I am so tired of hearing about how poorly emergency physicians treat pain. I understand that pain relief is often the paramount concern for some patients visiting us in the ED and that the Joint Commission has added yet another burden to our already overworked nursing staff to ensure that the pain scale is used repeatedly during the patient's visit to document change in patients' perception of pain. But how many times have you seen a pain scale less than an 8/10? Most patients I see are a 9 or a 10 yet somehow are able to be talking on their cell phones, reading a book, chatting with the eight family members who must accompany them, and appear in absolutely no distress. I am certainly not the most experienced physician, but I can recognize people who are having pain, whether they are crying or just sitting stoically on the stretcher.
Based on what the Swiss have done, I'd spend all day doling out morphine for paper cuts and ankle sprains. I think what we really need to address is our patients' expectations of the ED. We are not here to address chronic pain conditions. I will never get some patient's pain under control no matter how many narcotics I give him, and when I refuse to refill his prescription for Oxycontin or other chronic pain medications, he will complain that I'm not fixing his problem.
Then, I'll give in to the particularly demanding patient that I just want to get out the door and then get a call from the pharmacist stating that this is the fourth narcotics prescription he filled in two days! Nobody likes to be in pain, but we do dumb things. We cut ourselves, break bones, burn our skin, and strain our backs, all of which cause pain. As a society, we do not tolerate being uncomfortable, but it is often not possible to relieve all pain short of an epidural or general anesthesia, which are usually not appropriate. I certainly understand that there is inadequate pain relief in certain groups such as pediatric or geriatric patients with orthopedic injuries or patients with kidney stones or biliary colic, and with these patients I am sure to make them comfortable, but I have no problem denying narcotics to the patient with the 10/10 pain after three DVD boxes fell on her head.
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Joshua Rogers, MD
The authors are the principal investigators in the Olive View-UCLA Department of Emergency Medicine/Division of Infectious Diseases, and have been awarded a five-year, $9 million grant from the National Institutes of Health to study the use of off-patent antibiotics for treating uncomplicated skin and soft tissue infections. The study will be conducted at Olive View-UCLA, Johns Hopkins University, Maricopa Medical Center in Phoenix, Truman Medical Center and the University of Missouri in Kansas City, and Temple University Medical Center in Philadelphia.