First, Nurse K works in the ED (Emergency Department).
Let’s think about that. Chronic pain is something that is long term, so it should not generally result in a trip to the ED. Emergencies are the kind of injuries or illnesses that lead to acute pain. There should be a method, for the patient with chronic pain, to deal with break-through pain. The method should not be to go to the ED. The method should not be to procrastinate on refilling a prescription, until the weekend, so that your doctor is not available. This is manipulative and self-destructive.
The problem patients Nurse K describes are patients who are abusing the system. Legitimate chronic pain patients should be just as upset with these patients as Nurse K is.
The abusers of the system only make it more difficult for those with legitimate chronic pain to receive appropriate pain management.
Legitimate chronic pain patients should hate these people who make a mockery of genuine chronic pain. Those who put on an act to receive their pain medications.
How we deal with pain tells a lot about who we are.
I’ve had patients with extremely bad injuries. Injuries so bad that I feel very uncomfortable not giving them something for pain.
When the patient says, “I’ve had worse,” and I doubt that I have; or “I’ll wait until I really need something,” and I’m hoping that will be sometime before the surgeon starts cutting; or “I used to abuse drugs and nothing is worth living like that again;” or is lying in bed with a heart rate of 150, pale and sweaty, but discouraging large enough doses to make a significant dent in the level of pain; with that perspective, we are able to see the range of response to pain.
What is 10/10 pain?
For most people, burns seem to be the worst kind of pain. Imagine a red hot frying pan.
Now, reach out and touch the tip of your finger to the frying pan for half a second. What would happen if this were done for real? You have a burn. It hurts. Few people would repeat that experiment any time soon.
Now, imagine having your hand being held against the red hot frying pan, the entire palm of your hand, it doesn’t matter which one.
Think about that pain for a while.
If you have any kind of imagination, and you do not have a psychological illness that isolates you from this kind of empathy, then this should make you uncomfortable, at least.
The pain scale is not from This Is Spinal Tap. It does not go to 11.
Work on a burn unit. These patients have experienced this kind of pain, but now are experiencing severe chronic pain similar to the acute pain they experienced with the initial burn. This is not the only kind of acute or chronic pain worth treating. That is not what I am stating.
I am trying to give an idea of what debilitating pain is.
Fibromyalgia is a way to give a name to a much lower level of pain. If it has a name and a diagnosis, well then the drug companies can sell you a treatment for it. Pregabalin (Lyrica) an anti-seizure, neuropathic pain medication is approved for treatment of fibromyalgia. Here is an interesting view of the effect of pregabalin.
Pregabalin does not have any studies that show addiction to it. It is interesting that recreational users of drugs would rate it as similar to benzodiazepines (part of the class of drugs these drug users desired). Pregabalin, the only drug approved for the treatment of fibromyalgia, is not an opioid (a natural or synthetic derivative of the opium poppy, related to morphine). The idea of using opioids to treat fibromyalgia is not one the FDA appears to be endorsing.
I am very liberal with pain medicine (when OLMC allows it) and I do not take pain lightly.
Encouraging people to lie there, and to give in to the pain, is just the wrong approach. The more you give in to the pain, the more pain medicine you need, the more you become dependent on pain medication, the less you are able to take care of yourself, the more you become a victim of your own response to the pain.
You become your own victim – not a victim of the chronic pain.
This is tragic. The epitome of tragedy, Hamlet, said –
there is nothing
either good or bad, but thinking makes it so: to me
it is a prison.
O God, I could be bounded in a nut shell and count
myself a king of infinite space, were it not that I
have bad dreams.
That last line confuses many people, not having the ability to understand Hamlet’s “bad dreams,” but it would never work if he were to say, “were it not that I have fibromyalgia.”
Hamlet’s dead father would come to him in his dreams and tell him that he was murdered by Hamlet’s uncle, who is now also Hamlet’s step father and the new King. Very unhappy times for Hamlet and this is just the beginning!
Hamlet may have been the prince of despair, the Shakespearean character most likely to whine, but fibromyalgia would never have worked for him.
Maybe it was King Lear with his prove to me that you love me, or Othello with his willingness to let Iago convince him that his wife was fooling around, but Shakespeare knew how to write tragedy. All of these responses to adversity prove to be tragic. And fatal. And whiny.
Was Nurse K being inappropriate?
Not at all. Chronic pain patients would be better off listening to her, than those who say just lie there and suffer, but do it dramatically.
.
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