Lessons Learned From the ER

By Victoria Reed, PNN Columnist

Many people have a need to use the emergency room at some point in their lives. As a person with degenerative disc disease, there are times when my chronic back pain is exacerbated by an acute pain event that causes my back to occasionally go out.

By “out” I mean my back seizes up, stiffens and excruciatingly hurts. It doesn’t seem to take much to trigger an onset of pain. One time it happened when I tried to get up from a seated position off the couch. Another time it occurred when I bent over slightly to get something out of a drawer. A third time was triggered by vomiting from a stomach bug, so not only was I sick, I could barely move. Unbelievably, a fourth episode was caused by a sneeze!

During these episodes, I can’t walk or move without significant pain and I need assistance from my family. I will usually be bedridden for the better part of a week or two. One time it was so bad that I had someone take me to the emergency room to try and get some relief.

At the time, I was receiving treatment with a mild prescription opioid for my other chronic pain conditions. However, the medication was not doing anything for the acute pain.

At the ER, the staff was generally compassionate and treated my pain. I was sent home with a small amount of a stronger pain medication to use for a few days. After a while, the back started to calm down and I went back to my normal daily pain level.

VICTORIA REED

Subsequently, I had a follow up visit with my pain management doctor. I didn’t like the look on his face when he walked into the room. This doctor had always been reluctant to treat my back pain with anything other than spinal injections, which were no longer effective. He confronted me about the ER visit and was worked up into a lather about it! He implied that I was drug seeking. Wait, what? No, I was not seeking anything other than pain relief.

I explained that my trip to the ER happened on a weekend, so I wasn’t able to call his office. Regardless, there was no convincing him otherwise. He refused to renew my opioid prescription, but didn’t discharge me from the practice. I walked out of the office shocked, hurt and angry because in my mind, I had done nothing wrong.

I thought it was a basic human right to seek treatment for excruciating pain. I still believe that. But that incident made me realize that some doctors just don’t see it that way and think everyone is drug seeking.

Back then, I was younger and inexperienced with the specialty of pain management. I was unaware that I should get prior approval before receiving any opioids from anywhere else. There had been no contract signed, nor any discussion of what the procedure was.

Ultimately, that trip to the ER for an acute episode of back pain caused me to lose my regular pain medication. Needless to say, I never want to go through that experience again! 

Fortunately, I have since been accepted for treatment by a wonderful, compassionate pain management doctor and have been 100% compliant with the procedures and the pain contract that I signed.

On another occasion, I went to the ER during an acute flare of my rheumatoid arthritis, which caused extreme pain and swelling in many joints. The low dose steroid that I took daily just wasn’t doing much and my stomach doesn’t tolerate higher doses very well. My intent in going to the ER was to obtain a higher dose steroid through an IV that would bypass the stomach.

The first question I was asked as I was being triaged was, “Isn’t RA a chronic illness?” Already, I could see where this was going.  I replied, “Yes, but I’m having an acute flare.” That got an eyeball roll from the ER provider, but once I made it clear that I was not seeking any opioid medication, they were willing to treat me with the high dose IV steroids that I had requested.

I felt that if I didn’t say everything the right away, they would have labeled me as a drug seeker and turned me away altogether.

There is opioid hysteria going on that changes the way pain patients are treated and viewed. How do we use the ER without fear of being labeled as drug seekers? Acute, uncontrolled pain needs to be treated, regardless of whether we are already under care for treatment of chronic pain. All patients deserve to be treated with compassion and fairness.

I would definitely think twice (actually 3 or 4 times) before I go to another emergency room for treatment. We should not be afraid to go for fear of being labeled a drug seeker, nor should we have to be afraid of losing our doctors and medication. The negative stigma associated with prescription opioids is real and ultimately hurts an already vulnerable population of patients.

Victoria Reed lives in Cleveland, Ohio. She suffers from endometriosis, fibromyalgia, degenerative disc disease and rheumatoid arthritis. PNN invites other readers to share their stories with us. Send them to editor@painnewsnetwork.org.