Chronic Painer Revenge Fantasy
Courtesy of Sean Conlon, a chronic pain sufferer in New York who used to be anonymously known as Redhawk but who now blogs under the pseudonym Payne Hertz. I won't link him, but with a little internet sleuthery you can find his whiny blog yourself, if you are so inclined. He thought I was on the wrong track with my pain scales, so he came up with this:
"This has led me to create my own pain scale, one which uses very objective criteria and which has the advantage of firmly establishing an objective, empirical baseline in the doctor's mind from which he can better understand and rate his patient's pain as well as measure its impact on the patient's life. Unfortunately, this scale only works with male doctors.
To use my scale, first grasp the doctor firmly by the lapels. Now, while simultaneously releasing a loud "Ki-Ai!" Karate shout, bring your knee vigorously into your doctor's testicles. While the doctor is on the ground writhing in agony and trying to catch his breath, explain to him "That's what level 10 feels like." After giving him a minute or so to regain his composure, kick him in the shins, telling him "that's what level 7 feels like." Now spin him around and give him a firm boot in the ass, and say "that's level five." Follow this up with a couple of slaps in the mouth, which will rate a "3." When you are done establishing these objective pain-rating baselines, bend over and give him a gentle pat on the back and say "that's level one."
Sean, I would love for you to try that out sometime. But my question for you is, if you are already at a "level 10" from your chronic mystery pain and someone were to hypothetically spray you in the eyes with pepper spray, stab you in the neck with a pencil, or break your elbow by vigorously hyperextending it, would that not bother you at all because you're already maxed out, or would your pain level go up to a 15 or so? Just wondering.
And I would also like to mention this excellent observation from girlvet, who recently posted:
"I have seen a couple of people get out of control when they didn't get their narcs. I read an article in emergency medicine magazine that takes about a doctors role in treated chronic pain in the emergency setting. What's fascinating about it is that the author says that 50% of chronic pain sufferers have personality disorders or affective disorders. I can vouch for that. They wear you out, the people who come in for chronic pain because they are people who are neurotic and difficult to work with. Antidepressants have been found to be very helpful in these people, along with psychological help. They seldom get it."
Indeed.
And if anyone reading this happens to work in an Emergency Department in New York and is unfortunate enough to come across this gentleman....you might want to guard your nuts.
"This has led me to create my own pain scale, one which uses very objective criteria and which has the advantage of firmly establishing an objective, empirical baseline in the doctor's mind from which he can better understand and rate his patient's pain as well as measure its impact on the patient's life. Unfortunately, this scale only works with male doctors.
To use my scale, first grasp the doctor firmly by the lapels. Now, while simultaneously releasing a loud "Ki-Ai!" Karate shout, bring your knee vigorously into your doctor's testicles. While the doctor is on the ground writhing in agony and trying to catch his breath, explain to him "That's what level 10 feels like." After giving him a minute or so to regain his composure, kick him in the shins, telling him "that's what level 7 feels like." Now spin him around and give him a firm boot in the ass, and say "that's level five." Follow this up with a couple of slaps in the mouth, which will rate a "3." When you are done establishing these objective pain-rating baselines, bend over and give him a gentle pat on the back and say "that's level one."
Sean, I would love for you to try that out sometime. But my question for you is, if you are already at a "level 10" from your chronic mystery pain and someone were to hypothetically spray you in the eyes with pepper spray, stab you in the neck with a pencil, or break your elbow by vigorously hyperextending it, would that not bother you at all because you're already maxed out, or would your pain level go up to a 15 or so? Just wondering.
And I would also like to mention this excellent observation from girlvet, who recently posted:
"I have seen a couple of people get out of control when they didn't get their narcs. I read an article in emergency medicine magazine that takes about a doctors role in treated chronic pain in the emergency setting. What's fascinating about it is that the author says that 50% of chronic pain sufferers have personality disorders or affective disorders. I can vouch for that. They wear you out, the people who come in for chronic pain because they are people who are neurotic and difficult to work with. Antidepressants have been found to be very helpful in these people, along with psychological help. They seldom get it."
Indeed.
And if anyone reading this happens to work in an Emergency Department in New York and is unfortunate enough to come across this gentleman....you might want to guard your nuts.
