Should Chronic Pain Patients Be Treated in the ER?
What happens when a chronic pain patient goes to the ER?
In the video below, A Chronic Pain Patient in the ER, a chronic pain patient is presented as either untruthful or mentally unstable. I’m not even sure which. However, the point of the video and many of the comments is that chronic pain patients are viewed this way, especially in the emergency room. Therefore, they say, the ER is no place for chronic pain patients.
The character wiggles and whines and that’s funny. But she knows the name of too many drugs and that sounds fishy. She’s been seen by too many doctors and that’s suspicious behavior. She’s had too many negative tests, which indicates she’s probably not very sick.
Yes, the video is funny, but my final verdict on YouTube was a thumbs down. I wish the author had not said this in reply to many comments: “if it offends you, perhaps it hits 2 close 2 home.” It makes it more difficult to see him as fair.
Most chronic pain patients probably go to the ER reluctantly
Probably closer to the truth is that many patients with chronic pain are unwilling patients like I was and often still am. I hope you’ll read that personal version of my story which I have only shared there on e-patients.net. I shared it hoping it will encourage patients to be willing to seek the care they need. But I also hoped it might make a difference in the way people view chronic pain patients. We don’t want to be chronic pain patients any more than others want us to be.
Whether or not the depiction in the video is funny or accurate, do you think that chronic pain patients can or should be treated properly for pain by going to the ER? Will they be able to get the tests or treatments they need?
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31 thoughts on “Should Chronic Pain Patients Be Treated in the ER?”
I think that no matter what all patients should be treated in the ER. I understand that sometimes doctors have to CYA and are worried about addicts and drug seekers. They cannot know and trust everyone who comes into the ER.
I do not go to the ER unless I have new unusual worrisome symptoms that cannot wait till office hours or if not related to my AS something else is wrong I.e. Broken bone, severe allergic reaction. But I don’t think that any person should ever be turned away from the ER. That being said we probably shouldn’t be using the ER as a doctors office. If you are there frequently you need to speak w your dr about adjusting your treatment since it is clearly not working or find a new doctor who can manage your symptoms appropriately.
Good points, Sunworshiper. I don’t think they are allowed to turn them away. But from what I’ve read from some doctor’s blogs and videos, there are doctors who are strongly discouraging pain patients from showing up in the ER. If patients are doubted like in the video, they might not get what they need anyway. I haven’t met any doctor who understands my pain level even in office hours so I’m not sure what to do. I’ve had to request repeatedly to get what I do have for pain relief – which is so far Lortab.
I agree that I am always afraid that ER staff will suspect that I am coming in just to get medication. That is because I have encountered young doctors who jump to conclusions as soon as they hear my primary complaint is pain. I had to write a letter to one hospital about a bad experience in their emergency room. One time I told a doctor that “if she was going to be mean to me, I would prefer to see another doctor. I felt bad enough without her attitude.”
I think that the Emergency Room can be a part of a pain management plan for a patient with chronic pain. I have two types of pain medication at home for managing my severe headaches. Due to brain hemorrhage,damage, and surgery, I cannot take the medications like Imitrex. I have one medication for mild pain. A second medication for the headache if it becomes moderate to severe. If it is unrelenting, then I go to the hospital to get checked out to be sure that it is not something more serious or something other than a headache. After explaining the protocol, to the ER staff, I have been diagnosed with severe dehydration and they have found urinary tract infections. Sometimes, I just require stronger pain medications to get the pain to a manageable level. I average 2-3 visits to the ER a year due to headache pain. Normally, I am reluctant to go but I feel better about going because it is part of a plan that my doctors and I have worked out ahead of time. However, because of this discussion, I will review the plan the next time I see my neurologist.
Thank you for talking about the red elephant in the waiting room. This is a very important topic and very often doctors deny it happens.
Until we all get the care we need,
Emmi, your case is special as many chronic pain patients are. I like that you and your docs have a plan. Do you think they might give you something from your chart or a letter that you could use in an emergency stating who your doctor is and what your condition is so that you would be treated as a special case in the ER? As difficult as the topic is, thinking ahead like you do could make a difference in how we are treated. It must be scary to have pain in your head you can’t get under control. :/
I had to go to the hospital one time! Terrible pain everywhere! My OB sugested i go! Of course we waited for 2 hours till they finallly gave me a shot and sent me on my way! No tests nothing…I know they thought i was crazy.I did what i had to do. Thanks for this article!
We do look as if we are drug seekers… Weve been down the road to much worse then 40 percent of er visitors have been in. I was in once with a child who had a broken bone and a grandmother brought in her 9 year old grand daughter for her earring being stuck.. sadly they can only affix a band aid to our problem if they help at all. They cannot offer us anything that our GP or rhuemmy can.. Think ahead and make and keep those appts with your…. i couldnt live without my gp. i call often and beg for stuff and they know im daying if i call and need them… er doesnt wanna hear it if you arent bleeding or broken.
