Talking About Pain: Being Heard in the ER
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Or you can read it the old-fashioned way below…
Many people often describe feeling judged, stigmatized, or blatantly ignored when seeking treatment for chronic GI pain. No one should ever have to be treated this way. And no one should ever be made to feel worse at a time when they are already physically and psychologically vulnerable and in need.
We have discussed all of the different types of treatments that can be used to manage pain – medications, natural products, and alternative therapies. So now it’s time to discuss how that knowledge can be used to ensure that you are heard and cared for when you are seeking help in the management of your pain.
The Communication Gap
Unfortunately, there is a large communication gap between patients and providers that needs to be bridged before patients can stop feeling like they are being judged or ignored when they are in need.
There are many reasons that these experiences occur so frequently.
The Brain-Gut-Pain Axis
First, a person’s perception of pain is known to have a lot to do with mental and psychological state. The brain has the ability to make pain better and worse. This doesn’t mean that you can simply will yourself not to feel pain. But it does mean that people have the ability to actually increase the level of pain that they are experiencing by focusing in on it and developing stress and anxiety about it.
We also know that the brain and the gut can have a circular impact on each other. A poor mental state can make your gut health worse, and poor gut health can make your mental state worse. The relationship between pain and the brain adds yet another layer of complexity. This, unfortunately, leaves many doctors questioning whether the pain is real, psychological, or exaggerated.
The Current Epidemic
Second, our country is in the middle of an opioid crisis. Approximately 90 people every day die from an opioid overdose. Emergency rooms are seeing the full force of this crisis. They are overwhelmed with people seeking opioid prescriptions to prevent withdrawal. They are also treating people who have already overdosed on their medication or on heroin.
When you consider what the doctors and nurses in an ER are seeing on a regular basis, you have to cut them a bit of a break for being on guard around anyone who is in pain. Add to that the fact that most GI pain is hard to pinpoint and at times may seem “invisible”, and the healthcare professionals who are there to help you become even more skeptical.
In addition, these doctors and nurses are being tasked with minimizing their use of strong pain medications and preventing drug seekers from gaining access to certain medications. This changes the way that they care for the patients that come to them in need of pain relief. It’s not a responsibility that they have asked for, but they are stuck with it nonetheless.
Different Languages
Another common problem is that providers and patients often speak different languages. I talk a lot about learning to be your own advocate in another series on this website. Becoming a strong self-advocate and learning to communicate effectively with your providers is one of the best things that you can do for your health and quality of life. It can completely change your experience in the medical system and open doors that will allow you to access the help that you need.
Unfortunately, this communication gap becomes even larger when you are stressed out and in real need. It becomes harder to remember the things that you SHOULD be saying and to phrase your thoughts in the appropriate way.
What’s the Solution?
The good news is that there really are solutions to these problems. Let’s walk through the steps that you should review and prepare for now, when you are feeling relatively well, so that you will be ready for your next visit to the ER or doctor’s office and the inevitable scrutiny and questioning that you will be up against.
- Clearly describe your pain.
In my first article in this series, I discuss the many types of pain that people can experience. It really does matter to a doctor HOW your pain feels. This helps to tell them what might be happening inside of you, and whether they need to be concerned for serious issues and run some extra tests. It also helps to tell them how to TREAT your pain.
If your pain is burning, say so. If it is cramping, say so. If it goes in and out, this is important information as well. If it is worse when you stand up or sit down, let them know.
If you can pinpoint where the pain is on your body, then make sure they are aware of this. If it is generalized across your entire torso, that is important to state as well. However, if it is hard to pinpoint exactly where the pain is, then it is even more important that you are able to describe HOW the pain feels.
- Clearly explain what got you to this point.
Explaining how you got to the ER includes a lot of different things – what you did that day, when the pain started, how quickly it got this bad, and what you have done to try to make it better.
If you did something that you know caused it, tell the doctor and explain why you know that’s what caused it. If you have no idea where it came from, that’s helpful information, too.
Be able to explain what you have done to try to make it better. That could include anything, like taking a hot bath or shower, eating a meal that you generally tolerate well, taking a Tylenol, or taking a prescription medication that your doctor prescribed. All of that information is very important for a doctor that is trying to make sure you don’t have something severe happening inside of you. And it shows that you have already done your due diligence before heading to the ER.