Labels: bad ideas, drug-seeking scumbags, pain, quotes, self defense
posted by scalpel at 9:09 AM
43 Comments:
Whenever I've been asked to do these pain scale thingy's, I've always been told to imagine 10 as the worst pain I've ever had. So that's what I do. Could that change? Of course. Pain changes. Is my scale different than someone else's? Definitely. Your scale gave higher ratings than I would have but that's probably because I'm used to dealing with pain everyday, and it has a different subjective meaning for me.
This is a great idea, except I don't know any ER docs who wear lapels. Rats.
It sounds to me like Sean is already a level 5 at baseline.
He's wrong Scalpel...kidney stone pain trumps all that. ;)
Good post!
I get really upset seeing comments from medical personel that someone who has a chronic pain condition has a personality disorder. I have endometriosis and adenomyosis. After the next baby, this uterus is coming out! However, until then I have to deal with the hand I was dealt. I didn't ask to get this. It took 2 years of me being very persistent to get the care that was needed. After 4 trips to the ER in 2 years, 2 laps, multiple workups, I finally was diagnosed with endometriosis and adenomyosis a few weeks ago by a pelvic pain specialist. If drs treated the patient's pain correctly maybe that person wouldn't be in the ER to begin with.
I know my obgyn undertreated my pain and my pcp and endo specialist agreed. By the time I saw my obgyn, the crisis was over because it would be a week later. My pcp saw me when it reoccurred last time in the office (She sent me to the ER thinking I had appendicitis). She told me that day from now on, if my ob wouldn't treat the pain, she would. She knew how much I hated to go to the ER for it. She said if I needed anything stronger to call her, there was other things she could give me (I have never taken her up on that offer). My ob only gave 15 Darvocet a month, which did NOTHING. My pcp worked out a pain management plan and all agree to it (pcp, endo specialist, and ob). I take 800mg motrin. If in an hour it doesn't work, I am to take a 5mg tablet of lortab. If that is still not working, I can take another tablet an hour later or if it is really bad I can go straight to the 10mg. I can take up to two 5mg tablets every 6 hours. This has worked well since May and I have not been in the ER for endo and adenomyosis. This is because it is being properly treated. However, if my ob had prescribed something more than Darvocet, I would have never have been in the ER in the first place. Thankfully, I had wonderful drs and nurses each time that treated the pain and didn't treat me like I was a low life drug seeker. It was one of those ER drs that talked me into asking my ob for the first lap. It was two others that talked to me when I relapsed and told me I needed the second lap because it was back.
You apparently are one of the 50% without a personality disorder then.
Good luck with your treatment.
I have a horrible memory, so please forgive if I've ever posted to your blog about this topic. I have Reflex Sympathetic Dystrophy; you can't see it on an x-ray, MRI, ultrasound or CT scan. Maybe, depending on whether the ostioparosis sets in, you can see it on a bone scan. It ranks quite high on the MCGill pain index.
I've not been to the ER for pain, because I doubt anyone would believe me. My pain clinic can manage things better anyway; they can tytrate lyrica, prescribe lidocaine patches, and in my case use narcotics appropriately and allow me to go to school. But I've had horrid flares before, and sometimes literally cannot eat. I always fear that the pain will either cause my heart rate to go crazy (which we suspect is happening), or the flare and the not eating due to nausea will cause some issue if I can't eat for long enough.
I've always wondered if I did have an emergency, how would I be taken seriously? I am allergic to Ibuprofen, so yet another strike against me. Could you post about that?
Like I said, I prefer to manage pain at home or with doctors who know me, but I also want to be prepared.
An RSD patient with an NSAID allergy is going to generate some suspicion, but the quality of your experience will depend a lot upon your expectations, your preparation, and how well you interact with the staff.
If you expect to be admitted to the hospital for your pain, you'll have more success finding a physician who will be willing to admit you for pain control instead of showing up to a new ER and expecting the ER doc to find a "no doc" physician willing to do so. Make sure your pain doctor or PCP has admitting privileges at the ER you are going to visit.
If all you expect is a shot or two to get you through the night until you can see your pain specialist in the office the next day, you shouldn't have any problem at all (especially if you don't have twenty other ER visits for that reason).
If you expect the ER doc to prescribe you anything stronger than vicodin to go home with, we probably aren't going to be able to do so. But we can treat you with strong medications while you are in the ER.
Being nice to the staff always helps too.