Good point about the GP. I call them for my emergencies too. They know me & about my RA, etc. so they have been responsive. I did go to several bad ones before I found this one who seems to trust me and treat me. Of course, I’m usually calling for antibiotics, not pain prescriptions.
I guess I have a different perspective on this…I’m an NP who works in urgent care (not in an ER) but I see patients in our clinic who walk in off the street and request “oxycontin” or “percocet” for chronic pain and I have no records on them. It is my license on the line. My prescriptive authority when DEA is watching how many prescriptions I write out. Yet on the flip side, I’m a chronic pain pt also with RA and fibromyalgia and PN. I have never gone to an ER for any of the pain associated with one of those illnesses. Nor do I believe I should – it should be addressed at the time of a doctor’s visit how to manage it, and what to do if it worsens on a w/e. I would just call my doctor on call and speak to that person.
I can see how ERs can perceive chronic pain patients as drug seekers, it can certainly happen. I’m not sure how to fix the situation though.
Thanks, Marie. Good points. I don’t have the answer either. It is a hard thing. I was wondering what our many nurse readers would say.
I would like to think that anyone could be treated in the ER for a legitimate medical emergency.
I think it is pretty obvious from the video that this person was not being honest and truthful and that she was looking for a fix.
I feel bad for the people who really need pain relief from ER,but cuz of people abusing even the ER,us true sufferers suffer even more!
l have never gone to ER for RA,but after 3day migraines,vomiting.need lV to rehydrate and pain med.I think the er knowing your history is necessary and in my case,my dr. is on call,or can be reached to verify my needs.I am from Canada,dont know rules for US.
Sounds like documentation or verification is a big help. Thanks, Trudii.
After the first flare of my husband’s psoriatic arthritis that left him bedridden, I asked his rheumatologist what we should do the next time this happened, since it had been a weekend. His answer was to call him on Monday. I asked about taking my husband to the ER, and he said that the hospital wouldn’t know what to do. I had to create my own plan for weekend flares. Massage therapy, chiropractic care and acupuncture is what we can get on a Saturday, and it helps. There’s not really a good solution.
I hope you all can get what he needs in case of emergency severe pain. It seems like most of us just live through it – like childbirth.
It probably does make sense what your rheum doc says. Since even some rheum docs & pain docs are barely able to find solutions much of the time to give enough relief, then an ER doc might not know what is best for a PsA or RA patient.
My attitude is that it wouldn’t be right for me to go the ER for my chronic pain.
However, if I have a new, acute type of pain I would like to be able to go to the ER. I’d probably call my GP first and beg her to call the ER ahead of me if at all possible.
I have a pain contract and getting any sort of pain medication except for NSAIDS and tylenol from anyone other than my GP for any reason would invalidate that contract. I’m not going to do anything that might jeopardize that contract. I doubt anyone with a chronic pain contract would either. So if I’m seeing anyone other than my GP for something that’s painful I make it clear that I don’t want pain medication if asked.
A pain contract is not something I had considered in this post. Thank you for adding that to the conversation.
Most of the autoimmune arthritis patients I’ve heard from who *have* gone to the ER receive prednisone / kenalog injections. That would not violate a contract. But it surprises me how many ER docs will give high pred doses like that when the rheum docs would not. Not sure what to make of that.
I know it’s more than two years later but…..
With all due respect – that’s a load of crap!! I’m sorry but I watch my wife go through PURE HELL on a daily basis! She has suffered unbelievable and unimaginable pain for years now. Last night like many others we were up ALL nigh. Her suffering and me watching and doing all I could, which isn’t much! Taking (2) 15mg IR Oxycodone & (2) 4mg Hydromorphone (Dilaudid), which is her script, DID NOTHING!!! I packed her in ice enough to freeze a polar bear and NOTHING!! This ADDED pain is from adding the 80mg Atorvastatin (Lipitor) to the already 160mg Fenofibrate she already takes. They are both ‘high cholesterol’ medications as her numbers are hitting close to 1000! Anyone can read the side effects of taking both Meds together and will see they cause muscle pain. It did before when they added the 40mg Lipitor and thus we took her off of it. But her numbers are so high they wanted to try again before she had a heart attack. Now it’s twice the strength with twice the PAIN!!
I am actually waiting for a call back from her PCP (Primary Care Physician) but I already removed all the Lipitor from her Meds!!! I refuse to watch her suffer like that anymore! The only reason I did NOT take her to the ER was because we both know they will do NOTHING!! I have done the ONLY thing I can left knowing that as her pain increases – nothing WILL be done about it. I have specially rigged our car so that we can park anywhere and, with the flip of a switch allowing the exhaust to enter the vehicle, we can simply go to sleep and FINALLY be free of the pain! I’m thinking right now that it won’t be long! I can give story after story about the mistreatment of pain sufferers but in the end it all lands on deaf ears! So this is all we have left!!
