“I’m not impressed with his pain.”
“I only give Norco if I see a bone sticking out.”
“She says her pain is a 10/10 but …”
On any given shift in the emergency room, I hear some version of these said by residents or fellow attendings. And whenever I hear these phrases, I think to myself, “When did we stop treating pain?”
I’m not talking about chronic pain. I feel terribly for those who live with chronic pain, and the physicians who struggle to treat it.
I am talking about acute pain seen by emergency doctors, urgent care providers, and primary care physicians. The pain of a gout flare. The pain of a large ovarian cyst. Whiplash from a car accident. A Bartholin’s abscess. A kidney stone. A sprained ankle. I’m talking about the people who took ibuprofen and Tylenol, on top of heat and lidocaine patches, and still come to us saying, “Doc, I’m still in a lot of pain. Can you help me?”.
The answer to that question is, “yes.” Yes, we can help you. We have drugs that will absolutely help you get through the pain of this acute episode. Yet in the last ten years, we have done a 180 from “I will help you with your pain” to “Under almost no circumstances will I give you narcotics.”
It’s obvious where this has come from. You’d be hard-pressed to find a physician that would deny the existence of the opioid crisis. It is unquestionably a real problem. You’d have no trouble finding anecdotes from around the country of people who were never addicts in the past, but got one opioid prescription and became addicted, graduating to fentanyl and heroin that eventually took their lives.
But this is not the norm. Hundreds of thousands of people have received opioid prescriptions for acute pain, and not become addicts. Not turned a prescription of twelve Norco from the emergency department into an addiction to heroin and fentanyl. Used the medication for its intended purpose, to help with acute pain, and then continued on with their normal lives.
I see my job as a physician to help people with their pain. And when over the counter methods fail, that often involves giving a small, short period of narcotics.
Do I encourage trying over the counter methods to control pain first? Always. Do I explain to them that narcotics are addictive, and that they are risking this if they choose to take them? Every time. Do I check the Prescription Drug Monitoring Registry to ensure they are not receiving large amounts of prescription drugs? Absolutely. Do I make the patient feel like a drug addict for wanting relief from their acute pain? Never. Do I feel like a drug dealer for helping people to reduce their pain with the tools I have and am trained to prescribe? Not at all.
The opioid crisis is real. But so is pain. And as long as I am a physician, I will appropriately and compassionately treat the pain of those who come to me seeking relief.
The author is an anonymous physician.
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