There lies the difference between the drug seeking patient and the true chronic pain patient. Thanks. Fortunately when I have gone to the ER, I have told them who all my drs are. They have consulted with them by phone if available. I never expected to be admitted. I wouldn't be able to tell you what to give (although one time the dr asked me what I wanted for relief, I told her my dr prescribed darvocet. Well she gave me Nubain (I couldn't even walk out of the ER after that and would be leery of taking that again! Strong stuff). I am ALWAYS nice to the staff. I even sent the ER doc who talked me into the first lap (and patiently answered every one of my questions regarding it and endo) a thank you card and an update of when my surgery was scheduled for. She still has the card to this day (she remembered me when I brought my daughter in for a bacterial infection - never did figure what it was but she had IV antibiotics and other oral antibiotics too). Thanks for clarifying! Anon 7:19pm
"50% of chronic pain sufferers have personality disorders or affective disorders"
That's just a stupidly, ridiculous statistic. Cite it with a proper reference.
You think Drs like Sharpie haven't seen every drug seeking weirdo and heard every story out there? His feelings are based on what he has seen (and I concur) over and over and over. These "seekers" think their stories are all new and original, like we've never seen/heard this crap before. We can tell, trust me, if pain is real. And we resent our time being wasted.
"It sounds to me like Sean is already a level 5 at baseline."
Ditto.
A kick in the shins is a 7?!
I didn't make the 50% claim, I just referred to girlvet's post. Even if the number isn't accurate, there are clearly many patients who present to the ER with chronic pain who have personality disorders.
now scalpe, why did you want to go and put a 'kick me' sign on your back?
dittos.
I will agree that many people who present to the ER probably have personality disorders. They already havie a lower threshold for tolerating pain and frustration, so they would be more likely to seek emergency care when in pain. Given their comorbid disorder, they're more likely to leave an "impression" on the staff about their pain/treatment that the staff may then globalize to all other chronic pain patients (hence we get ridiculously, stupid statistics with no real factual basis). It would be interesting to come up with more factual numbers though.
This little scenario is equally true of drug seekers. Hence why the blogger may now sees all migraine patients as "migraine" patients. Certainly there are many malingerers, but many of the attitudes towards the malingerers have been globalized to the real patients.
Question:
You don't like drug seekers claiming to have "migraines". I think we can all agree that they are wasting precious time and resources and are just plain infuriating. You don't seem to like people with real migraines either. They're also a waste of your time as far as I can gather from your comments. You treat them anyway being the nice guy that you are.
My question is, how are you treating them? Are you simply throwing narcotics at them, or are you using real migraine treatments (Imitrex injection, Toradol injection, DHE injection, DHE IV, Depacon IV, Benadryl IV, Compazine IV, Mag Sulfate IV, etc)? This could help solve both your problems. Your real migraineurs will love you because they'll get some REAL, lasting migraine relief from an actual migraine abortive treatment, not just a narcotic bandaid. And your drug seekers will be crying to their mommas when they're still needing a fix and their entire bodies are tingling, they've got muscle/stomach cramps, their throats and chests are tight, they want to puke their guts out, and they're just too sleepy to complain about it. You get to by-pass all the "allergies" too. Don't forget to push some Reglan unless you really want them to suffer.
My point is: giving out narcotics right away rewards those who truly are drug-seeking and is under-treating the real migraineurs. If they're going abuse our malady, give them a taste of the real life.
No surprise. Nearly everyone observes a correlation. A few examples: Reich and Thompson (1987)- over 37% of chronic pain patients presented with discernable personality disorders, when compared against two groups of psychiatric patients.
Fishbain, Goldberg, Meagher, Steele, and Rosomoff (1986)- 60% presented with a personality disorder with avoidant, obsessive-compulsive, and histrionic personality disorders being the most common.
Polatin, Kinney, Gatchel, Lillo, and Mayer (1993)- high occurrence of personality disorders (51%) in a population of chronic low back pain sufferers.
I still have trouble understanding why chronic pain = emergency. I would bet that a rigorous study of the ER chronic pain group would show a much higher incidence of serious psychopathology.
Interesting post, Scalpel. This made me appreciate the tough job docs have separating the real patients from those who don't present with anything verifiable - just give me the freaking drugs! I can see where the flood of drug seekers can jade one's perspective and heighten one's suspicions. More than anything, patients need to feel that docs are listening, and, unfortunately, pain is one of those manifestations that can't be measured by a machine. As a writer, I'm supposed to be an effective communicator, but there's something so attractive about a kick in the jewels that puts it all into perspective...
