Apparently these days, treating pain requires stones, or does it? See what guest blogger Dr. Morty Fein has top say…
The pain was excruciating – so intense that it woke her out of a sound sleep. The young charge nurse had finished a night shift and was in bed sleeping in the late morning. Diffuse, intense abdominal pain came out of nowhere and she tossed and turned and tried to ignore it but it simply wasn’t possible. She got up, paced the floor and finally got dressed and drove herself to the emergency room of the very same hospital wherein she had just worked a 12-hour shift. By the time she was in the ER, she was doubled over. She was quickly ushered inside and given an injection of a non-steroidal anti-inflammatory (NSAID, ketorolac, aka Toradol). A scan revealed a stone – actually several, kidney stones – with one stuck in her ureter that would have to be passed. After some hydration and feeling a bit better from the Toradol, she was told to go home, hydrate and pass it. No pain medication was given.
Passing a kidney stone is universally recognized as lying along a spectrum from unpleasant to excruciating. In pre-opiophobic times, people suffering with them were routinely given opioids to ease the pain. Concern about addiction and diversion – no matter how rare they might be in a non-addicted person who receives a handful of doses in the setting of a pain crisis – has changed the practice. Additionally, trying to make hay while the opiophobic sun shines, some particularly zealous ERs are bragging about being “opioid free.” And so, with a new, dramatically overstated sense of risk, a new form of sadism has been unleashed.
Upon returning home in the early evening, she laid down to rest. With no sleep she had to call in sick for her night shift. She tried to sleep, took some oral NSAIDs and did until late that night intense pain returned and escalated to excruciating. She woke her family and at 2am they returned to the very same ER, in her very same hospital. A second ER visit within 24 hours. A new scan, a dose of morphine, and a lecture. A male physician assistant told her that passing kidney stones isn’t as bad for women. This time after a bit of a battle, she left with a prescription for hydrocodone and a referral to a urologist. She returned home and called in sick for another shift.
This young nurse’s tale is not unusual, I suspect, and it represents a thumbnail sketch of disturbing national trends. We are witnessing misplaced and overzealous caution manifesting in near complete avoidance of opioids in what otherwise are completely appropriate settings for opioids. We are witnessing a disingenuous abandonment of attention to pain by many practitioners who wouldn’t need bamboo stuck under their fingernails to be pushed to screaming “good riddance.” We are witnessing a shocking loss of empathy. And we are witnessing a resurgence in sadism that was first called out by the late, great Sam Perry in 1980. But that’s not all. It is not just sadism, it is costly sadism.
This nurse missed 2 shifts due to pain and exhaustion (that’s not to say she would have not missed any work with pain this intense even if treated, nor should she, an opioid inexperienced individual, be reporting for duty newly on hydrocodone). But it is emblematic of the bigger issue of loss of productivity in those poorly treated for acute and chronic pain. Her family saw her suffer and families across the country are seeing people with pain terrorized and terrified. Pushed to the brink of suicide. I have often thought that it would be worse to watch my loved one suffer than suffering myself. The young nurse’s pride and faith in her own hospital was shaken.
And her pain caused her to generate double the medical costs for the episode. Data are lacking as to how opioid time, dose and supply limits are affecting costs, let alone opioid avoidance. Extra office visits, extra ER visits, additional drug and procedure costs all justified in some people’s minds if the risks are so dramatically overstated, but the costs, I imagine have gone through the roof in some instances.
Maybe that in the end will lead to better, smarter, opioid policies and elevating the standard of care. If certain parties don’t care much about the human costs, they may be swayed by the healthcare costs.
We need change. We need empathy. We need compassion. Some of us need opioids. Perhaps with some improvement, we will all sleep a bit better at night.
As usual, comments are welcomed with enthusiasm!
I just went through this this week. I wrote my representatives in my state, see below:
Dear Sirs,
I have been informing you of the situations we often find ourselves in prior to the CDC guidelines being put into law by the Executive Order 17-18 in the state of Missouri by Eric Greitens.
