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(News.com.au)   Doctors at risk of misunderstanding pain. Chuck Norris, Sarlacc unavailable for comment   (news.com.au ) divider line
    More: Interesting, University of Queensland, Sarlacc, Alice Springs, Chuck Norris  
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1103 clicks; posted to Geek » on 03 May 2013 at 9:59 AM (3 years ago)   |   Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



18 Comments     (+0 »)
 
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2013-05-03 09:22:11 AM  
No shiat.

The biggest problem is that providers need to get over their biases towards pain control, and instead of just throwing two month supplies of Darvocet and Lortab at people, work with pain management specialists to find a regimen that works with each patient.

And people need to stop treating EVERYONE as an addict who seeks help for pain. Once you've been doing it a little while, you can learn the addicts. The 90 year old woman with the angulated hip is not one.

Seriously. I can't count the times I've gone and picked up  children who have  long bone fractures - like their freaking femurs and haven't been given anything but tylenol with codeine. (which, hilariously enough besides that, around 20% of children under six can't metabolize into the active prodrug).

NSCSB Time on why I feel the way I do about pain control.

8 years ago, I was very, very stupid: I went to work with a severe strep infection, dehydrated, with a 103 fever. I passed out behind the wheel, and slammed into a ditch breaking my right radius, dislocating my elbow, and breaking several bones in my wrist. When I came to, I had to splint my own wrist, and I walked to the guard hut where I was working at the time, and called for an ambulance. When they showed up, they refused to give me pain medicine. They said I couldn't be hurting too bad, because I was asking for meds for it, and that my wrist probably wasn't broke, despite looking like a dinner fork. Three hours later, after getting numerous x-rays and being manipulated by the physician without any pain control, I was FINALLY given an IM shot of Dilaudid and a prescription for lortab 10s, and sent home in a soft cast.

For three hours, I sat there and was told that it wasn't as bad as I said it was, and I didn't need anything.

Last year, I was at home visiting for new years when I threw my back out. I didn't think nothing of it, so I took an advil, and went to sleep. woke up 3 hours later in such pain that my grandmother called 911. Same crew shows up from all those years before.

I told them to fark off and signed the AMA form, and had my mom drive me to the hospital.
 
2013-05-03 10:28:58 AM  

hardinparamedic: And people need to stop treating EVERYONE as an addict who seeks help for pain. Once you've been doing it a little while, you can learn the addicts. The 90 year old woman with the angulated hip is not one.


But her grandson who steals her pills may be.
 
2013-05-03 10:29:53 AM  
Can't stand opiates. I have only asked 3 times in my life. Treated with suspician.

/vet
//back issue
 
2013-05-03 10:42:26 AM  

StoPPeRmobile: Can't stand opiates. I have only asked 3 times in my life. Treated with suspician.

/vet
//back issue


I get the opposite problem. I try to explain anti-inflammatories are the only thing that actually ever effectively remove the migraines and back pain I have and they keep trying to throw codeine and other narcotics at me. They only treat part of the pain and make me feel like crap. Morphine makes me want to crawl out of my skin, percocet makes me severely agitated and pukey. One doctor I asked just to get referred to a specialist to look at my spine and he handed me a script for T3s. No, I want to know what the fark is up with a couple vertebrae so it can be fixed. I must have thrown out 5 different Rxs for T3s in the past few years.

They don't listen well. They can't accurately remember what you said a few minutes later. They incorrectly write down what you are saying as you say it. They make assumptions. You say something like "The last time I was on Paxil was 15 years ag," and then they say "So you're currently on Paxil?" a couple minutes later. How can you get efffectively treatment.
 
2013-05-03 10:48:00 AM  

hardinparamedic: And people need to stop treating EVERYONE as an addict who seeks help for pain. Once you've been doing it a little while, you can learn the addicts. The 90 year old woman with the angulated hip is not one.



I love how these hospitals claim that they aren't there for pain management because it's too expensive. They are there for "emergencies". Yet they have billboards all around town touting their new online check-in system, and some even have a lit up clicker on the billboard telling you how long the current wait is. If I have an emergency, then 1 I am not bothering to check in, and 2 who cares what the wait is when it's truly an emergency?
 
2013-05-03 11:04:31 AM  
I seem to be allergic to opiates. Some hooker gave me an oxy years ago and I felt like I was near death for a day and a half.
 
2013-05-03 11:07:13 AM  
If I'm going to a doctor for pain and he asks me to rate it on a scale from 1 to 10, I'm gonna say it's an 11. That's just how it works.

/ actually, that's not true. When I've gone to emergency for various pain-inducing conditions, the doctor has often commented on my seeming indifference to it.
// and then I go home and actually get some blissful sleep since I'm not distracted anymore
 
2013-05-03 11:07:41 AM  

socodog: I seem to be allergic to opiates. Some hooker gave me an oxy years ago and I felt like I was near death for a day and a half.


That was probably just acute onset of HIV
 
2013-05-03 11:12:27 AM  

socodog: I seem to be allergic to opiates. Some hooker gave me an oxy years ago and I felt like I was near death for a day and a half.


blogs.thepoconos.com
 
2013-05-03 11:18:33 AM  

starsrift: If I'm going to a doctor for pain and he asks me to rate it on a scale from 1 to 10, I'm gonna say it's an 11. That's just how it works.

/ actually, that's not true. When I've gone to emergency for various pain-inducing conditions, the doctor has often commented on my seeming indifference to it.
// and then I go home and actually get some blissful sleep since I'm not distracted anymore


There was one time in the ER when the doctor walked in the exam room, already starting to say, "So can you rate your pain fo..." and stopped when he saw me curled on my side, clutching the bed rail, and sobbing with pain. He stopped, said, "So you're the one with appendicitus. I'll get you some Demerol" and left.