Since when did the ER become the place to get treatment and/or workup for chronic pain--ongoing narcotic treatment and ongoing workups for medical problems do NOT belong in the ER or urgent care. Go to your primary doctor and work with them--if you don't have one, get one!! Period.
It's ridiculous to complain that it took 4 ER visits to figure out you pain. You should have seen your primary after the first one, who should have then referred you to GYN, who are the proper people to do a laparoscopy to diagnose endometriosis. There is a reason people are told in the ER and urgent care to follow up with their primary doctor.
The references provided for chronic pain = personality disorder are old and come from an era when it was en vogue to try to psychopathologize pain disorders. Ever heard of the "migraine personality"? Bunk. There has been a significant amount of back-tracking on that now. It's also true that while a large number of people may be diagnosed with a personality disorder or personality disorder traits (the owner of the blog has several as do a sizable portion of the population), that doesn't necessarily make it a valid diagnosis. It's often a diagnosis of countertransference because the treating doctor is frustrated and perplexed by unsuccessful treatment attempts as well as is the patient. Chronic pain patients who are being under-treated are not surprisingly depressed, anxious, and cranky, especially when the legitimacy of their pain disorders are being questioned continuously and they feel they must fit the prototype of the "sick role" in order to get proper care in our health care system.
You also have to be really careful and read articles thoroughly because they can be easily misconstrued. It is accurate that patients with Borderline Personality Disorder have higher incidences of headache and migraine disorders. But it is not necessarily true that migraineurs have higher rates of BPD, as a group. For example, 40-60% of patients with bipolar disorder have migraines, but migraineurs in general are not at a higher risk of bipolar disorder. I have never come across anything indicating a higher incidence of BPD within migraineurs in general either.
We have to be careful with the assumptions that we make because it can effect the quality of care that we give.
A pain scale is no problem to demonstrate. A Taser shot is about level 6 or 7.
No one has ever felt better than level 3 without chemical additives.
I carry a Taser and a couple of Oxycodone in case I need to demonstrate the scale.
Why not just give the patient whatever it takes to make them smile?
It's faster, cheaper and more merciful than trying to guess how little you can get away with giving them.
They're junkies?
They're gonna die?
That's their choice.
When you are doubled over and crying because it is worse than anything you have ever been through (I didn't cry in labor with no epidural and I didn't bawl when I tore all the cartilge in my knee), that's when it becomes something that needs to be dealt with urgently. I have been through a hell of a lot without needing a pain med. For your information, I STARTED IMMEDIATELY with my obgyn (who I don't need a referral for) who said take motrin. Problem was I was already overdosing on the motrin. If you had read the post, you would have seen that my PRIMARY CARE dr sent me to the ER because she was concerned it was appendicitis. I didn't want to go and she called the chief of the ER to tell him I was coming, explained that I had GYN problems, and to please rule out appendicitis first. She sent me because as she told me, if it was my appendix, that she couldn't get me in for a CT scan or have the BW run fast enough. She was worried it may rupture if it was appendicitis. I think before they figured it out, I must have had at least 10 visits with my obgyn (who prescribed Darvocet and did nothing), and several with my primary care dr (who finally took over prescribing something in May). The last lap my obgyn told me it was negative. He didn't see what was wrong. However, I demanded to be sent to a pelvic pain specialist (I pushed for everything with the 2 laps and the specialist). He agreed to send me to one. It was the SPECIALIST that diagnosed me. Want to know how? My first lap I had adhesions on the left ovary and tube that tied down to the bowel and peritineum wall. My ob took them out and I was fine till I flared back up in May 07. He said he didn't see any active endometriosis lesions and I didn't have that! The second lap, he told me was negative. However, I picked up a copy of both operative reports to take to the specialist. GUESS WHAT? The second operative report said lateral to the adexna bilaterally was scarring most likely due to old endometriosis. That is completely different than a NEGATIVE report. I went to my new patient appt (waited THREE MONTHS to get in with him) with the pelvic pain specialist and he said that 90% of women that had adhesions for no reasons (I had no risk factors) are due to endometriosis. Then he said the fact that the second operative report reported scarring and stuff sealed it. Exam where he was able to reproduce the pain confirmed it. Those ER visits were over a 2 year period. So once every 6 months. Had the drs have controlled the pain to begin with, I would have never have had to visit the ER. SO GET YOUR FACTS STRAIGHT. What about a legitimate patient that pushed and pushed for answers like I did? I even got my HMO to pay in full treatment with a pelvic pain specialist who is out of network. I really really hope that no one that you love or yourself ever goes through what I did for two years anon 9:00am!
