My back hurts

[Hamhock]

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There is no need to mock and slam something that you don't understand and can't or don't want to appreciate.

That's not Kool-Aid. That's faith/religion.

HH

 

[Hamhock]

and a DO that's why the profession was created. T

nope.

HH

 

[bravotwozero]

If I am not mistaken, there were studies that looked at manipulation versus nsaids to treat lower back pain, and the study showed both of them to be equally efficacious.

Assuming there weren't serious flaws in the study (and I will admit that this is a big IF with much of the research in the field), I would say that's reason enough to use it in a PRIMARY CARE setting, where the patient has appropriate follow up. There's no medication in the world that doesn't have any side effects, and nsaids are no exception, particularly when it comes to gastric issues. Why not avoid it if you can, and bill for omm?

Of course, I don't feel omm has a role to play in an ED setting, so in that context I might just bust out an order for ibuprofen.

 

[Katydid]

Nine times out of ten, I do not want narcotics for pain. If it's bad enough that I feel like crap, a couple of ibuprofen and getting on with my life usually works.

If that doesn't do it? Something is wrong with me. Either I'm birthing a baby (that was some fairly nasty pain, thanks), or I'm birthing a kidney stone (that was worse than labor and delivery). The first one, well, I just wanted the baby OUT OF ME. The second one, I was in enough pain that my husband noticed I looked like hell when I came home from work, after fighting the urge to pull my right knee up to my chest while driving around delivering for the pharmacy.

The kidney stone was a rather unpleasant experience. I've never actually had pain that made me break out in a cold sweat and have the urge to vomit before. I couldn't get comfortable. I couldn't sit up, bend over, lie back....nothing without a whole hell of a lot of pain.

That was the tenth pain experience. The shot of Stadol and Phenergan was a total relief. Suddenly, when it kicked in, I didn't want to throw up anymore, and I didn't feel like someone was repeatedly kicking me in the back.

I understood, after that, how people get addicted to narcotics. The pain, and pretty much anything else, just ceased to exist or matter anymore.

 

[tkim]

I don't mean actual psychiatric problems. But if you put your hands on a patient they feel like you are listening to them and that you spent more time in with them than you actually did. If something as simple as sitting down makes patients happier and they feel you care, directly addressing their complaints with OMT should work in a similar fashion, no?

One is handholding and nodding, the other is OMM. They are not the same, but you, as the self-appointed expert of OMM, seems not to be able to discern the difference.

As I recall, we weren't talking about holistic humanistic hand-holding, but OMM in the treatment of medical conditions. Of course, this usually devolves into the tired, 'osteopaths are more holistic, humanistic, and darn it, we treat the whole person'. That's crap. It's not the degree, it's the person that determines how you care.

There is no need to mock and slam something that you don't understand and can't or don't want to appreciate. I'll sit over here and finish my kool-aid and help who I can. Sorry for rocking the boat...

Something I don't understand ... Hmmm, last I checked, I passed all three COMLEX exams. How about you?

 

[Powdermonkey]

I'm not positive this is what you mean, because you seem to be afraid to come out and say it, but - are you implying that your DO education teaches you to be nicer to your patients? To treat them more like people?

That's laughable. It has nothing to do with your education. Maybe you are implying that there is a selection bias because nicer people are more likely to choose a DO school? That's even sillier.

Whatever it is it's there, I've noticed it and so have my classmates. I'm not saying that they are "nicer", it just seems to me that in general the DO physicians I've rotated with spend more time explaining things to the patients and making sure they understand what's going on. Just an observation I've made this year, nothing more.

I see a one year OMM 'fellowship' with a large helping of cranial in your future. Godspeed.

Sorry dude, it'll take a while for you before the Kool-Aid wears off.

...

I don't understand your point. What does someone's headache resolving have to do with anything?

...

I've personally treated friends for nausea, headaches, and congestion with the essence of testicle, the nectar of yak urine, and manipulation of spiritual axis and had excellent results.

...

That's not Kool-Aid. That's faith/religion.

I was just giving you an example where I've seen cranial do some good. And again you start with the mocking and belittling. I could give two ****s if you like OMT, use it, or even care about it. No skin off my back if you do or not. I think you were taught some pretty powerful diagnostic skills if your OMT department was half as good as ours is and it would be a shame not to use every tool that you can to help patients heal faster. Everything has it's time and place though. And trying to do manipulations on a STEMI who is coming into the ED is not the right time. We're on the same page there.

The whole reason I brought it up to begin with was because we have some good techniques that can sometimes help people with back pain and other musculoskeletal pain instead of taking NSAIDs or other drugs. Why is that a bad thing? Why not give them some meds to help with acute inflammation and pain and then use some OMT or send them to someone who practices OMT in an outpatient clinic to see if they can help them from developing chronic problems?

nope.

Care to educate me then?

One is handholding and nodding, the other is OMM. They are not the same, but you, as the self-appointed expert of OMM, seems not to be able to discern the difference.

I never claimed to be an expert. I know I'm not. I'm just trying to have a discussion with you about the value of OMT as a treatment modality. I like using it because I've seen it work and I'll continue to use it when I deem appropriate with certain patients. I like being able to take someone who is in pain and using counterstrain on a few points have them get up from the bed and be pain free. I'm still going to write them a script if they need it for pain meds but just tell them to hold on to it and don't fill it unless they need it. Even if what I do just helps shorten the duration of the disease by 24-48 hours, isn't that worth it?

Something I don't understand ... Hmmm, last I checked, I passed all three COMLEX exams. How about you?

👍 Congratulations, seriously. And no, I have not yet. I'm taking step 2 in a month. I wish I was done with all the ridiculous tests though. I wasn't trying to say that you don't know anything about OMT and if it was taken that way, I apologize. You had plenty of it in the first 2 years of school.

