pain control admissions

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RevEM

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When do pts get admitted for pain control? Specifically, backpain, but any pain in general.

I had a pt with low back pain after camping on an airmattress and lifting her 35 pound little kid. she is set up for "an injection" for her chronic back pain in 2 days but came to the ER so she could be admitted for her pain and get some rest (she has 3 kids she tells me) and get the shot sooner. Completely normal neuro exam. In fact, I met her while she was walking back from the bathroom. She looked uncomfortable but ambulating.
When I started the conversation about trying pain control measures first she said she didn't want to be knocked out by meds (she takes 2 percs every 6 hrs for the last 6+ months for chronic pain). Then she starts crying and said the last time she was here they admitted her for this same thing.
So the attending sent her home this time but she was not happy.
When is admitting for pain control appropriate because she was admitted last time which made our job really hard this time around.
thanks for any input,
Rev
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RevEM said:
When do pts get admitted for pain control? Specifically, backpain, but any pain in general.

I had a pt with low back pain after camping on an airmattress and lifting her 35 pound little kid. she is set up for "an injection" for her chronic back pain in 2 days but came to the ER so she could be admitted for her pain and get some rest (she has 3 kids she tells me) and get the shot sooner. Completely normal neuro exam. In fact, I met her while she was walking back from the bathroom. She looked uncomfortable but ambulating.
When I started the conversation about trying pain control measures first she said she didn't want to be knocked out by meds (she takes 2 percs every 6 hrs for the last 6+ months for chronic pain). Then she starts crying and said the last time she was here they admitted her for this same thing.
So the attending sent her home this time but she was not happy.
When is admitting for pain control appropriate because she was admitted last time which made our job really hard this time around.
thanks for any input,
Rev
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If you can document that they are up walking and able to carry out their ADLs then admission is not appropriate. If all they can do is lay in bed and can't move or get out of bed, then it might be reasonable, though people legitimately in this much back pain are rare.
 
GeneralVeers said:
If you can document that they are up walking and able to carry out their ADLs then admission is not appropriate. If all they can do is lay in bed and can't move or get out of bed, then it might be reasonable, though people legitimately in this much back pain are rare.
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She's got a chronic pain condition with an acute exacerbation. With chronic pain, the whole goal is functionality. Being admitted into the hospital is about as low-functioning as you can get. While it may feel better to get put into a narcotic haze and have no responsibilities, in the long term this is highly maladaptive. For reasons I don't entirely understand, our chronic pain patients are almost exclusively gastroparetics and most have developed into organisms without the ability to care for themselves outside of a hospital setting. Even when their symptoms are well controlled in the hospital on oral medications, they come back within 1-5 days of d/c to be re-admitted like clockwork. I'm not saying that putting a patient in acute intractable pain into the hospital is going to automatically create a drug-seeking troll, but you have to think about whether admitting a patient with a chronic condition for which hospitalization may harm the patient (they miss their injection, their chronic meds (neurontin, TCAs, SSRIs) aren't continued, or their pain doc doesn't come to the hospital) is in the patient's best interests.
 
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We have a huge cadre of bogus "gastroparesis" patients in Vegas too. Huge. It's all actually narcotic addiction and acute withdrawals but they know the game.

I have started to admit more and more chronic pain, "I want a Dilaudid holiday." patients. I had a complaint from one who I sent home and my administration crucified me so **** 'em.

"Yes sir! Yes sir. 8 mg you say? Right away sir. Please remember to give me high marks on your customer satisfaction survey sir. Is there any thing else sir? Benadryl sir? Absolutely sir. Wouldn't want you to get itchy while you enjoy your Dilaudid sir. Now then can I **** your **** or is the only sucking here going to be you on my soul?"
 
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docB said:
We have a huge cadre of bogus "gastroparesis" patients in Vegas too. Huge. It's all actually narcotic addiction and acute withdrawals but they know the game.

I have started to admit more and more chronic pain, "I want a Dilaudid holiday." patients. I had a complaint from one who I sent home and my administration crucified me so **** 'em.