Since when did the ER become the place to get treatment and/or workup for chronic pain--ongoing narcotic treatment and ongoing workups for medical problems do NOT belong in the ER or urgent care. Go to your primary doctor and work with them--if you don't have one, get one!! Period.
It's ridiculous to complain that it took 4 ER visits to figure out you pain. You should have seen your primary after the first one, who should have then referred you to GYN, who are the proper people to do a laparoscopy to diagnose endometriosis. There is a reason people are told in the ER and urgent care to follow up with their primary doctor.
Not to hit on another growing crisis in this country, it's not like there are zillions of obgyns to change to either.
Oh and I followed up with my gyn each and every time as well.
You shouldn't make inaccurate assumptions about people.
Actually, there is a huge amount of current research linking chronic pain syndromes with psychiatric disorders (usually PTSD, depression, or personality disorders.) I'd bet the 50% figure is low, actually. Here is a very small sampling that I pulled up quickly, just to show that not all the papers on this subject are old, as another commenter claimed.
Buskila D, Cohen H.
Comorbidity of fibromyalgia and psychiatric disorders.
Curr Pain Headache Rep. 2007 Oct;11(5):333-8. Review.
"it was hypothesized that ... chronic pain syndromes are variants of depression"
Peterlin BL, Tietjen G, Meng S, Lidicker J, Bigal M.
Post-Traumatic Stress Disorder in Episodic and Chronic Migraine.
Headache. 2007 Sep 14
"Childhood abuse has been suggested as a risk factor for chronic pain in adulthood. In addition depression, as well as several other psychiatric disorders, are co-morbid with migraine."
Balousek S, Plane MB, Fleming M.
Prevalence of interpersonal abuse in primary care patients prescribed opioids for chronic pain.
J Gen Intern Med. 2007 Sep;22(9):1268-73. Epub 2007 Jul 20.
"Interpersonal abuse is associated with clinical problems including chronic pain disorders."
Abbate-Daga G, Fassino S, Lo Giudice R, Rainero I, Gramaglia C, Marech L, Amianto F, Gentile S, Pinessi L.
Anger, depression and personality dimensions in patients with migraine without aura.
Psychother Psychosom. 2007;76(2):122-8.
"personality traits and psychosomatic mechanisms of migraine patients may make them vulnerable to stress and less skilled in coping with pain"
If your doctor, or whoever, suggests that psychological factors are contributing to your pain, you might as well take the suggestion seriously and see a mental health professional. Sure, maybe that's NOT a factor for you, but with the strength of the correlation, you'd be unwise to refuse to consider it.
FWIW, I am not a doctor and I am not a chronic pain patient either. I AM a psych patient (bipolar), so I know what it's like to have people tell you that you have a psychiatric disorder, or that various things are related to your psychiatric disorder. And you know what? Sometimes they're right, as much as you don't want to hear it. Truth hurts.
A few thoughts...
- how on earth is kicking the doctor in the jimmies going to make him better able to treat your pain? Next time I need someone to help me, maybe I'll give them a papercut and pour lemon juice on it so they know I really want their help? That makes no sense.
- ERs are of course a terrible place for chronic pain workups. But in addition to true emergencies, they are in many regions the only place to get palliative care outside of business hours. Suffering, while in most cases not at all life-threatening, does motivate people to seek medical care on evenings and weekends.