For those (who I’m sure is MANY) who thinks my wife is a drug addict just because she is on pain Meds, then you obviously have NEVER suffered any REAL pain!! She had a career that most people would kill for! She made over $75 an hour just by herself working as a top graphic artist/web designer for one of the largest and best known tech companies on the planet! At one time she was only 5 down from the companies CEO and one of the worlds wealthiest people. We had an amazing life! A new house on the 18th fairway of a PGA tournament golf course with stunning views and a Grand Spiral staircase entry. We sailed all the time and enjoyed life to its fullest! Nobody gives up all that for some crappy pills that destroy your life!! She tried with all her might to work. In the end, she even had her doctors assistant meet her at her work during lunch just to get an injection in the neck so she can handle the pain enough to work the rest of the day.
In the end – it’s ALL gone!! And now soon, it will all be over!! The laws and people made getting relief from pain IMPOSSIBLE and I will be damned if I will watch my wife suffer like that any more! We have talked about it and in the end it’s not us that made the final decision – it’s those who refuse to allow pain sufferers the simple dignity of being free from such horrible pain. We have dreams like everyone else. We just cannot realize them for the great and un-relieving pain!
First I’d like to make a few comments about the video. In alphabetical order it was: adolescent, arrogant, ignorant and (unbelievably) SEXIST. If the video reversed the male doctor and female patient I believe instead of seeing comments on youtube confirming the hysterical woman stereotype, I honestly believe we’d be hearing from low life men pointing out tips for the *male* patient character to help him get unneeded narcotics. This is totally misogynist. And beware, the maker of that video might some day find himself in a situation like mine.
I speak as a man who lives with chronic pain. The only visit to an ER in my life was the morning after I was devastated with RA. I was treated very well there and mercifully have never needed to visit another ER.
Jay, that’s something that usually bugs me & I can’t believe I wasn’t even thinking of that. Yeah, it was sexist & rude. The author seems to lack compassion even if he does have a point that some patients are fakers / liars. His comments kinda showed his cards I felt. IMO.
I lived in a motorhome and traveled all over the U.S. for many years. While I had great insurance and a wonderful “home” physician, my only option for hands-on urgent medical care during those years was Minor Emergency Clinics or Hospital Emergency Rooms – docs simply will not see an emergency patient in an office environment, period. They have to say they will for insurance purposes, but believe me, there are 1000 ways to avoid it, and they do.
In every instance, including a 5-day admission through the ER and two other times pain meds were prescribed, I NEVER had an issue with being suspected of drug seeking – why? I believe it was because my backstory didn’t fit the “profile” for drug-seekers. I didn’t have a local doc, existing scripts that had run out, or any of the other red flags. It’s as if my story was completely unique and I was therefore given a free pass to being treated with zero suspicion.
Two comments on my experience:
1. How sad that urgent care docs become so cynical; but they don’t get that way in a vacuum. We all know there are drug-seekers who shop ER’s just as they shop doctor’s offices and pain clinics, but surely they aren’t the majority of patients who need pain control?
2. If I ever have to go to an ER again, maybe I’ll just tell a little white lie, and pretend I’m a traveler who has fallen ill in their fair city. Apparently, that circumvents all suspicion, and I won’t have to beg the staff to believe that I’m not a drug-addicted liar who wants them to lose their license.
But, I digress….the question is, ” should a chronic pain patient be treated in the ER?” My answer is NO, not unless it’s a life-threatening situation, or you are instructed to go to the ER by your physician, who is calling ahead. Who needs the grief?
Thanks, Jackie for the input. These responses have shown me it would be very valuable to have some kind of plan, documentation, etc to avert suspicion.
I have psoriatic spondylitis, and had a severe attack of costochondritis last July very late on a Saturday. That’s inflammation of the chest wall muscles, often causing severe chest pain that can mimic a heart attack. I was undiagnosed at that time, and very reluctantly went to the emergency room.
Although they had to treat me as a potential heart attack, they also treated me as a potential drug seeker and/or someone having an anxiety attack. I didn’t want to be there, and was 95% certain I was NOT having a heart attack, but the pain was excruciating and it wasn’t worth the risk of just trying to ignore it.
What finally got me the pain medication I really needed was when they actually gave me the option to either take an anti-anxiety medication or morphine. I told them all I wanted was to be able to go home and get a good nights sleep, and let THEM make the decision of which medication to give me. So they finally gave me some morphine (the IV anti-inflammatory they had already given me wasn’t enough). And I was finally able to go home and sleep. I guess because I wasn’t pushing for narcotics helped.