"Yes sir! Yes sir. 8 mg you say? Right away sir. Please remember to give me high marks on your customer satisfaction survey sir. Is there any thing else sir? Benadryl sir? Absolutely sir. Wouldn't want you to get itchy while you enjoy your Dilaudid sir. Now then can I **** your **** or is the only sucking here going to be you on my soul?"
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How many of your gastroparesis patients don't have DM? I'm sure that's not the only cause, but there are 2 or 3 patients with no comorbidities who are in 2-3x/month for "gastroparesis". I'm starting to feel about it like I used to feel about all the chronic pancreatitis patients with a "burned-out" pancrease (so their enzymes were never bumped) but a normal blood sugar.
 
Doc B, we get all the same patients as you and the only thing that helps their "nausea" is rapid IV Push Dilaudid. If you really want to piss the patients off, admit them, then write for pain meds as follows: Dilaudid 1 mg in 100 ml NS run IV over 15 min. Repeat Q4h prn pain.

Nothing reveals a true drug seeker like one who starts screaming and complaining that their meds aren't pushed fast enough.
 
GeneralVeers said:
Doc B, we get all the same patients as you and the only thing that helps their "nausea" is rapid IV Push Dilaudid. If you really want to piss the patients off, admit them, then write for pain meds as follows: Dilaudid 1 mg in 100 ml NS run IV over 15 min. Repeat Q4h prn pain.

Nothing reveals a true drug seeker like one who starts screaming and complaining that their meds aren't pushed fast enough.
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That's the problem. I can't piss them off or I'm hosed.

As you know our bs gastroparesis population here is really difficult. They really can't tolerate po until they get their fix. They really do have Ks of 2.0 and ketones in their urine. And no amount of Zofran, Phenergan or clonidine+bentyl+ativan will get them to quit. And none of them have any veins left.

But the fact that administrators listen to the complaints of these people just signifies the final death roll of the profession.
 
docB said:
That's the problem. I can't piss them off or I'm hosed.

As you know our bs gastroparesis population here is really difficult. They really can't tolerate po until they get their fix. They really do have Ks of 2.0 and ketones in their urine. And no amount of Zofran, Phenergan or clonidine+bentyl+ativan will get them to quit. And none of them have any veins left.

But the fact that administrators listen to the complaints of these people just signifies the final death roll of the profession.
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Our admin is similar, though maybe not quite as militant about it. Why hospitals would want these losers to come back is beyond me.
 
I sort of thought that the greater Philadelphia area was the epicenter of idiopathic gastroparesis and cyclic vomiting...I've come to like haldol for its antiemetic/antimoaning capabilities with these patients. Probably won't be as popular when I work in a more customer service position. Oh well, I'll enjoy it while I can :)
 
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we started using PR dilaudid 3mg suppositories for our chronic pain patients who are so 'nauseated' that they can't take anything. nothing shuts them up faster than a suppository where the sun don't shine. many of our pcp's support this as well.

we've got a fairly well developed 'advisory' system where we tag the frequent flyers, involve their pcp's and get them on a protocol which includes no rx's on d/c, pr dilauded instead of parenteral dilaudid, etc. works like a charm.
 
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Greenbbs said:
we started using PR dilaudid 3mg suppositories for our chronic pain patients who are so 'nauseated' that they can't take anything. nothing shuts them up faster than a suppository where the sun don't shine. many of our pcp's support this as well.

we've got a fairly well developed 'advisory' system where we tag the frequent flyers, involve their pcp's and get them on a protocol which includes no rx's on d/c, pr dilauded instead of parenteral dilaudid, etc. works like a charm.
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PR dilaudid is brilliant.

I once had a chronic gastroparesis pt who had been stuck so many times, that there was absolutely no access any more (even the PICC team tried and failed). She was dehydrated and demanding admission, dilaudid, and phenergan. So, I put in an IO into her tibia.

I hoped it would deter her from future returns, but alas, it didn't.
 
name? said:
I sort of thought that the greater Philadelphia area was the epicenter of idiopathic gastroparesis and cyclic vomiting...I've come to like haldol for its antiemetic/antimoaning capabilities with these patients. Probably won't be as popular when I work in a more customer service position. Oh well, I'll enjoy it while I can :)
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Droperidol works better. It also starts with a D, so you can get away with it a little easier. And if you have a less than intelligent nurse, droperidol is actually for nausea, so when they tell them what it is for, they don't all pissed off like they do when the nurse says it is a psych drug.
 
Droperidol is the magical wonder drug.