- As a patient, I find the pain scale to be useless in the ER setting. I've seen it be useful in other ways -- monitoring my mother-in-law's post-operative pain, for example, where it doesn't matter much what the original number was; the relative change after meds are administered (or after use of PCA etc.). On the very few occasions I've been in an ER and asked to rate my pain, I never really know what to answer. I've experienced reasonably severe pain (unmedicated childbirth, joint dislocations) , and can imagine worse pain than I have experienced. So for example at UrgentCare at 4am Saturday morning the pain from my spasming neck might only be a 3 according to the worst pain I've experienced. And yet I'm afraid that describing it as such will result in me not getting taken seriously and/or not getting any pain treatment at all. And the reason I am there in the middle of the night when I can't sleep and can't much move my head is specifically to get help with that. So mostly I try to avoid answering the number question and instead say something like 'it hurts enough taht i'm not able to sleep or stay comfortable in a position for more than a few minutes.' and let them decide what number to assign to that. I don't think the pain scale is a useful mechanism for conveying how bad the patient considers their pain, or more importantly, what they want done about it. After all even given the same amount of pain, some people (not drug seekers, just normal people in pain) want total relief, and others don't want anything at all. So I guess I think the frustration motivating that guy's wildly inappropriate fantasy is with the pain scale being more of a hindrence than a help in the ER environment. Would that he might find a more appropriate (and less self-defeating) target for his wrath.
P.S. After all that, I forgot to say that I like your pain scale a lot more than the number one as a patient since it leaves to the doc to do their job -- asking relevant questions and assessing my condition based on their experience. A followup about what the patient is looking for in terms of pain relief might also expedite things for everyone (but I bet you already do that)
~ Anonymous who just commented a minute ago
Maybe living with unrelenting pain and little sleep for years might be a contributing factor to personality disorder? I hope you never have to find out.
To Anon 10/31 9:38AM
Did I read this correctly?
"It's also true that while a large number of people may be diagnosed with a personality disorder or personality disorder traits (THE OWNER OF THE BLOG HAS SEVERAL, so do a sizable portion of the population), that doesn't necessarily make it a valid diagnosis."
I am surprised "the owner of the blog" did not respond.
I started moderating comments because of some idiots who posted nothing but personal attacks on "the owner of the blog."
At least that anon had some interesting points mixed in amongst his Fristish internet psychoanalysis, so I published his post.
I've had worse.
I have no problem with believing there are plenty of drug seekers using the ERs to get their fix. I also have no problem believing that REAL chronic pain patients may have personality disorders. But, I totally disagree about the cause of those disorders.
When you are in "uncontrolled" chronic pain. I'm talking real pain that is documented well, and you live everyday of your life this way, do you think it might eventually cause personality problems and emotional issues? People are forced to give up their live from chronic pain, they lose mobility, they lose many friends and family members, they are left out of or refuse participation in social functions. So, how could all this not cause mental health issues?
On top of that, they deal with a very uncaring medical community, who refuses to treat effectively, and then they get themselves on blogs and talk about what BAD people these chronic pain patients are. Maybe when you are crippled and in a wheelchair from RA, you will reevaluate your thoughts of all this.
As for the guy in this story he doesn't even warrant the space you have given him.
So, if writhing around on the floor is a 10/10, why do so many people stop put on the make-up, drive themselves in, stop for coffee etc. then tell me that their pain is 10/10. Makes me somehow doubt you. Remember, health professionals are people too. I have, or I work with people who have had; ruptured ectopics, ruptured discs, ruptured appys, broken bones, broken hearts, kidney stones...etc, few would have said 10/10.
I do believe that many people who suffer chronic pain have some form of mental illness. Just living in pain can be depressing. The answer isn't narcotics.
Life is pain.
As a follower of both blogs I have enjoyed the back and forth debate... Although now sword...naughty, naughty, for publishing names..you might just deserve a #7 on the ole pain scale..a kick in the shins for that..
I guess I can see it from both sides of the coin, I've been in a work place situation involving seeing CP and I have CP. I am lucky as the source of my pain is blatent. Most people who will look at me say "ouch, that looks like it hurt"..YEP, still does..
The great debate among CPer's is about signing contacts, having meds monitered, donating urines, having 1 prescriber and 1 prescriber only, NO ER visits, etc..My idea is to DO THEM. A PROPERLY treated CP'er is going to have 1 prescriber, enough meds, clean urine and wouldn't be caught dead in an ER.
Until standards of care are established that can weed out the offenders, CP'ers are doomed to be judged so I have no problem puting my name to a piece of paper (that would serve just as well to wipe my butt), I will have my pills counted and gladly pee in a cup and I won't debate the issue because the sooner we weed those out, the sooner we get treated better..Yes, to those in the CP world..I am misguided!
