I have never gone to an ED with a primary complaint of pain. That said, when I have had to go, pain has been an issue. In all the cases which led to hospitalization, I asked to be given only what I am prescribed to take at home, and hospital staff are happy to oblige. While in the ED, I refuse pain meds, as I truly don’t want my home regimen screwed up.

But what I wanted to say — anyone being treated for chronic pain has insight into how pain works and how many different modalities beyond narcotics can provide relief. Everything from heat/cold to antidepressants and anticonvulsants. Deep breathing exercises, mindful meditation, drugs like NSAIDS (I had the greatest relief ever from bone pain when a nurse had me try Toradol… It broke my heart when I was told I couldn’t continue to take it… Due to some mamby-pamby reason like a plummeting Hgb).

I do not envy you health care professionals as you face drug-seekers — you have my sympathy. But I do get angry when I feel lumped in with said drug-seekers, because I would likely only show up in an ED if drugs had *ceased* to work — my arsenal at home is as strong as I wish to go with medication for pain. In that eventuality, I would be worried about an underlying acute disease “process” kicking in… but might be too quickly pigeon-holed to get the attention I might need.

So I hope you are able to maintain your cool and work the problems before you, as they are singular people, not representatives of all that is wrong with the world.

There are days I long to take as much medication as I am told to take — but have never fallen in love with that gorked-out feeling, or daytime television. I know that it is a slippery slope once I start to seek real relief — so I undermedicate and try to cope. I am not coping well at the moment and for the first time in three years am considering a change in the narcotic part of my pain meds.

You probably don’t believe it, and it really doesn’t matter, but were you doctors and nurses to experience what I experience daily? Well, I don’t think you could manage. I don’t think you can even *conceive* of this level of pain, sustained over extensive time. So why should I expect health care workers to really try to “treat” or control it, were I to present to you as a patient? It scares the bejesus out of me to ponder a visit to the ED because of uncontrolled pain.

It’s bad enough that as an inpatient recently, an ICU nurse responded with one of my regularly scheduled methadone as an answer to my complaint of acute pain. I explained the lengthy half-life, I explained the immediacy of my pain (post-op) and she said, “Well, I will just put down that you refused your pain medication.”

She said it with such glee.

Most of the chronic pain patients that come in have some real pain kernel that started their whole dysfunction and we turned them into addicts because they were complaining of pain we were supposed to treat via the ’5th vital sign’ (actually the sixth, I think pulse ox is kinda important).

A lot of nurses get mad, though, when I give narcotics to people–so what am I supposed to do? Let them withdraw in my ED? I suppose that’s one option. Send them to psych? Can’t if they’re here voluntarily. Give them NSAIDs? Possible but they often don’t work and if they’re hypertensive or have gastric disease, not good either. We’re a bit stuck.

“It’s not your license, K, what do you care?” is the refrain from my fellow nursing staff. Everyone has been brainwashed into thinking narcotics are the only treatment for pain and that anyone who wants them should get them, and it pisses me off to no end.