Works for my fibromyalgia-type pain patients, too.

In Australia, some people chemically restrain their psych patients with 10mg IM droperidol. Lovely study of 10mg IM droperidol vs. 10mg IM midazolam vs. 5/5 of each - and midazolam alone loses.

That being said, I use 1.25mg IV or 2.5mg IM in routine use.
 
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Interesting seeing all the various strategies in dealing with this unsavory pt population... At our institution, we have a "3 round then admit" policy where they will get 3 rounds of pain meds and if they are still in pain, admission for intractable pain/nausea. This goes for both the sicklers and the gastroparetics. Sometimes, it feels like the path of least resistance because I can write the narcs for q30 min repeat, and have many of them out the door (reasonably) quickly, but then they are right back to the ED in 2-3 days. We have tried stadol for the gastroparetics which apparently works on a different opioid receptor, one that doesn't decrease gastric motility, but the seekers hate it and now have stadol on all their allergy lists. PR Dilaudid sounds intriguing. These pt's eat up so many resources, it's horrible. We facilitate turning these pt's into drug addicts. They'll wait for hours and even overnight in the waiting room to get their "fix". They know we can't send them out with 10/10 pain or without treating their pain, and they'll be the first to call the hotline or file complaints if they don't get their narcs.
 
...only with SCC patients. Otherwise they all go home. At my private hospital they ALL go home, I have never admitted for chronic pain.

About 3 years ago it was rampant in the county and it was pretty much entirely BS. So one of our neighboring ED's stopped prescribing narcotics at all, and we stopped playing the "I need X narcotic" games.

Once you have admins support after about a year it is REALLY nice not having to deal with that crap.

Once in a blue moon someone may come in and get one perc PO, but then it's "I'm sorry sir, but this is a chronic condition, in fact "Chronic" is the exact antithesis of "EMERGENCY" I can get you something while you are here, but I can't write you for any scripts, and I can't give you anything IV...."

Now we have very little "chronic pain" people, we have two clinics in town that they can see, but it is well known through the community that we don't give narcs, wheather IV or Rx.

Lastly, having the state DEA prescription database is great. You basically can print out every controlled substance, where it was prescribed, filled, how much and who wrote it.

Its a lot easier to go into a room and say, "Mr. Smith, you had over 10 prescriptions over the last month from 10 providers at 10 different hospitals. I'm sorry but I'm not going to be able to do much for you as it seems that you may have a chronic pain type issue that needs to be handled by regular doctor, or a pain specialist"....

To be honest, 90% of them don't have a huge issue with it, and in the end its what is BEST for the patient from a medical standpoint.

Lastly, I'm not sure that you (in a non-judgemental way) are living up to the "do no harm" which is so important to our profession when we dole out addicting meds over and over again to people that obviously have a problem (all PRC crap aside).
 
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TC has the right idea - my preferred mindset for prescribing narcotics is the harm aspect. Sure, we have a duty to treat pain and alleviate suffering. Luckily, we don't have so many frequent fix seekers that I have to vary my practice significantly from patient to patient, and I can generally give as strong a medication as I need to get people out of pain.

As far as Rx goes, I have no problem giving people zero to go home with because I am concerned that they are doing harm to themselves with narcotic dependence, or because I am concerned about harms to society by narcotic diversion. But, I just wrote a stage IV metastatic cancer patient for forty 80mg oxycontin because they'd screwed with her chronic pain regimen and it wasn't working - so I gave her a decent supply and reserve until it could be remedied. Hard and fast rules don't work, but you can be very conservative with your prescriptions without being heartless.
 
...agreed. I should clarify my above is for chronic pain patients without diagnosed etiology (e.g. back pain, pelvic pain, migraine, DGP etc.)

....I'm definitely on board with metastatic CA patients getting whatever they need to be comfortable.

As far as DC Rx's, I was the same as Xealea, except for a month ago we had a family that was diverting the patients meds (selling them). So I'm a little more strict with the DC Rx's and make sure there is coordination with the palliative care team.

....scum of earth = stealing moms cancer pain meds and selling them while she cries in pain :mad:
 
X mentions the stage IV Ca patient. That patient has objective findings, unequivocal. Likewise, as I told my boss, the only headaches that get narcs from me are fractures and tumors.