For the last months, the left side of my back, neck, skull, breast plate, arms and hands have been in excruciating pain. I raised the flag to my pain management doctor after a week of this excelling pain. I was told to hold until my next appointment. I see him every two weeks. When I saw him, the pain was worse of course as it always gets if not taken care of. He said it was the “weather” (Which it could be but I know it is not) and gave me injections. He would not change my break through regiment of low dose 3x’s per day Hydrocodone. (That is the ONLY medication that I can tolerate without side affects)
Since than the situation has gotten dire. The pain is making me physically sick, unable to move my upper body at all and I have not slept more than an hour in the last month. My blood sugars are off the charts as they do when my pain in untreated. It is not just above and beyond my regular pain; it is excruciating, lying in my bed in tears. I have break through medications but they are low dose and 3 times per day, not enough especially when it goes above your normal pain.
I feel like their is a nerve pinched in my C1-C4 area or I have a disc that has blown. I know my body, have lived through 7 winters in chronic pain and this is not the weather. I begged my doctor to see me and help me work through this and he refused. He is a good doctor but his hands are tied. I tried to get up and work part time recently (15 hours per week) & lost that employment on top of all of this. I just am devastated over that.
My doctor for the 2nd time in a row this past month told me to go the ER. Really, that is why I come to you, your my PAIN Management doctor right? I need an order for an MRI with contrast probably and I need anti inflammatory with stomach medicine so I can keep it down and probably now, go into traction!
Prior to the CDC guidelines, my doctor would have upped my dose temporarily until they could see what was going on so I could at least get out of bed. Now, doctors both primary AND pain management doctors are terrified to treat us adequately. I am on Medicaid so the bill of maybe $10 for my script went up to about $4000 in an ER visit. Do you see what madness they have created? I hope the state is ready to swallow that “pill” when it hits their budget.
The other issue I face is I WILL be flagged if I go to the ER with a progressive pain situation even thought my doctor is sending me there after a month of begging for help. I cannot win. This is in lieu of my previous flag which should have been removed by now and has not for moving and having surgery. I AM NOT A CRIMINAL! The most I have had is two parking tickets. I am a tax paying citizen who’s only issue is a chronic disease and pain from that illness. I had to file for disability, ,was denied and now had to hire an attorney and wait 2 years for a court appearance. How am I going to survive those two year, how? God help us all as our lives completely fall apart…..in pain.
With this being said, what would you do? Picture yourself or a loved one in this situation. WHAT WOULD YOU DO?
Thank you,
Karen
I have experienced this sadistic kind of treatment over and over. I am in fear of going to the doctor, dentist, or hospital. I have chronic intractable pain. Fibromyalgia and neck pain , RLS, hip pain that brings me to tears and leaves me writhing in pain. No doctor will allow me anything strong enough to be comfortable. I live in constant anxiety for when it’s time to fill my tylenol 3 because the pharmacist will make my life difficult too. The staff gives side glances. At doctors appointments I am met with hostility. I am a kind and agreeable introvert so its not like I go in there guns blazing so to speak. I saw a ER nurse on Twitter who calls herself “shitmagnet” brag on Christmas day that no one better come to her ER and say they need pain medications or they would automatically get Tylenol. I have met some like her in my trips to the ER. They enjoy making fun and tormenting pain patients.
Nothing in my training compares to what I learned having from acute nephrolithiasis. I was working a night shift in the ER in 1989. I felt a twinge, urgently peed blood, the got acutely Ill with 10/10 renal colic.
It was 0630. Shift change at 0700, the longest 30 minutes of my life. My patients were all seen, nothing to do but wait.
My Angel nurses had me on a gurney, IV running by the time the day doc arrived. I received my first Morphine at 0705. 30 mg of morphine later, it was barely under control, likely because the agony had a head start on me.
Thought taught me a lot, and for the rest of my ER career,I set records for getting access and opiates to my writhing back pain patients.
Those days are sadly gone.
I agree , You are labeled a drug seeker . I don’t even go to ER anymore. I have to take for Fibromyalgia, herniated disc, pinced nerves, slipped disc,CFS,mingraines,etc.lots more. I am homebound and only get out to go to Drs. I hate being on meds but have to live or my blood pressure goes so high to stroke level. So what do you do ? Try to save as many as I can so if Dr let’s me down I can find another . But I suffer alot ! What is the world coming to when you have to live in chronic pain with barely any relief
I too am stuck. I have fibro, degenerative disc disease, two herniated lumbar discs.
