Wednesday, June 17, 2015

Here's an idea for the ER--ask people if they need pain meds


Once, my mother dislocated her shoulder falling--and she lay in the ER for six hours with no pain med waiting for a doctor. No water either--in case she needed surgery (not how these are fixed). Her tongue was stuck to the top of her mouth and she was so miserable, kept saying it hurt (she had dementia). But no--nothing.

Based on a new study on treating acute pain the ER (Annals of Emergency Medicine), the conditions of most ERs are not conducive to fully individualized pain treatment. Well, boy howdy!

Researchers provided 1 milligram of intravenous hydromorphone to patients reporting severe pain. Thirty mins later, they were asked do they want more. Then this was asked again at 30 minute intervals. One milligram was given if the patient said yes.

Of the 207 patients, 114 received just the first doses, 78 got two doses, nine received three, and six got four.  All but two were satisfied with their pain control in 2-4 hours.

Pain preception is highly subjective and varies by patient. It is not necessarily related to those scores--where they ask, what is your pain from 1 to 10. A yes or no question lets patients decide. They can gauge the pain, think about the side effects--drowsiness, nausea--and make the call.

Yes, ERs are very cagey about people coming in just to get pain meds...but this is usually prescriptions.

Maybe all ERs should look at this.  I wish my Mom had it to do over.

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