In my tropical, community practice, in my experience, the vast majority (with only 1 patient who wasn't) of the chronic pain/seekers are white mainlanders. I do not see these gastroparetics, and, if I did, I would probably go nuts.

I haven't admitted a patient for pain since I was an EM-1; 8 years later, through the retrospectoscope, I would not have admitted that patient.
 
Anyone else see the "Sphincter of Odi Spasm" patients? This is all the rage in my area and has replaced "Cyclic Vomiting Syndrome" as the BS diagnosis of choice. Like CVS, it has no objective findings, no tests, and can only be treated with massive infusions of IV Dilaudid.

One thing people may want to note is that typically Press-Ganey surveys are not sent to people who have an ER visit within the last 60 days. That generally excludes most frequent fliers from getting a survey.
 
How can you guys work at places where the administration takes the side of drug seekers? I can only imagine how bizarre and frustrating these conversations must be.

Also, it's not as if treating these chronic pain patients is a benign endeavor. Doing such only further creates dependency and provides incentive against getting clean. Chronic pain is not the domain of the ER and we are doing a great disservice by perpetuating this behavior.
 
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The only "emergent" part of the gastroparetic pt's is the fact that they know all the right key phrases and the "pain and nausea" are intractable, and they all claim they can't keep anything down. So, you can't send them out if they can't tolerate PO intake and claim their pain is 10/10. It's like we've got our balls in a vice by these people. I walked in not long ago to a girl with half her hand rammed down her throat trying to make herself vomit. The really good ones can do this on command. Meanwhile, you've got the GI docs all loving this diagnosis so they can place 2-3 gastric pacers that never seem to ever work and make more money by having these pt's referred to them, though they refuse to treat their chronic pain "adequately" because they always just come right back to us. I'm not denying there's some element of GP that's real, I'm well aware of the motility studies, blah blah, but c'mon... From my mentors, you just didn't see this type of stuff 10-20 years ago where they show up in the ED every few days for their dilaudid fix and rug length rolled up list of medication allergies. I really hate dealing with these people.

Oh, the Press Ganey thing for frequent fliers is valuable info, I didn't know that.

The only good thing about them is that I can typically get them admitted very easily with little pushback from the medicine residents (Academic center) because they all love easy admissions that let them cap out early and they know they can push out fairly quickly and will not still be on their pt census list by next call.
 
I read the comment about Gastroparesis Patients being Losers...sorry; but, I am a Gastroparesis Sufferer and want nothing more but my life back...so I had to share an article I wrote after reading what I read here. I am currently trying to get it published...I truly wish doctors would take more interest in trying to understand what we go through...you have no idea...I was suicidal my first year, because the thought of spending the next 30 years living this way was unbearable and more than I could stand the thought of...please, please do your research before you judge us...I am 11 years in and so very tired...thank you for taking the time to read my article...
 

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Gastrolady said:
I read the comment about Gastroparesis Patients being Losers...sorry; but, I am a Gastroparesis Sufferer and want nothing more but my life back...so I had to share an article I wrote after reading what I read here. I am currently trying to get it published...I truly wish doctors would take more interest in trying to understand what we go through...you have no idea...I was suicidal my first year, because the thought of spending the next 30 years living this way was unbearable and more than I could stand the thought of...please, please do your research before you judge us...I am 11 years in and so very tired...thank you for taking the time to read my article...
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UpYR4Mi.jpg
 
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Gastrolady said:
I read the comment about Gastroparesis Patients being Losers...sorry; but, I am a Gastroparesis Sufferer and want nothing more but my life back...so I had to share an article I wrote after reading what I read here. I am currently trying to get it published...I truly wish doctors would take more interest in trying to understand what we go through...you have no idea...I was suicidal my first year, because the thought of spending the next 30 years living this way was unbearable and more than I could stand the thought of...please, please do your research before you judge us...I am 11 years in and so very tired...thank you for taking the time to read my article...
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I'm sorry, I know I'm just giving food to the troll, but that article was terrible.
 
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Gastrolady said:
I read the comment about Gastroparesis Patients being Losers...sorry; but, I am a Gastroparesis Sufferer and want nothing more but my life back...so I had to share an article I wrote after reading what I read here. I am currently trying to get it published...I truly wish doctors would take more interest in trying to understand what we go through...you have no idea...I was suicidal my first year, because the thought of spending the next 30 years living this way was unbearable and more than I could stand the thought of...please, please do your research before you judge us...I am 11 years in and so very tired...thank you for taking the time to read my article...
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Blah, blah, blah.
 
