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When to go to ER?

KimD592KKimD592 Posts: 435
edited 06/11/2012 - 8:59 AM in Chronic Pain
The pain is really bad. The NP at my NS office wants me to go to the ER down at University of Penn, which is an hour away from me. My fear, though, is that I will get there and they will tell me there is nothing they can do for me. The pain I am having is literally like an electric shock everytime I move. If I am sitting still, I am fine. As soon as I get up and start moving, it is like a shock going through my back. It is truly a horrific pain, and has gotten significantly worse over the last 2 days.

Here is what I have tried...Prednisone, heating pad, hot showers, flexeril, oxycodone, diclofenac, extra strength Tylenol, bedrest, etc. Nothing..is..helping, and it is making me physically ill. Everytime I feel this "shock," it literally makes my stomach turn. I even threw up once this morning because of it. I also can't help but scream obscenities every time I feel it...it is THAT bad.

I just don't know what else to do. They ordered a new MRI, but I probably won't be able to have it done until next week. The easiest solution to that would be to go to the ER, where my NS is affiliated, because they'll be able to do the MRI then. The NP said they would call ahead and let them know I am coming, since I am coming from an hour away. However, I really don't want to go there, only to have them push more meds on me, which do not help. All it does is add more meds to my ever-growing home pharmacy that I have got going on here. Seriously...if I really wanted to, I could sell even half of what I have and make a small fortune! I am sure many of you can relate.

Is there anything else that I can try, that you can think of? Please...I am desperate!


  • Only you know what you can tolerate.
    Did you ask your doctor why he things the ER will help? Will it expedite the MRI/approval?

    If you really don't want to go (I know you have a family to consider making arrangement for); then you know how to keep the pain manageable...don't move. This means relax and take the night off.

    Can you go to your doctor tomorrow or is he suggesting you go to ER tomorrow too?

    If you can tolerate it, do so and contact your doctor in the morning and ask why the ER vs. his office?

    Good luck
  • It seems like your doctor is working with you.
    So you really have 2 options - tolerate it by doing what you know keeps it manageable OR call your doctor and head to the ER.

    Don't let it get too late though.

    Good luck
  • Personally, I would go. No one is going to be able to help you til you have that MRI and it sounds like that will otherwise be held up, correct? If you don't want the meds, don't take them, but at least you'll be closer to what is going on in there and closer to relief :) Good luck!
  • Two years ago, at 6 p.m. On Labor Day Friday, naturally when I do not
    Want to bother my Dr. - I was having more & more intense pain
    Than usual.

    I had pain medicine & I was about ready to lose it. I had had a huge
    Complicated fusion. I was like you, my husband took me to the
    Emergency room, they took me very seriously, put me in a private
    Room, gave me an IV, the Dr. Thought that it was my appendix.

    The pain did not get better, they gave me a catscan, a complete
    Xray which they were able to match up with my post op

    The Dr. Asked me if.. I had been going to the bathroom, that
    Was putting pressure on everything, he gave me some
    Medicine for that but they kept me until about 3 in the morning.

    I was convinced if I went, I would look silly, I told the Dr.
    That I had medicine at home & was not there asking
    For pain medicine, I was just in extreme misery and
    There I was on the Friday of a holiday weekend.

    They assured me that I did the right thing and to go
    See my regular Dr. First thing on Tuesday. He told
    Me, better safe than sorry.

    I would go based on my own experience but that
    Is me, with my familiar hospital a few minutes away.

    Good luck, hope you feel better xx
  • one has to be very careful when going to the er especially with pain or back issues. drs and nurses are on the look out for people trying to get pain meds and these 2 words are major red flags. even if you rally have issues be careful. they will ask you how much meds you are taking or have you seen your dr about changing meds etc etc. don't be surprised if they don't rally do anything. rarely do they give out opiates when one walks in. they deal with this issue all the time and they, drs and nurses, get very suspicious. they almost assume all people who come in for pain issues are trying to get opiates. get your dr to call the er and or the hospital and let them know what is going on and why you are going there. a lot of times they will try to call drs if there is no message from your dr. just to let you know, i have had major pain issues for back pain and i have never gone to er. i never run out of meds, i talk to my pain dr if meds don't work, i will make an appointment to see him if needed. if pain is so bad like you describe, maybe you should call your dr and let him know and try to get new meds and a new dose. i think going to er is the last thing one should do. this is what a lot of er drs think also. they get very jaded about prescribing new meds even if it is not an opiate. i once had a major kidney stone that was blocking my ureter and my kidney burst from back pressure. even then the nurse and dr made me give a urine test in front of them to make sure i was not cheating by putting some blood in my urine. like i have said, use er when there are no other options at all.
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • dilaurodilauro ConnecticutPosts: 9,846
    When you are in the pain you are in and have been taking the various medications you have, trying other conservative measure , feeling nausea and physically sick, you need another path.

