I have just finished reading the letters in the January 2001 EMN. It was with amazement that I finished reading the first letter that appropriately addressed pain as another vital sign. It was amazing because this letter was immediately followed by an entire page regarding the treatment of pharyngitis, which included the responses of four physicians and the use of antibiotics. Not a single one of them addressed the real reason the patient came to the ED: the patient was in pain.
My cynical response is that all of this academic discussion regarding the use of antibiotics is secondary to a two-day course of solid pain management. In my practice, I will readily prescribe a two-day course of narcotic pain medication (usually hydrocodone pills or elixir). Mom sleeps at night, the child can take fluids, and either additional Tylenol or Motrin can be suggested for the fever.
I have yet to find that a two-day course of this treatment provokes an addiction. Remember, our EDs will always have more pain medication than our patients have pain.
Harold “Tad” Duke, MD