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This most recent post flare up is the reason why I think that the psych patients often have more insight than the ones checking in for medical symptoms for which no etiology can be found. At least they're aware of their illness ....
 
Gastrolady said:
I read the comment about Gastroparesis Patients being Losers...sorry; but, I am a Gastroparesis Sufferer and want nothing more but my life back...so I had to share an article I wrote after reading what I read here. I am currently trying to get it published...I truly wish doctors would take more interest in trying to understand what we go through...you have no idea...I was suicidal my first year, because the thought of spending the next 30 years living this way was unbearable and more than I could stand the thought of...please, please do your research before you judge us...I am 11 years in and so very tired...thank you for taking the time to read my article...
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I am sorry that you suffer from a condition that I have very little power to help. Unfortunately, many of the things that make you feel better temporarily actually make you worse in the long run.

Interestingly, just yesterday, the CDC (arguably the country's most respected authority on matters of health) recommended that opiates not be used to treat chronic pain outside the realm of terminal cancer.

I do not want you to suffer needlessly, but it is becoming increasingly clear that treating conditions such as yours with opiates is hurting, rather than helping, you.
 
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Tricyclics, gabapentin, exercise, CBT. All have been proven to improve quality of life in chronic pain. Opioids haven't and they have a host of side effects when used chronically that are not widely reported. Sure there's a drug for opioid-induced constipation but what about opioid hyperalgesia? Not to mention development of tolerance that greatly increases risks of accidental ODs for patient as well as greatly increasing accidental (and sometimes fatal) ingestions in household members, especially toddlers.

Specifically for gastroparesis, the drugs we use to control symptoms tend to be ineffective and hospitalizing someone for a goal (symptom control) that being in the hospital is not going to help makes the patient less functional. It also reinforces the message that this is an acute flare-up that should be treated with band-aid meds rather than pushing a patient down the path of appropriate f/u, testing for underlying causes, and comprehensive management. If the 3mg of dilaudid the patient received in the ED didn't improve the pain at all, is admitting someone to receive more IV opioids a rational move?

To the resurrectionist,
I'm sorry that you have a condition that has such a negative effect on your life. If there was an effective treatment that I had available, I would give it to you immediately and feel great that I was able to "fix" things. Gastroparesis, fibromyalgia, reflex sympathetic dystrophy, etc. are beyond the scope of my ability to fix. As mentioned above, due to a variety of factors, patients with these conditions are using the ED for symptom relief in lieu of obtaining appropriate outpatient care. I don't despise or look down on patients with these conditions, but my sympathy doesn't change the fact that I have essentially nothing to offer them. It's not uncommon that flare-ups are tied to psychosocial stressors or loss of ability to maintain previously effective regimen. Unfortunately I have neither the time to be an effective therapist nor the resources to reinstitute lost insurance, guaranteed timely outpatient follow-up, etc. I can admit you to the hospital for hydration, typically with minimal relief of symptoms until the flare runs its course. Being hospitalized won't get you outpatient follow-up, it doesn't plug you in with a therapist to improve coping skills, etc. I follow my patients' progress upstairs and they're not getting gastric pacemakers, multimodal pain regimens, etc. When I have an department full of patients waiting to go upstairs that I know will benefit from hospitalization, this option becomes problematic from an ethical standpoint.
 
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I love that the CDC has new recommendations for opioids. They should not be used for chronic pain, and if used for an acute condition, should be prescribed for no longer than 3 days. I've definitely stopped giving out narcotics for ANY chronic pain, including back pain, sciatica, gastroparesis, fibromyalgia, and migaines. The case is closed on opioids. They have no benefit whatsoever on these patients, and cause long-term morbidity and mortality. Now that we have the CDC guidelines, our correct decision not to administer opioids is completely defensible to hospital administration, other physicians, lawyers, and the patients themselves.

Press-Ganey be damned, we have to do what is right for the patient, even if it makes them unhappy.
 