    I have seen and heard so many stories about people going into the ER that are only looking for stronger pain medications. It could be a simple headache or a real issue.

    Having your doctor call ahead, explain to the doctors at the ER WHY you are going there would be so very helpful. This way, if/when you go there, the "Questions, Not believing, etc, shouldn't be a problem.

    But even the 1 hour car ride is going to be uncomfortable for you. Is there any way your doctor can suggest something locally for you?

    I'd hate to see you take that drive and there really isnt any more that they are going to do. If they do the MRI then, well, you've got that diagnostic test done with, but what about your pain?

    Kim, wishing you the best in whichever path you take.
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • If er gets the mri done faster and a good dr on call is there to giive something in the iv to get releif then thats what i would do, Not only would do,I have done it,

    Not every er dr is an idiot that will think someone is seeking drugs, Unless you become a regular customer in the er to get shot up with morphine which would raise a red flag of someone might be just there for the drugs, having information on a spinal condition is very common in the er and is helpfull especialy if its in there record that like myself i have failed back surgery and nerve damage and if i go to er its for a good reason,

    Reason being my own dr is not controling the pain like he should be and i will not pass out or have a heart attack from severe pain thats out of control,

    If anyone is in out of control pain and i mean serious out of control pain then no reason not to let er hadle it untill dr comes up with a beter plan,

    At 1 time they were ready to keep me as in patient for pain control but the diladid and the valium kicked in and i was fine to go home,

    From that date i keep valium on hand to stay out of er, You do what you have to do,
    Nobody has time to contiplate what will er think and will they think i am a drug addict or not if someone is in serious pain,

    Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
    2012 scs implant ,
  • Hi Kim,

    Just checking back in to see how you are doing?
    Not sure if you went to the ER or not but I hope your pain is under better control today.
  • Just wondering what you decided to do, you will have to let us know whats going on. ER or not, I think its a personal decision, with your doctor calling ahead of you and you not asking for meds, I dont see how they could possibly label you as a drug seeker.

    One note on the things you have tried for pain. I dont have your same symptoms, but I do get nerve pain with electrical shocking pain from time to time. When I'm like that, heat is my enemy and as much as I have been opposed to ice I have learned to use it because it does work. Ice will decrease inflamation, while heat will increase it. This is something you might want to try to see if it helps at all to get you through this tough time. It by no means will fix anything gone wrong, but may give you a much needed small break from your pain. Good luck....Mitch
  • SavageSavage United StatesPosts: 5,427
    ...why doc would want you to go to ER one hour away, unless that is where he works out of and easier for doc to get reports.

    I have gone to ER for what I like to refer to is reboot. The pain is so out of control it needs to be stopped. That one very good reason to stay ahead of the pain.

    To say ER won't help...not sure how you know...even if past experience not so good. And really when we are needing relief and doc gives advice...not following it more than a few times can get frustration to doc.

    If it's a doc don't trust, may be time to look for another. Or, try to trust doc, that he may not be able to explain every single reason for his decisions. For ex..as others said if MRI will happen sooner...Doc probably doesn't want you in ER saying.. yeah doc said I'd be taken more seriously and not have to wait so long for MRI..can get today.

    And re' others thinking your seeking pain meds...You can't be responsible for others and their thoughts. Just need to work with doc to take care of self best you can. Sometimes our attitudes may lead someone to doubt..if we go to ER like apologizing before we hit the gurnee.

    I go to ER when it's out of control. Pain control is my priority. For me...it has to be.

    I wish you the very best as you make your decisions and I do hope you find relief soon and relief on a regular basis.
    Spine-Health Moderator
    Please read my medical history at: Medical History

  • Well, I ended up going to the ER and was in the hospital for 3 long days. My doctor is affiliated with University of Pennsylvania, so he wanted me to go there. I ended up having an MRI of my thoracic and cervical spine. They also started me on a higher dose of steroids, in case it is related to the AS. After my surgery in July, my doctor had said there was still some disc material bulging out, but it was not touching a nerve or the spinal cord, so he was fine with it, as was I. The new MRI did not show any significant changes, and my c-spine was fine. So, they started me on a fairly high dose of Prednisone (25 mg every 6 hours), which I am to taper down over the next 4 weeks. No heavy lifting for the next 2-4 weeks, and then possibly another round of PT.