What's sad is the demerol barely touched my pain. I think if I had to make a reply I would have said 100 or something like that.
 
2013-05-03 11:22:57 AM  
Pain don't hurt
 
2013-05-03 12:05:45 PM  

starsrift: If I'm going to a doctor for pain and he asks me to rate it on a scale from 1 to 10, I'm gonna say it's an 11. That's just how it works.


When I went to Labor & Delivery---at my mother-in-law's urging...I didn't think I was in labor---I told them 2 out of 10.  Based on that response, the nurse said, "Well, there's no way you're in labor then, but to be safe, we'll have a doctor check you out," implying that I wasn't in enough pain to be in real labor.

Kid was born a few hours later.

Seriously, people have different thresholds for pain, and different tolerances to pain.  Childbirth wasn't nearly as bad as chronic back pain or migraines, if you ask me.

For back pain, I was told to take ibuprofen; in contrast, I could have received far more potent drugs during childbirth, even though childbirth didn't hurt as much as back pain.  Go figure.

And for migraines, nothing works for me except Imitrex.   Even Vicodin does nothing.
 
2013-05-03 02:12:19 PM  
Just have Batman pay them a visit. That'll solve that.

/sometimes, I like to share my pain... with someone like you...
 
2013-05-03 02:27:47 PM  

FizixJunkee: Seriously, people have different thresholds for pain, and different tolerances to pain.  Childbirth wasn't nearly as bad as chronic back pain or migraines, if you ask me.

For back pain, I was told to take ibuprofen; in contrast, I could have received far more potent drugs during childbirth, even though childbirth didn't hurt as much as back pain.  Go figure.

And for migraines, nothing works for me except Imitrex.   Even Vicodin does nothing.


I feel your pain. I've had a few bouts of kidney stones; while the pain was significant, I've easily had migraines that were 2x-3x as bad.

Go to the ER for kidney stones? They'll give you intravenous morphine (eventually) and send you home with a bottle of Lortabs.
Go the ER after a 3-day migraine? Here - have a couple Advil, because we automatically assume you're a pill seeker.

Western medicine is far too concerned with treating the symptoms (rather than fixing the causes) of chronic pain. Sad thing is, when doctors refuse to address chronic pain issues, patients are essentially forced to self-medicate any way they can to get relief. I think the medical establishment needs to ask itself some hard questions, like 1) would you rather work up a pain management plan for someone & get the issue under control?, or 2) would you rather wait until that patient needs a liver transplant from years of excessive OTC pain reliever use?

/opiates do almost nothing for migraine pain
//Amerge (naratriptan) FTW :)
 
2013-05-03 02:38:10 PM  
CSB:

My ex-girlfriend had been dealing with pelvic pain for most of her life when she finally found a doctor that was able to treat her.  She had seen so many docs before that just blew her off, or flat out told her she was imagining the pain.  One of them screamed in my face when I tried to explain what she went through on a daily basis.  It got to the point where she couldn't sit down for more than 5 minutes, couldn't do any physical activities, and sleep for more than a few hours at a time.

But this one doc, he is the last of a dying breed.  He actually sat down and took time with the us.  The first appointment was 3 hours long, question and answer with the doc, nurse, and a physical therapist, all who specialized in treating pelvic pain.  His first words to my ex, after she described her pain were "I believe you".  We both lost it right there.

She walked out of that initial appointment with a whole spectrum of meds at low doses to start taking to see which ones worked.  Every week she went back and they adjusted the meds based on what worked and what didn't work.  Always starting with a low dose, and working up until there was a noticeable difference.  It was a masterclass in how to treat patients with complex pain problems.  At first I didn't think it would work, and it took almost two years of medication, therapy, and careful symptom tracking, but she is now pain free.
 
2013-05-03 05:58:55 PM  
FizixJunkee:
Seriously, people have different thresholds for pain, and different tolerances to pain.  Childbirth wasn't nearly as bad as chronic back pain or migraines, if you ask me.

Yup. I found childbirth clearly was beat by kidney infection and that was trumped by infected molar.
 
2013-05-03 07:09:32 PM  
You can walk on a broken ankle.  I know this from experience.  If I say I'm in pain and your a medico... you'd better start offering pain meds.  Good ones that'll make me less stabby will suffice.  Get the hot male nurse I was wheeled past to do it as well.

I've found the vast majority of people in the 'care profession' actually don't give two shiats about another human other than themselves and are some of the worst clock-watchers around.  Worse even than civil servants.
 
2013-05-03 11:43:01 PM  

FunkOut: They don't listen well.


This is actually a really good book:  http://www.amazon.com/How-Doctors-Think-Jerome-Groopman/dp/0547053649

It's what happens when a doctor takes a hard look at how docs interact with their patients.  He admits it's pretty bad.

What I've learned is you have to streamline your words and be as clear as possible.  Hit the #1 symptom, be specific and as quantitative as possible.  For example, I was recovering from pneumonia once and I said I was really wiped out.  Doc didn't flinch, started to wrap up with a "you're almost recovered".  I said "look, I've been sleeping 14 hours each day and it still took all my energy just to get here.  I can't work and my clients are leaving me".  Then he perked up and ordered a breathing treatment and another round of different antibiotics.  A week later I was way better.  Came this close to spending another week in bed feeling horrible because "fatigue" is too common and vague of a symptom.

But yeah, it still blows.
 
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