percentage of ER patients who are just looking for drugs to treat an addiction, but the majority of people who are forced to go to the ER are not drug addicts. People use everything they can to manage pain, including over-the-counter drugs, ice, heat, etc., before they even get to the ER. So, an ER offering only “non-narcotic pain relief and counseling” is the stupidest thing I’ve ever heard.

And then, when you place blame on low patient satisfaction scores, you’re basically just blaming the patients for not agreeing with your anti-drug ideology. You mean patients in pain are not satisfied with anti-inflammatories and counseling? Gee, who would have thunk it?

Briam, usa
The heroin dealer around the corner won’t say no

Honeybee, Dallas
Then let them go to the heroin dealer.
But remember that 9 out of 10 won’t to a heroin dealer.
Instead, they will go through withdrawal and get their lives back.

Yes, it’s probably true that 9 out of 10 patients denied treatment for pain won’t go to a heroin dealer — it’s not like they’re easy to find. But suggesting that most patients who go through withdrawal will then get their lives back is utter nonsense. In fact, when it comes to the treatment of addiction, the opposite is usually true — those who experience the torture of withdrawal are usually even more motivated to relapse.

Let’s see what else Honeybee has to say, shall we?

Honeybee, Dallas
To be fair, it doesn’t sound like any legitimate user is going to be denied any drug.
I don’t see the problem. Yes, there will be a few more hoops, but nothing ridiculously unreasonable. Huge mistakes were made with alcohol and tobacco; I’m glad the govt and the doctors are trying to prevent a similar disaster with opioids/opiates.

I suppose there will be a lot of people who refuse to see the problem — that is, until they experience the problem for themselves. And it’s unreasonable to compare alcohol and tobacco to opioids, just like it’s unreasonable to compare opioids to cannabis, especially when we’re specifically talking about the potential for addiction. This is a person who obviously believes the drug war has been a success.

Honeybee, Dallas
Note how many of the chronic-pain claimants have a host of other health issues and constant problems abiding by the simple 30-day refill policies (“I got sick” or “I went out of town” or “The pharmacy charged too much”). This is textbook addict behavior and addicts want their drugs on demand with no questions asked, no hoops presented.

So should the doctors enable the addict or cause them to suffer withdrawal? Objective observers will say to step the addicts down gently but firmly. Yes, they will suffer. Yes, their pain will feel worse. But they will survive. Cutting them off is necessary, but we also need to help them withdraw.

Hillary Clinton, is that you?

familydoc, brooklyn, NY
I reach for narcotics rarely now and haven’t found my patients to be in more pain. It may sound lame to hear doctors recommend therapy, heat and a variety of complementary approaches to pain but I’ve found it returns patients to functionality faster than masking the pain with narcotics…

Perhaps your patients stopped complaining to you about their pain, or maybe they see a different doctor when they’re in pain. Perhaps your patients have learned to find their pain relief elsewhere, instead of from their doctor.

What sounds lame is to pay a doctor to tell you to plug in your heating pad. Too bad you can’t take a heating pad wherever you go, right? You went to medical school for that? I’m paying you to refer me to a heating pad and a therapist?

(It’s like these doctors have never heard of the internet, where advice is plentiful and free.)

I think it’s hilarious that doctors have created their own downfall, making themselves obsolete. Just freaking hilarious. 🙂

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11 thoughts on “Take out your heating pad

  1. The last doctor hasn’t seen his pain patients in a while because they’re going somewhere else.

    I just read that Colorado’s deaths from narcotics OD has decreased by 25% since legalization of cannabis. Oklahoma and Nebraska continue to have the same old problems.

    My fondest hope is that these assholes who wax judgmental/pompous about pain, should come down with an intensely painful chronic condition, and be denied pain meds. Call me vindictive, but they ask for it, so it shall be theirs. So mote it be.