    I was still feeling pretty terrible all day yesterday...the shock-like sensations everytime I was up and moving around. However, after 3 days of being on a higher dose of Prednisone, I think I may be finally experiencing some relief. Naturally I feel horrible from the Prednisone, but I have been up and moving around this morning, albeit slowly, and I haven't felt the pain yet. So, fingers crossed this helps! Just glad to know nothing reherniated, but I was feeling pretty frustrated last night when I was still feeling the pain, and they could not tell me what was causing it.
  • i have been having chronic pain issues for 10 years and i never had to go to the er for meds. i have mine and if something is wrong and won't work, i will call my pain dr, make an appointment and see him, an er is not supposed to replace your dr it is for emergencies and increase in pain is not an emergency imho. it is not life threatening. why not call dr, most have an answering service even if after hours and talk to him. ask him if you can increase dose until you see him and then make an appointment. the er is crowded enough and there are people who are in very bad shape,heart attacks, strokes. etc that need an er doc. if you want to sit for 3-4 hours to get pain meds, be my guess. it seems more logical to have pain dr take care of the problem not the er. just my own opinion so don't get upset
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • Sorry Jon, but I think you are missing some important details with this story. Kim's doctor instructed her to go to this ER and Kim did not want any meds in the first place, just imagery and advice.

    I'm like you in that I have a pile of meds at home always and I view the ER as more pain and suffering than relief due to the drive, wait and hassle. As far as a system reboot for some, that is a personal decision and the harm of out of control pain to the body can be a real emergency (very high blood pressure, shock, etc). I know when I'm at my highest pain level, all my meds do is make my brain hazy but they dont seem to touch the pain......Mitch
  • Thank you, Mitch - you are absolutely correct.

    Jon - I did not want to go to the ER for pain meds, and I had been in contact with my MD's office since the pain began 3 weeks ago. They started me back on a Prednisone taper and ordered a new MRI, but it would have been at least later this week until I would be able to get in to have it done. In the meantime, the pain got to be severe, to the point that I could not move. I did not go to the ER looking for pain meds - the doctor ordered me to go because they were concerned I reherniated the disc I had operated on this past summer and that it may have been causing cord compression. In fact, I joke around that I have enough pain meds at home to start my own pharmacy, so that was the last thing on my mind when I went. Plus, I knew the pain meds were not going to touch this pain I was having, as it felt unlike any pain I have ever felt before. It seemed to be more nerve-related to me, and no pain meds I have ever been prescribed have ever helped with my nerve pain. Based on my symptoms and the NS's concerns about cord compression, we decided it would be best to go to the ER and have the MRI done ASAP. It appeared to be emergent, due to the fact that I could no longer walk at that point. Also, my situation is complicated by the fact that I have an autoimmune disease, ankylosing spondylitis, along with a multitude of other health problems.

    In the end, they concluded it was likely inflammation in the area, probably caused by my AS, and I am now on a high dose of Prednisone. As of today, the shock-like sensation I was experiencing whenever I moved has subsided. I still have minor discomfort in that area, but nothing I have needed to take pain meds for. If you knew me, you would also know that I have a fairly high pain tolerance, so for me to run to the ER for simple back pain would be ridiculous. There were many nights after my surgery that the pain was so bad I would be vomiting, but I still refused to take the meds I was prescribed because I hated how they made me feel.
  • my message was not going to er for meds, it was going to er in general. why go when one has a doctor and why would a dr send one to the er? what can they do that he can't do? one should have a dr for pain issues and also if there is a problem, call him after hours if necessary. If he sends one to er for another reason besides meds, why can't he take care of that problem himself? if you need mri, he can order one asap. mri's are not emergency proceedures and they are used for pre op scans to see where dis problems are.
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • SavageSavage United StatesPosts: 5,427
    ...ordered from ER and kept in hospital.
    They almost didn't do it..but they discovered pain trom ischemic bowel.

    Very painful and needs attention.

    I have also called doc while in pain and doc tells me to go to ER.

    My doc sent me to pain management in part because didn't want responsibility of medicating unknown pain.

    Just because I hve spinal issues..doesn't mean pain can't be from another cause and I would need attention.

    Wth hx of chronic pain, people and sometimes doc, will just put everything wrong and painful under "chronic pain umbrella"

    ER did tht also and missed my stroke..which who knows but could have been treated more immediately with less residual effects now. Who can say?

    We are patients and if we go to ER we are babies and if we tough it out, we are ignorant and in more dangerous and complex condition. Seems like we can't win.

    For me..yeah I have meds here and I take them..but sometimes they do not work...and besides doc telling me to go to ER to get handle on the pain... it's 2012 and I have enough chronic pain that I tolerate and when out of control...if there is a way to stop it and control it...I will take that route.

    There is enough suffering with all of us...no need to be satisfied with... more suffering.