Also, if you have not been able to drink much and are becoming dehydrated, make sure to mention this. Getting fluids into your body through an IV can actually work wonders on reducing certain types of pain on its own.
- Clearly describe what has helped you in the past.
If you have already been to the ER in the past with this type of pain, it is helpful to tell the doctor what has (and has not) worked for you. But be very cautious about saying something like “Vicodin is the only thing that works…don’t waste your time with the other stuff”. This is a huge red flag for drug seeking behavior. It is also a red flag for someone with a GI condition, because Vicodin can wreak havoc on the GI tract (see here for more information).
Your doctor wants to hear that you know Drug X won’t work for you because you have tried it at 3 different ER visits and got no relief. Or you took drug X daily for a month and it didn’t make a difference.
If you are requesting a certain medication that you know works for you, explain the history. If you have been to the ER before and a single dose of that drug knocked your pain down to a manageable level, that’s great. Tell the doctor.
Use the knowledge from my other articles on medications, natural products, and alternative therapies to show that you are attempting to speak their language and that you are genuinely trying to improve your quality of life and health.
There are certain things that doctors and nurses do and do not want to hear from their patients. For instance, if you tell the doctor that you desperately need fluids and are only asking for an IV medication because you can’t keep anything down, that is helpful for them to hear. Letting them know that what you are seeking is a single dose of something that can help you bring your pain down to a manageable level so that you can relax and sleep is also helpful for them to hear.
On the other hand, being told that you’ve tried everything and you’re in the worst pain of your life, all while making an enormous fuss, is not helpful. It labels you as a problem patient and marks you as a potential drug seeker.
At NO POINT am I endorsing the way that our healthcare system handles emergency room visits and people who need help. I’m simply trying to describe the state of things. And for as long as our system remains this way, the best thing that you can do for yourself is become aware of the state of things and learn to operate within them.
A Helping Hand
I’m sure that many of you have already seen a huge flaw in everything that I have said thus far – this is an awful lot of stuff to have to know, think about, and do while you are feeling awful.
And I get it. I’ve had my share of visits to the ER, and I’ve dreaded every single one of them. Feeling judged and belittled when you are desperate and in need is a horrible experience. Advocating for yourself becomes very difficult when you know that you are having trouble thinking straight and desperation is setting in.
One of the best things that you can do for yourself during an ER visit is to bring an advocate with you. A significant other, a friend, a family member – whoever you have in your life that can help to speak up for you when you are in need. If such a person is available to accompany you to the ER, it can make a huge difference in the care that you receive.
Unfortunately, that sort of person will not always be available. In those times, it can be very helpful to have a written log of some of the information that I discussed above. This log should explain what your typical pain management regimen is at home – this way the doctor knows what you already deal with on a daily basis and what you have already tried before arriving there. It should also include a list of the medications that you know do and do not work for addressing your pain. If you have tried something that failed, include it with a comment like ‘no success’. If you have tried something that worked, say ‘helpful’, or something along those lines.
This may seem like a weak replacement for the discussion points that I discussed earlier. But the mere act of having such a log available during an ER visit actually speaks for itself in many ways. It shows your doctors and nurses that you are actively involved in improving your health, that you are informed regarding your condition, and that you want to help them as they try to take care of you. Something so small can quickly change the way that you are treated.
Conclusion
Our healthcare system is far from perfect, and we don’t have any perfect solutions for the treatment of pain. But that doesn’t mean that we shouldn’t be able to get the care that we need.
By understanding your options, whether they are medications, natural products, or alternative therapies, you can start to build a multifaceted pain management regimen that works for you. And by understanding how to describe and discuss your pain and your pain management strategies, you can begin to build a stronger relationship with your healthcare providers.
Finally, by glancing behind the curtain and seeing the perspective of the ER doctors and nurses that you encounter when you are in need, you can develop strategies that help you to bridge the communication gap so many people face when seeking care.
If you are interested in learning more about becoming your own advocate, check out this series. And if you are interested in any other topics related to GI health, just use the Search bar on the top right of the screen to find the many other articles on this site.
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