Every day in the emergency department I am confronted by pain. In fact, the treatment of pain is one of the most important skills emergency physicians, indeed all physicians, possess.
For instance, I recently cared for a child with sickle cell disease who was having a pain crisis which involved severe leg pain. His life is one of frequent, intense pain. I gently, and repeatedly, treated his pain with morphine until he had relief. I see hip fractures; all broken bones hurt. I am thrilled to alleviate that discomfort. Pain is one of the things I can fix, if only temporarily. It makes me happy to see the relaxed face of a man or woman with a kidney stone or migraine, who suddenly smiles and says “thanks!”
But pain is also the source of so much subterfuge. Emergency department are full of individuals who use controlled substances for recreation. I know because they have pain that is entirely unverifiable. They have terrible right flank pain with no gall-bladder, no pancreatitis, no kidney stone (documented by CT), no pneumonia or rash. They have nothing to cause the pain. And yet, dose after dose of narcotic later, snoring in their ER stretcher, they look up at me with hazy eyes and say, thickly, “Cann I gettt somethinn elsss for paaiin…it hurtssss so…bad. zzzz. Itzzz a tennn.”
So I began to wonder about science and the pain scale. Read more »
*This blog post was originally published at edwinleap.com*