    And we cant judge if person can wait for doc appt and like I said..3xs now.. my doc will send me to ER and care begins.

    Trying to unravel the causes of chronic pain is a nightmare...but taken one step at a time in a prudent manner..we may find cause.

    But if I never know for sure what causes what pain..I want relief for some kind of quality in my life.

    Obviously, just my opinion and...I'm just saying..
    We are individuals and we are patients..not doctors.

    Spine-Health Moderator
    Please read my medical history at: Medical History

  • Jon - my point is that I did everything I needed to do prior to going to the ER. I suffered for 3 weeks before even thinking about going. I had been in contact with my doctor since the pain first began. Again, he was concerned about cord compression and the fact that I was unable to walk, so at that point it became more emergent. I have a pain management doc, a neurosurgeon, a rheumatologist, etc, and all were in agreement that I needed to be seen ASAP. I also needed a high dose of steroids, which needed to be done in the hospital initially, as once they concluded I did not reherniate, then it became apparent that I was experiencing inflammation related to the AS. Had I been able to actually walk and drive myself, in order to get to the necessary appts and MRI's and this and that, it would have been a different story. Again, I was following my NS and rheumatologists orders, as I am dealing with more than simple disc herniations/DDD. I have other medical problems ranging from AS to Wolff Parkinson White (a heart condition) to high blood pressure which often becomes dangerously high on high doses of steroids, so I needed to be in a setting where they could closely monitor me. So, as you can see, I was not only admitted to the hospital to have MRI's done...I am a pretty complicated patient, unfortunately.

    I am done with this conversation, though, as I really do not feel I should have to explain myself to you, nor does it even matter. My point was, my doctorS though it would be best that I go, since I was rapidly declining, so I went. In the end they discovered what the problem was, I was treated, and I am feeling 95% better. I am able to walk again, and I was even able to sit on the floor and play with my kids yesterday. MAJOR improvement over how I was feeling just 1 week ago.
  • I agree wirh jon to a point, I agree er should be considered last,

    But nobody can tell me er wont help or thy cant do more then the pain dr especialy when pain is so out of control that a person might feel there having a heart attack from the stress of the pain,

    And i am not talking slight increase in pain where you can take an extra pill and manage untill you get back in to your pain dr office, The pain specialist of course should always be contacted 1 st and see if he can get you in for a posible injection to calm the pain,

    Some people can manage there pain with pain medications and such and never see inside of an er, But that in no way covers every person on the face of this earth we live on,

    I am not 1 for going to er but in my last 8 years after surgery i found myself inside an er i think 2 times,

    When nerve pain kicks in and your blood pressure rises and your heart feels like its going to explode and you feel as if you will stroke out and its the weekend and pain dr wont be in untill monday , Then there is nothing wrong with going to er and let them help get pain under control,

    Its wrong if someone is just simply over reacting to change in symptoms in pain which can be handled with extra medication and is able to wait to see there pain dr,

    But if you feel your life is on the line then you dont wait and think about anything other then leting er help you, There should not be this stigma about er being a bad place to go because its just pain and it wont kill ya,

    Fact is that pain can kill ya when a person is so much in pain they over medicate without even knowing it when pain dont let up and they poping pills and lay down to pop more pills untill they never wake up,

    I know 2 people this hapened to so i would never say to anyone dont go to er,

    I seen people go to er that i would never of considered going to er for who are not spine related issues, Things that i myself would of called my regular dr for and would of waited a week without a problem,

    I remember my 1 st visit to er when nerve pain just started after surgery and pain medications did nothing, Er. Dr understud my situation and through an iv give me morphine with valium combo of some sort and my blood pressure returned to normal and pain subsided,

    My pain was under control and now my brain returned to normal without the stress and now i was able to bring this up to my regular pain dr so it would never hapen again and to make sure valium is on hand to avoid er in the future,

    If er can help someone who been shot in the back with a gun or was hit by a car and they can get pain under control and then stop the bleeding, Of course they can help someone who has just as much pain from a spinal injury if needed,

    But er is only for severe cases and should not be abused by anyone who can manage there pain by other alternative measures,

    And if your dr tells you to go to er that makes it that much more ok to do so,

    Dr,s know they have in patient pain control if needed at the hospital when its needed,
    Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
    2012 scs implant ,
  • I should also mention that I am a telephone triage nurse, so I see a lot of people go to the ER for ridiculous reasons...parents running their children to the ER for a fever of 101, cold symptoms, etc. I definitely reserve the ER as a last resort, as I am constantly counseling my patients not to go to the ER unless absolutely necessary. I am on Prednisone and Humira for the AS, so I am at a much greater risk for developing a serious infection. Trust me, the ER is the LAST place I wanted to go with a compromised immune system.
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