The bigger issue is to try and define the word "PROPERLY" in the above..I've been known to raise an eyebrow at someone on 1800mgs of oxy..so I guess someone should give me a #7 on that pain scale..(which I have printed out and hung all over the office!)
I made a poll for my sidebar and will abide by the readers' decision. The poll will close on Thursday.
aren't personality disorder going out of style as biologically defined, medically treatable mental illnesses becoming better understood?
Chronic fatigue and fibromyalgia are both thought to have nueroendocrine components. NEURO meaning brain. It makes sense that pshychatric disorders will be part of the spectrum of chronic pain syndromes as, likely they arise from the same source. Combine that with getting up everyday to face pain for the rest of your life.
Why do docs act so dismissive of mental illness? I seem to recall the brain being part of the human body and thus falling into the realm of medicine. They are dismissive and rude, likely as a cover for having no idea how to deal.
As always, if the dr doesn't know the answer there is no problem.
It's interesting mitzi called me sword, because initially I had planned to blog as two personae: "scalpel" the nice doctor and "sword" the mean and snarky character that sometimes comes out. Thus the title, "Scalpel or Sword?" Sort of like Dr. Jekyl and Mr. Hyde. I never got around to adding the second character.
Maybe I do have a personality disorder, LOL. Or maybe I'm just a Gemini.
I have a couple of questions for Dr S or S.
How many patients that claim to be C-pain sufferers have you seen in withdrawal? Of those, how many complained of severe pain at their particular cp site compared to those who complained of general narcotic-witdrawal symptoms with no reference to a particular site?
How did this influence your diagnosis?
Jason
1) Hardly any. Maybe a handful.
2) All of them. Patients in withdrawal complain of withdrawal symptoms, but of course they also complain about not having any more narcotics to treat their back pain, hoping that we'll give them narcotics. Most people who complain of withdrawal aren't really in physical withdrawal, it's more psychological.
3) If they are in opiate withdrawal, I try to avoid narcotics and manage their withdrawal symptoms. Alcohol and benzo withdrawal are more dangerous than opiate withdrawal. Opiate withdrawal patients might get IVF, clonidine, antiemetics, and benzos, but no parenteral opiates. If they stabilize, I might give them a few vikies for the road. We don't have a big heroin or oxy problem around here, so life-threatening opiate withdrawal isn't that common.
I gotta jump in here with my [not so] humble opinions.
#1 Outing Obnoxious Blogger was OK by me. He deserved it. From my experience [professional and personal] in Mental Health, he's got some Paranoid Personality Disorder features.
#2 As someone with chronic pain for 16 yrs. due to degenerative disc disease and arthritis...I have NEVER gone to the ER b/c I ran out of Pain meds or muscle relaxers. In fact my last 2 er visits were, in order, for a car crash with belly and shoulder pain; and chest pain w/SOB.
#3 I've read the research that people who have chronic pain actually have a HIGHER pain threshold and tolerance than those who do NOT have chronic pain.
#$ I have heard it posited, though I've seen no research, that those who have used denial as a coping mechanism for an extended period of time have a higher pain tolerance. It makes sense in theory since they are accustommed to denying the existance of unpleasantness in their lives. They are used to getting things done despite the chaos or pain in their lives. And they are used to ignoring things that bother them.
I'd be interested in hearing the opinions on others on this theory.
Out of 68 votes, only 14 (21%) thought I should remove Sean's name while 32 (47%) thought I should leave it. The rest didn't care. The readers have spoken. Thanks to all who voted.
How's Texas Medical treating you? I hear Houston's going downhill.
Let the games begin.
Well, you've narrowed me down to the fourth largest city in the nation.
I'm starting to get a little nervous, des Moines.
To me it's amazing that doctors recommend personality disorders for chronic pain when so many patients later find out they have been misdiagnosed AFTER the psychiatrists, anti-depressants, etc. don't work. In the end they have to be glad SOMEONE paid attention before it became fatal. There are lots of people who suffer needlessly for conditions that can be treated but have been dismissed by their doctors out of some kind of prejudice(race, sexism, socioeconomic class, etc.) on the doctor's part. However, the doctors never have to live in the wake of their mistakes, only the patients and their loved ones do.
Reading can bring such joy. This is the first time i've laughed since my accident. Although it hurts to laugh it is very much appreciated. Thank you for brightening my day. I'll be repeating this in my head tomorrow when i go for my cronic pain assessment.
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