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GeneralVeers said:
I love that the CDC has new recommendations for opioids. They should not be used for chronic pain, and if used for an acute condition, should be prescribed for no longer than 3 days. I've definitely stopped giving out narcotics for ANY chronic pain, including back pain, sciatica, gastroparesis, fibromyalgia, and migaines. The case is closed on opioids. They have no benefit whatsoever on these patients, and cause long-term morbidity and mortality. Now that we have the CDC guidelines, our correct decision not to administer opioids is completely defensible to hospital administration, other physicians, lawyers, and the patients themselves.

Press-Ganey be damned, we have to do what is right for the patient, even if it makes them unhappy.
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I shed a small tear when I saw those guidelines. My wife deals with a lot of chronic pain patients and she'd been preaching a message very similar to these guidelines for years.
 
WilcoWorld said:
I am sorry that you suffer from a condition that I have very little power to help. Unfortunately, many of the things that make you feel better temporarily actually make you worse in the long run.
Interestingly, just yesterday, the CDC (arguably the country's most respected authority on matters of health) recommended that opiates not be used to treat chronic pain outside the realm of terminal cancer.

I do not want you to suffer needlessly, but it is becoming increasingly clear that treating conditions such as yours with opiates is hurting, rather than helping, you.
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Having read some of the comments from seemingly distraught patients (with chronic conditions) on this forum, it seems like the common factor is the perception that judgment (being a drug seeker) from ER doctors comes too quickly when temporary relief from an acute exacerbation is sought.

The hesitation in ERs, at least in my experience, is SOMETIMES being categorized as one with "chronic condition" so the doctor immediately assumes they know why you're really there and who you are so the visit starts rather oddly.

And while chronic conditions can and should be managed outpatient, there are situations that result in ER visits. Sometimes symptoms can become too severe even when you have consistent outpatient care and regulated treatment.

So, for me, going to the ER during such times is a simple attempt to feel better so I can get back to my life rather than it being a crutch. The best thing to do is go get checked out, get the fluids, get my pancreas to shut up and get antiemetics instead of getting so dehydrated that I pass out or have kidney issues or end up with acute pancreatitis complications (all have happened).

@Gastrolady, I understand the overall sentiment in terms of sometimes being pigeon-holed when seeking care. However, I agree with most of the thread that opiates are counterproductive in gastroparesis. When I get AP attacks and go to ER, I usually settle for the relief I get from the antiemetic doses. They don't take the pain away but they make it tolerable and that's what counts. Basically, I try to avoid opiates at all costs. It's not because I am not in pain (AP hurts like hell) but it is because the risks outweigh the benefits. I don't think my GIs hated me or didn't understand when they informed me about gastroparesis, hyperalgesia etc. years ago or when we made that decision to only use opiates for surgery/"kill me now" pain - I think they considered my quality of life (I do not want to be a zombie) and most importantly, the impact on my health at the time and in the future.

Everyone is different but as patients I believe that we have to be responsible for our health. Gastroparesis = slow motility. Opiates = gastroparesis. You are in pain but clearly, opiates are not the answer. They are a contributing factor to your condition...who knows, you may improve if they are no longer part of the equation. You seem eager to get better, why not talk to your doctor and try off the opiates for the sake of your health? And you have been through this for 11years so I am sure you know that there are other meds and lifestyle modifications that can help. I do hope your luck at the ER changes in terms of getting severe flareups under control.
 
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If someone is vomiting to the point they can't take any fluids and are going to get themselves severely dehydrated, I'll give them a round or two of opiates if antiemetics don't work. I can't send home someone who can't keep down water, and I'd rather give some Dilaudid than use up an inpatient bed.
 
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gotname said:
Having read some of the comments from seemingly distraught patients (with chronic conditions) on this forum, it seems like the common factor is the perception that judgment (being a drug seeker) from ER doctors comes too quickly when temporary relief from an acute exacerbation is sought.

The hesitation in ERs, at least in my experience, is SOMETIMES being categorized as one with "chronic condition" so the doctor immediately assumes they know why you're really there and who you are so the visit starts rather oddly.

And while chronic conditions can and should be managed outpatient, there are situations that result in ER visits. Sometimes symptoms can become too severe even when you have consistent outpatient care and regulated treatment.

So, for me, going to the ER during such times is a simple attempt to feel better so I can get back to my life rather than it being a crutch. The best thing to do is go get checked out, get the fluids, get my pancreas to shut up and get antiemetics instead of getting so dehydrated that I pass out or have kidney issues or end up with acute pancreatitis complications (all have happened).

