Last week I suffered a violent, EXTREMELY painful, recurring muscle spasm in my back. It was evening, so I called my PCP and asked if he could call in a muscle relaxant for me.
He said no. Might be a blood clot or a kidney stone. Off to the ER with you!
Ok, I said. Surely they’ll help me.
Went to ER. Told them I was having muscle spasms. Writhed in pain in front of them for 7 hours while I waited to be seen. Was tested for blood clots and kidney stones, and was there until wee hours of the morning, all the while telling people I was having spasms and needed a relaxant.
Was sent home with pain pills.
Today, the spasms have resolved, and I am no longer in pain. I follow up with my PCP.
His response: “yep, sounds like muscle spasms. I’ll write you a script for a muscle relaxant in case it happens again.”
sounds to me like your doctor did the right thing - if the issue were blood clots or kidney stones, and you had either a) gone to the drug store for the muscle relaxants or b) waited for a routine doctor’s appointment to write the script, it wouldn’t have been a good thing for you.
Yeah, it sounds like he was interested in your welfare (or in covering his own ass, depending on your level of cynicism). The seven-hour ER experience sounds pretty horrifying, though. I’d expect about three hours for a typical visit.
I’m a little surprised the ER would be more willing to give you pain pills than muscle relaxants, though, after your tests showed nothing serious (assuming you mean some kind of narcotic and not Motrin). Maybe they have a policy of not giving a patient a drug they ask for specifically—which a nurse I know claimed was the policy at an ER where she worked—but if that’s true and the idea is to combat drug-seeking, it seems counterintuitive to prescribe a narcotic rather than an unscheduled drug.
I was overweight in college, uncomfortably though not severely so. I’d started having horrible pain on the lower right side of my back and finally went to the student health center.
“I think I have a kidney stone. I have this agonizing, screaming pain every morning for about half an hour to forty-five minutes…”
“You don’t have a kidney stone. It’s muscle pain because you’re overweight.”
“…But this isn’t muscle pain. I’ve had muscle pain. I ran track and cross country in high school; I know muscle pain, and this is something different. Deeper.”
“No, you’ve just twisted a muscle, you need to talk to a dietician and do these exercises…”
Imagine my lack of surprise when lo and behold, I passed a kidney stone two weeks later. In sheerest agony, too, because I tended then to be somewhat resistant to pain medication. The pain was enough that I threw up and lost complete bodily function control kneeling in front of the public-restroom toilet. I was mortified when I walked out of there through the health center, dripping and fetid, to find my father.
You were not playing it up enough, maybe? I went to the ER for severe neck, back and arm pain. They asked me to rate my pain on a scale and I rated it almost as high as possible. because I figured childbirth or severed limbs might hurt worse. I lay there grey faced, wincing and trying not to move. They gave me a pill of Dillotid right away. Every time they came in and asked me how I was, I told them I was in extreme pain. The amount they gave me obviously wasn’t helping very much so then they gave me another pill of Dillotid and a shot of Dillotid on top of that. Then I lay there at last not in pain for next three hours or so. Sometimes you’ve got to nudge them in the right direction with a little theatrics or they just don’t get it.
I would agree, except I had no symptoms whatsoever that corresponded to those things (blood in urine, soreness to the touch, a recent history of long plane trips, etc.), and I was having violent, sudden muscle contractions in my back.
I am not a difficult patient, and I was willing to go with the “well, he needs to be sure I’m not about to drop dead of something” and go to the ER, but it really irked me that no one would observe the OBVIOUS thing, which was that the muscles in my back were contracting like iron vices.
This is a big part of what ticked me off about the whole experience. I am clearly not a “drug seeker” patient, though they had no way of knowing that, and if their general policy were to simply hold off on drugs until a doctor could prescribe I’d understand.
But within minutes of being admitted to the ER (it took several hours before I saw a doctor, but I was placed on a gurney and given a nurse right away) I had been injected with pretty heavy duty opiates for my pain and given an intravenous form of ibuprofen.
So, they were happy to drug me up on stuff I didn’t ask for, and which honestly didn’t help me one bit.
The final straw, though, was being handed a prescription by my PCP today for a muscle relaxant now that I don’t need it, and specifically said “no thanks” to. He insisted I take it!
Also, I’ve run into some minor difficulties in the past with the rating-pain-on-a-scale-of-one-to-ten thing. I broke my ankle and had surgery to fixate the break with a metal plate. After the surgery I got some kind of pain medication which was fairly adequate and did cut down the pain quite a lot. However, that night (still in hospital) my ankle was really hurting and throbbing with pain. The nurse asked me to rate my pain and I said 6/10. They gave me a little more medication but it barely lowered the pain and I couldn’t get any sleep all night. I wasn’t writhing in agony, but it was pretty damn “uncomfortable.” (“Discomfort” seemed to be their favorite euphemism for “pain”).