    Liked by 1 person

      • Well, I’m a throwback to the days when doctors actually saw their patients as people in need of their help, not like today when we are just inconveniences that they need to somehow deal with in order to get paid. I’m in the throes of some really bad pain and disability, at the mercy of these asswipes who treat me like shit until they find out I’m a doc, then they’re all over me. I personally don’t take opioids except postop, because they do nothing for my nerve pain and they do make me itch. So I don’t even ask. But I use a lot of Vitamin Cannabis now that I’m “legal.” That helps the nerve pain but does nothing for the joint pain. A joint for the joints seems fair, doesn’t it???? But no. So I’m silently going crazy. All I want to do is be well enough to do my work, which is helping people get pain-free with acupuncture. Ironic, ain’t it?

        Liked by 1 person

  2. I think a lot of these statements are talking about certain situations and not the whole population, even though they make blanket statements.
    I still think getting narcotics should be between the dr and patient, no one else, certainly not the government.
    I haven’t had any trouble getting pain meds. I can’t take them but have been offered them often within the past year.
    I’d rather be able to talk with my dr about alternative or conventional therapies, I wish this would bring about more conversations about alternative treatments, but most will just say they can’t give you anything. That sucks.
    I find it amusing that drs can prescribe bennies as much as they want and not opioids. They worry about addiction? Shouldn’t say anything might make it hard for me to get valium.
    Wendy

    Liked by 1 person

    • Hate to break it to you, but benzos are now on the chopping block. I don’t know who’s behind this drug Gestapo, but it offends me that whoever it is has the nerve to interfere in the doctor-patient relationship. Sure, drugs get diverted and abused. When have they not been? The fact that so many people are self medicating pain, physical and/or psychic, speaks of a sick society. That particular illness cannot be treated by policing its medicine. The cure for the illness is going to have to come from the grass roots. We have to find a different model for helping people who are suffering. A different model than acting as a nanny state going, Oh, no, mustn’t do that, it’s bad for you. We will make you unemployed because we drug test our workers. Then we will make you homeless, because it’s your own fault anyway. Then we will taser you as you sleep on your piece of cardboard and drag you screaming off to jail. And so on. So if you need benzos, now’s your chance to go to your doctor, before the drug cartels become the only source.

      Liked by 2 people

      • I read an article today about a new pill on the underground market, a combination of Xanax and Fentanyl. As you can guess, it can be deadly, and some people have died because they didn’t know what they were taking. The drug war continues to push people into the underground market, and the opioid war is just making things worse. I keep hoping that we’ve seen the worst of the results (suicides, poisonings, levels of desperation), but I’m afraid it will get a lot worse before it begins to stabilize. Tragedies, tragedies, everywhere…

        Liked by 1 person

      • Don’t have one, as I haven’t tried it. (Yet.) But in the comment sections, pain patients are mentioning it more and more. Unfortunately, just like with Big Pharma, these drugs are not manufactured in the U.S. And when they are, they’re made with foreign materials. Seems local is the best way to go. 🙂

        Like

        • Kratom is a tree that grows in Indonesia, where it is used like coca leaf, to ease the pain of hard agricultural labor. It binds to mu receptors and is helpful to wean off opioids, including methadone and bupe. Since it does bind to mu receptors it is potentially addictive.

          It has a two phase dose effect: stimulant at low dose and sedative in high dose. Only problem is that dose is individual, and since the material must be prepared from various forms of the leaf, dosages can be difficult to titrate.

          Side effects apparently can be a bitch: nausea and vomiting, mainly.

          I had some, took some, it was OK, then I chickened out and pitched it. I think I’ll skip that one.

          Liked by 1 person

      • I’m not surprised that benzos being fired against.
        They were once before, or Valium was, then it got better, now it’s all iffy again.
        I don’t think I’ll have a problem getting it. I’m on an as needed bases and have never gone over my script. But having vertigo without Valium would kill people.

        Like you, It appalls me that anyone is coming between the doctor patient relationship.

        I have a doctor now that will email a prescription that my insurance will cover, but it doesn’t cover enough for the month for my migraines, so she gives me a written prescription that I fill with GoodRx and pay cash. I hope there are more doctors who can find a way to work with their patients to help them.

        You are also right, this is a sick society, we don’t take care of our sick, we make them suffer.

        Liked by 2 people

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