Let me add that I have never taken opiods my entire life, I am 60. I have had wisdom teeth removed by an oral surgeon, never filled the prescription, because I had very little pain. Pushed out not one, but two 10# babies with no anesthesia, so if I say I’m in pain, you better believe it. So, I go to the er one really painful night. The dr. Comes in my room. First thing out of his mouth. I don’t believe in narcotics. I’m like ” well good, because I have a whole bottle” which I did. The pain was so bad I was hoping to get an injection of some sort. Left without help. I cannot believe those were the first words out of his mouth.
Just sickening what is happening in this country. Absolutely sick. These drs have no concience and it’s disgusting. I pray for karma on all of them.
It’s just that she was a nurse working @ the very same hospital rather that she was met with opiphobia rather than the understanding that this is real pain plain & simple! What do they all get a gold star if they don’t give out anythg opiate bc it seems that way!
This is just another story of peoples pain being ignored. Get to the real cause like the 10 people in GA that got caught buying prescriptions from the dark web and cashing them in. DO NOT PUNISH PAIN! So to make up for the monies lost for less pain pills sold legitimately, you are required to come in every week at 3-4 x’s the normal cost. Greedy and Sadistic. How many deaths will it take before someone gets sued for this or the government admits they screwed up?
I have not had one of these devils in many years, but they are excruciatingly painful. In the 1990s I had a series of them, all very small that got lodged at the junction between the ureter and bladder. They were way too small for surgery or the ultrasonic blasters that are sometimes used now. So my only option was fluids given by IV in the emergency room and fortunately some analgesic opioids. The third ingredient in the treatment was time. Eventually, each one passed with an instant ecstatic relief of the agony. As soon as the stone passed there was no more need for pain medication. And guess what? I have never used any opioid for recreational purposes. I shudder to think what would happen today!
I agree that this was totally wrong. There is now an excessive fear of prescribing opioids for chronic pain, despite published evidence that only a small percent of patients who are begun on an opioid develop addiction after 90 days — or should I say develop Opioid Use Disorder. But this patient wasn’t even dealing with chronic pain, but rather with a widely accepted source of severe acute pain, kidney stones. She should have been given the most effective analgesic — an opioid for her short-term disorder.
Having suffered with a very large, and very “lodged” kidney stone in my ureter for over a month and a half, and also enduring the daily stigma and agony of severe, intractable pain from an incurable illness, I can personally relate to this horrific story. Under no circumstances should any person – male or female – be made to endure the torture of untreated and/or undertreated, excruciating pain. Tragically, most in our country walk around completely clueless as to what awaits them in the post-surgical setting due to the false narrative that 2-4 weeks of opioids will leave them addicted to their pain medications. Or that those treated with life saving pain medications for severe, chronic pain diseases and disorders must fit into a one-size or even worse “no size” fits all category when it comes to Opioid pain medications. Those of us who have taken the opportunity to research the data know this fear mongering of doctors, patients and legislators has no basis in scientific fact. We must continue to speak out against those who continue to misrepresent the truth and put pressure on our healthcare providers both with regulation and guidelines aimed not to heal but to harm. It takes more than the patients standing up. It takes us all as we will all be affected by this tsunami of pain – both newly created chronic pain patients and existing in the tens of millions.
I’m a RN and this was totally wrong!! This nurse
Needed care and compassion something that she gives when working! Kidney stones and nsaid??? No no way!!she should have been given morphine as soon as she was seen in ER! People need to start being proactive
For their own health care. And especially a nurse that worked there! This is so demeaning to the patient! So damn sad….patients need to start speaking up and demand that their pain be treated! It’s our right not to suffer! So sad
As soon as you demand security is called and you are labeled. The old Catch 22.
Outstanding piece, as usual, Mortimer. We are not preaching “opiophilia”, but rather common sense “opioid moderatism”. Kudos!