I don’t know if I would go to the ER for severe pain again. Maybe. I think it was the best decision last July, given the situation, though.
Great idea Kelly to post this video for discussion! I guess in so many ways the video illustrates the misperceptions of chronic pain patients and the inept responses of our health care system. As a nurse, and a patient, I can observe the video from both sides. The ER really can only provide emergency services, which can be excruciating pain. BTW, The hallmark description of a brain aneurysm is “the worst headache of your life.” However, my colleagues and I avoid the ER at all costs! The ER has become an answer to providing care for the uninsured, the drug-seekers, overcrowded Primary care MDs, lack of off hours urgent care facilities, and the true emergencies all require provider attention. It can be a nightmare to be seen in a timely manner, not to mention receiving proper treatment.
I believe the field of pain management is still in its infancy. The practice has been to prescribe higher doses of narcotics, and then label the patient a drug seeker because they develop a tolerance with long term use. We need more research into alternative therapies and pharmaceuticals that work differently, but may still be effective to us.
Thank you, Rachel. Very helpful.
The last place I would want to go is an ER. I sounds like they’re the same here in Australia as they are in the US. You wait for hours and then who knows what kind of treatment you will get, sometimes good sometimes not.
I’ve discovered a great ER at a small private hospital in Melbourne. Ten minutes for triage and then great treatment and it won’t cost you any more than $260 dollars (well that’s what it was last time) Its good value, but a bit of a sad indictment on our society that you need a credit card for decent ER service! Can’t complain though here in Australia, we do have free options albeit slower.
Also – on the topic of drug-chasers or as I’ve heard it called locally ‘doctor shopping’, I’ve been asked a couple of times whether I’m in the medical profession. Apparently I sound too well versed in my disease and it’s treatment to be an ordinary person! LOL It never occurred to me that they might think I’m chasing medications! That’s probably because I’m not, I tell my doctors what I’ve got, what I’ve had and what I’m taking. Usually they’ve never heard of my Serrapeptase, and there’s nothing at all sinister or interesting about paracetamol!
Mostly they know to leave me to it and just do the regular tests to make sure nothing new has landed without my knowledge.
So far so good! I’m glad I have a high tolerance to pain and I can avoid so many difficult treatments.
I have had this experience many times. I don’t go to the ER unless there are new symptoms. In the 14 months since my RA diagnosis I have been to the ER three times…more times than in the previous 34 years of my life. The reasons were:
Visit 1: Tietze syndrome
Visit 2: Kidney infection
Visit 3: Pneumonia, tachycardia, pancreatitis
However, I was treated like dirt until tests came back all three times. I understand there are doctor shoppers, but I come with copies of my medical history and contact information for my doctors. Further, I understand we are all discouraged from using emergency rooms thanks to rising copays and such but it also means you can get treatment more quickly than through normal channels.
Case in point…almost a year and a half to get diagnosed with RA. Ten weeks to determine a colon infection…and they wonder why people are frustrated with the system? That’s a long time to feel bad.
Robin, I don’t know what number 1 is. I’ll go look it up.
How awful to be treated like dirt. I assume you mean they doubted your symptom complaints.
I have had the kidney infection & pneumonia problems during the last 2 years and of course it gets bad on a weekend… Never did I go to the ER for all of the reasons stated in the comments here. Each time, I got a hold of my primary doctor who could take care of me. One reason it’s so good to have a good primary & find one who will take us seriously & be willing to care for our emergencies. For example, after the first kidney infection, other UTI’s were treated quickly even after hours. The doc seems to realize that the suppressed immune system increases my risk. Not a substitute for the ER, but it has helped keep me out of there so far. Hope that continues!
I cannot live anymore with the pain associated with ra. I don’t know what to do
Wendy, I hope that you will tell someone closer to you how you are feeling. There are strong pain medications that could help get you some relief in the short term at least, while long term treatment is tried. Please don’t give up hope – I know it’s so hard. RA pain is so brutal but there is always hope. Sometimes surgery or a new treatment is just around the corner that could make a differenct. I wish I could do something more for you – I will pray that you get relief somehow and soon.
i ended up in ER with extreme pain from CRPS and was having a huge panic attack because the pain was so bad and i was newly diagnosed and we didnt have me on all the right meds yet,,,,,it was horrible how I was treated!!!! I was so scared I felt I couldnt breath,,,,this pain can be so intense it is frightening!! I also get horrible ingrown toenails on my affected foot…they come on within a couple of hours and take over toe with redness, enormous pain and pussing,,,it was a saturday and went to ER and tried to explain about the crps and how in a couple hours i wont be able to walk and they said I was wasting their time that the ER was for people in life or death situations and for me to wait and see my dr monday….good thing I am not passive because I let him have it but it saddens me to think of so many who get treated like this,,,,,it has to stop!!!!