@Gastrolady, I understand the overall sentiment in terms of sometimes being pigeon-holed when seeking care. However, I agree with most of the thread that opiates are counterproductive in gastroparesis. When I get AP attacks and go to ER, I usually settle for the relief I get from the antiemetic doses. They don't take the pain away but they make it tolerable and that's what counts. Basically, I try to avoid opiates at all costs. It's not because I am not in pain (AP hurts like hell) but it is because the risks outweigh the benefits. I don't think my GIs hated me or didn't understand when they informed me about gastroparesis, hyperalgesia etc. years ago or when we made that decision to only use opiates for surgery/"kill me now" pain - I think they considered my quality of life (I do not want to be a zombie) and most importantly, the impact on my health at the time and in the future.

Everyone is different but as patients I believe that we have to be responsible for our health. Gastroparesis = slow motility. Opiates = gastroparesis. You are in pain but clearly, opiates are not the answer. They are a contributing factor to your condition...who knows, you may improve if they are no longer part of the equation. You seem eager to get better, why not talk to your doctor and try off the opiates for the sake of your health? And you have been through this for 11years so I am sure you know that there are other meds and lifestyle modifications that can help. I do hope your luck at the ER changes in terms of getting severe flareups under control.
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Fwiw, acute pancreatitis is a different beast then gastroparesis, fibro, etc. There's definitely a subset of patients with chronic epigastric pain and vomiting that have been inappropriately diagnosed as pancreatitis due to a mildly elevated lipase level during one of their flares. For the rest, aggressive IV hydration +/- complete bowel rest are believed to modify the disease course in a way we don't see with these other conditions.
 
I very, very rarely admit for pain. It's usually a weak admit in my opinion.
 
Hearing the way you all have talked about gastroparesis makes me want to just give up. How completely deplorable that you talk about a disease you clearly don't understand this way. I suffer DAILY! I'm up right now since 4am pooping my brains out. And this is just a normal morning. I'll have you know I ONLY go to the ER when I have been vomiting for hours-a day. I've tried it all at home (zofran, phenergan, pain meds). When you can't keep the meds down, and your body is clenching up with dehydration, what are we supposed to do?! Sit at home and die so we don't inconvenience you and your opioid conscious?? I am truly DISGUSTED!! Basically what I took from this article is we should just go ahead and kill ourselves because you have us labeled and refuse to help us; because junkies are using our disease, and you aren't good enough at your job to tell us apart! This judgmental "everyone is a drug seeker" BS had got to stop!! If you don't know and understand enough diseases to help people, go back to school or STOP practicing medicine. You have become hardened, cynical dinguses and I for one don't deserve your judgment and hate when I'm at my weakest!! I will remember this is how you talk about us, and during my next flare, I won't go to the ER. I will just stay home and die
 
I'll admit for ureteral colic, if it's been a while and stone hasn't passed and the patients pain hasn't been controlled with mess


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REALgastropatient said:
Hearing the way you all have talked about gastroparesis makes me want to just give up. How completely deplorable that you talk about a disease you clearly don't understand this way. I suffer DAILY! I'm up right now since 4am pooping my brains out. And this is just a normal morning. I'll have you know I ONLY go to the ER when I have been vomiting for hours-a day. I've tried it all at home (zofran, phenergan, pain meds). When you can't keep the meds down, and your body is clenching up with dehydration, what are we supposed to do?! Sit at home and die so we don't inconvenience you and your opioid conscious?? I am truly DISGUSTED!! Basically what I took from this article is we should just go ahead and kill ourselves because you have us labeled and refuse to help us; because junkies are using our disease, and you aren't good enough at your job to tell us apart! This judgmental "everyone is a drug seeker" BS had got to stop!! If you don't know and understand enough diseases to help people, go back to school or STOP practicing medicine. You have become hardened, cynical dinguses and I for one don't deserve your judgment and hate when I'm at my weakest!! I will remember this is how you talk about us, and during my next flare, I won't go to the ER. I will just stay home and die
Click to expand...
Apparently you missed everything discussed above about how opoids don't actually help anything, and cause long-term harm.
 