But, just because you were tested on something doesn't mean you understand it or how it works. You can memorize tables and charts and facts and powerpoints and do just fine on standardized multiple choice exams. 75% of my class could care less about cranial and how it works. They did what they had to do to get through the exams and went on about their lives. A few more are interested in it but just can't seem to get it, and a few others can actually use it. It takes time to practice and hone your skills which most medical students have none of.

It doesn't seem like you think OMT is worthwhile. That's cool, no one is forcing you to use it. I can see its utilities and will try to use it like I described above when it is appropriate. I've helped out handfuls of nurses and doctors (as well as patients) and if thats as far as I take it so be it. Like I said in a previous post, I'm still new at this. I'm drinking my kool-aid, it's purple flavor, and it is delicious. I'll continue to do so until I'm shown the light and the error in my ways. I'm interested to see this fall if I can manage to incorporate any thoughts of OMT into my EM rotations at all.

 

[oldiebutgoodie]

The pain scale is another example of how we've let our dereliction of duty as the healthcare leaders lead to medicine being driven by nursing protocols. The Joint Commission and management of most hospitals seems driven by nursing people (who are often unscientific), which leads to our ridiculous "fall risk assessment", "home safety", "pneumovax" and other waste of time nonsense that we do in the ED.

Well, most nurses HATE the pain scale (I'm sorry, you can't be a 10 because you are eating Cheetos), as well as the other nonsense. It's Joint Commission nurses, who apparently never worked in a hospital who dream this c*** up/

Oldiebutgoodie

 

[oldiebutgoodie]

About a month ago I hurt my back moving, and took some Ibuprofen, the pain was completely gone, and i finished moving without issues.

I tried explaining that to a patient the other day, she laughed in my face while demanding some Percs.

It's hard to be sympathetic to a patient's pain/discomfort/general whining when I worked through chemo and radiation. Not that I am a wonderful stoic person, but staying home watching daytime television was just too awful. Maybe drug seekers just need to go out and rake leaves or something, then they'd be too tired to whine.

I know, very politically incorrect.

 

[Katydid]

I hear ya, oldiebutgoodie. I was in pain when I had the kidney stone....and went to work anyway. In retrospect, I should have stayed home, considering I was actively trying not to vomit, and keep myself from drawing my right knee to my chest the whole time, but I still went to work. And worked a full shift.

When I had my last sinus infection? I went to work. Spent the night at the ED because I had chest pains that turned out to be a massive panic attack (lots and lots of stress in my life right now)? Went to work the next day.

The upside of this is that I know that if I'm not getting any relief when I take a couple of ibuprofen (and still going about my life, thanks), then something is probably wrong.

The downside is that my family seriously freaks out if Mom announces that she's in pain, because when I have made that announcement, bad things have happened.

But, that means when I am at work, and we see the drug-seekers who have been doctor shopping, I get annoyed. Seriously, you think popping a pill is going to fix what ails you? I think not.

 

[WilcoWorld]

I recently developed back spasms in the middle of my shift that almost doubled me over. I sat down, popped 600mg of ibuprofen and finished my shift while hobbling in and out of patient rooms with one hand on my L spine at all times.

One patient's boyfriend asked for a work note for that day AND the next because it had been so draining to bring his girlfriend to the ED.

 

[ccfccp]

I recently developed back spasms in the middle of my shift that almost doubled me over. I sat down, popped 600mg of ibuprofen and finished my shift while hobbling in and out of patient rooms with one hand on my L spine at all times.

One patient's boyfriend asked for a work note for that day AND the next because it had been so draining to bring his girlfriend to the ED.

Depending on the girlfriend, I might have written that note. I can remember a couple (or more...)🙄

 

[WilcoWorld]

Touche!

 

[tonem]

A 60+ year old rancher restored my faith in humanity last year when he came in as a trauma after being attacked by a bull. He had multiple rib fractures, a tibial plateau fracture and I can't remember what else but when I asked him if he wanted anything for pain he said, "I could sure use some tylenol."

 

[alreadylernd]

A 60+ year old rancher restored my faith in humanity last year when he came in as a trauma after being attacked by a bull. He had multiple rib fractures, a tibial plateau fracture and I can't remember what else but when I asked him if he wanted anything for pain he said, "I could sure use some tylenol."

I had a similar patient - one of my favorite stories, a 50-60 year old guy comes in with an open mid-shaft tibia fracture. I go into the room while the nurse is completing her triage form and asks him what his pain level is. He thinks about it for a few seconds then says, "6 or 7." I mentioned to the nurse how we're going to "agressively treat that 7" while right next door to him was the twenty-something year old with 12-out-of-10 abdominal pain eating dorritos.

 

[PMPMD]

This thread is bringing back bad memories from pain clinic. Such as, people who had been uptitrated to several hundred mgs of OxyContin daily, PLUS breakthrough doses for back pain. AKA an intubating dose for a horse. Due to the phenomenon of opioid-induced hyperagesia, they were still in pain. I think using opioids for chronic nonmalignant pain, especially mechanical back pain, is a travesty. I am thankful for pain practices who refuse to write for opioids in this setting.

 

[EctopicFetus]

I dont take pills of any sort really but this last winter I was amazed..

I took vicodin after a scaphoid fracture and felt like I drank 2 gallons of vodka (from experience).. that was horrid.

Percocet for ankle fracture made me sleep..

So back to the magic med.. Ibuprofen.. i was at work with body aches like I havent had since playing organized football. The nurses saw I looked ill (probably the flu) and checked my temp.. 103.. I took 800 mg advil and felt like a new person.. truly an amazing med..