I only said my pain was 6/10 because I figured that 10/10 would be equivalent to actually having my ankle gnawed off by wolverines at that moment, and 9/10 is a kidney stone or childbirth. Also, I’m generally stoic about voicing pain and don’t want to seem like I’m exaggerating my symptoms - I’ve known some people who would probably rate a stubbed toe as 8/10 pain, and I don’t want to be seen as a whiner or “boy who cried wolf” and then not get needed pain relief because they think I’m exaggerating.
So I think next time I’m in severe pain, I’ll clarify better with the nurse/doctor/whoever to make sure that my pain scale at least roughly matches up with their pain scale.
Heh, I broke my ankle last year and had the whole surgery and the works and thank goodness nurses who looked at me rather than listened to what I said on the pain scale… I guess I have a vivid imagination because although it hurt like heck I was all “Oh, probably a four? Maybe a five? I mean it’s not like rabid weasels are eating my innards, now that would hurt.”
They still kept me beautifully doped up and in minimal pain considering. At one point I was on the morphine drip but needed a little something extra to get pain-free enough to sleep and I vaguely recall reporting my pain at a two and being told to let them know when it hit three and they’d dispense percocet.
I think if I went through that again I’d probably exclude some outliers on my ideas of what the hell is really painful and move mine up the scale a tad.
A lot of doctors have policies about what they will and won’t call in. For instance, I don’t call in antibiotics, because I try to do what I can to avoid giving them out for obviously viral illnesses like colds, and that’s what most of the people calling to ask for them have. In general, I don’t call in pain medication, either, because someone with pain severe enough to require prescription paid meds is someone I probably need to see.
If you had called during business hours, I would have asked you to come in and be seen, but then my clinic is set up to accept walk-in traffic. It sucks that you had to go to the ER over it, but that’s the health care system we have.
Indeed, pain scales say more about the patient than the pain. Some people will call a hangnail 10/10, while others can have three limbs violently severed and call it a 3 or 4. (Don’t get me started on pain scores over 10.)
For four winters, my mother would get in bed after Christmas, in pain. Every year it lasted longer, until that one when she didn’t leave the bed for 9 months; that year’s pain was being helped along by depression. The doctors (GP and trauma) kept giving her stronger and stronger painkillers which didn’t ease the pain (from what I could see) but made her groggy. In July the traumatologist admitted he had no idea what else to try and got her an appointment with the doctor who taught traumatology at the medical school nearby. Because this was in June and Navarra is closed between July 6th and August 31st, the appointment wasn’t until September.
The professor saw her walk in, said “disc. Surgery. Parts she didn’t understand, adressed to the three students standing there. Are you from town or out of town?” “Out of town.” “Surgery tomorrow then. If you’d been from in town it would be today. reads her file ugh, this has been going on for how long? They should have sent you in two years ago! Painkillers? Urgh! Should have been muscle relaxants…”
Depression, back surgery and painkiller addiction. And people still ask why I don’t have fond memories of my teens :smack:
Slight hijack, out of curiosity—how do medical staff know what to believe? I was having a lot of pain last week and was feeling frustrated because I feel like doctors are defaulting to “no pain meds” in case the person is a drug seeker. That makes some sense (why chance prescribing something to someone who doesn’t need it but merely wants it?) but I think that leaves behind a lot of people who are in pain. In my case, I’d had a procedure which was pretty painful, and I can’t imagine anyone faking needing this procedure just as a way to get meds, but I suppose it does happen.
To the OP, I think it’s not a bad idea to have the muscle relaxants on hand. I assume your PCP is now going with the idea that you will recognize this type of pain and injury if it happens again and he’s spared you a trip to the ER.
I get that as an approach to prescriptions (muslce relaxants in my case).
But in a way that’s exactly what I’m upset about. It seems as if my doctor’s only requirement for giving me a prescription was that he had to see me. Not that I needed it. Not that I was still symptomatic. Not that I asked for it again when I saw him. Simply because I made an appointment and described for him the then-defunct problem, he handed me a prescription for pills that I no longer needed. I don’t see that as consistent.
I would have been happier if he’d said “well, you were definitely having spasms…sorry I couldn’t help you at the time, but you clearly don’t need anything for it now.”
Could be, but he specifically told me he doesn’t think it’ll happen again. He said he thought it was a fluke. But you’re probably right about his reasoning.
This fascinates me as well because I have never had any problems getting pain meds, but I don’t like using them. When I have a migraine doctors seem only too happy to drug me up (at the time I am very grateful) but less likely to follow up and try to treat the problem.
Just curious, why couldn’t the doctor have done both? Why not go ahead and help the guy’s pain while at the same time telling him to go to the ER to get checked for kidney stones?
Because treating the pain before you know what’s causing it can have significant consequences. Like masking the pain so much one covers up an appendix that’s about to burst, or giving a med that’s contra-indicated for the eventual diagnosis.