REALgastropatient said:
Hearing the way you all have talked about gastroparesis makes me want to just give up. How completely deplorable that you talk about a disease you clearly don't understand this way. I suffer DAILY! I'm up right now since 4am pooping my brains out. And this is just a normal morning. I'll have you know I ONLY go to the ER when I have been vomiting for hours-a day. I've tried it all at home (zofran, phenergan, pain meds). When you can't keep the meds down, and your body is clenching up with dehydration, what are we supposed to do?! Sit at home and die so we don't inconvenience you and your opioid conscious?? I am truly DISGUSTED!! Basically what I took from this article is we should just go ahead and kill ourselves because you have us labeled and refuse to help us; because junkies are using our disease, and you aren't good enough at your job to tell us apart! This judgmental "everyone is a drug seeker" BS had got to stop!! If you don't know and understand enough diseases to help people, go back to school or STOP practicing medicine. You have become hardened, cynical dinguses and I for one don't deserve your judgment and hate when I'm at my weakest!! I will remember this is how you talk about us, and during my next flare, I won't go to the ER. I will just stay home and die
Click to expand...

k
 
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REALgastropatient said:
Hearing the way you all have talked about gastroparesis makes me want to just give up. How completely deplorable that you talk about a disease you clearly don't understand this way. I suffer DAILY! I'm up right now since 4am pooping my brains out. And this is just a normal morning. I'll have you know I ONLY go to the ER when I have been vomiting for hours-a day. I've tried it all at home (zofran, phenergan, pain meds). When you can't keep the meds down, and your body is clenching up with dehydration, what are we supposed to do?! Sit at home and die so we don't inconvenience you and your opioid conscious?? I am truly DISGUSTED!! Basically what I took from this article is we should just go ahead and kill ourselves because you have us labeled and refuse to help us; because junkies are using our disease, and you aren't good enough at your job to tell us apart! This judgmental "everyone is a drug seeker" BS had got to stop!! If you don't know and understand enough diseases to help people, go back to school or STOP practicing medicine. You have become hardened, cynical dinguses and I for one don't deserve your judgment and hate when I'm at my weakest!! I will remember this is how you talk about us, and during my next flare, I won't go to the ER. I will just stay home and die
Click to expand...
Feel better?

Narcissistic... check
Borderline... check
 
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You all are disgusting. Truly. You don't know anything about me. Yet you feel you can talk this way about my health/mental health. And you are doctors?! I have no more questions about how the medical field had failed me. This forum has answered them all.
 
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theseeker4 said:
Apparently you missed everything discussed above about how opoids don't actually help anything, and cause long-term harm.
Click to expand...
I didn't miss anything. I read all your comments. I took myself off pain medications. In hopes it would help things long term. I use oils, I've changed my diet and entire life. And still, during a flare, IV pain meds PLUS, fluids and anti nausea meds are the quickest and most effective in getting a flare to stop. Did you all ask or just judge?! You are all so damn judgmental you seriously can't see past yourself. Just judge judge judge. I really wish you all could get a chronic illness for a few years. Have your lives flipped upside down and be treated the way you doctors treat us. Would be a real eye opener. Good luck "doctor".
 
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REALgastropatient said:
I didn't miss anything. I read all your comments. I took myself off pain medications. In hopes it would help things long term. I use oils, I've changed my diet and entire life. And still, during a flare, IV pain meds PLUS, fluids and anti nausea meds are the quickest and most effective in getting a flare to stop. Did you all ask or just judge?! You are all so damn judgmental you seriously can't see past yourself. Just judge judge judge. I really wish you all could get a chronic illness for a few years. Have your lives flipped upside down and be treated the way you doctors treat us. Would be a real eye opener. Good luck "doctor".
Click to expand...
Dude, just shut up. There are at least two of us here with rather profound chronic illness, and I am one of them. How many times have I been in the ED for it? NEVER. So, get off your high horse, and zip it. You would rather stay home and die? Go for it. You're disgusted? Go to another country, and get none of these meds. But do NOT come to a site for doctors - NOT patients - and tell us we suck. Or, if you do, we'll respond as we see fit. But you convince no one with your histrionics and "you don't understand" mentality. You would get appropriate care from me, but not my respect. But you wouldn't know that, because I would be cordial, and caring, and polite, and solicitous. But patients like you - who think you are unique - are not.
 
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