Pain Management Patients in the Emergency Room - How Should They Be Treated?

When pain management patients visit the emergency room, there's always a question of whether or not the person is a legitimate chronic pain patient, or a "drug seeker". Narcotic abuse, in the US is at an all-time high and doctors need to be very careful about prescribing opiates to patients with subjective pain complaints in the ER.

When a patient presents illegitimately, he or she is often younger, well groomed, and often give evasive answers. It may even be difficult for the person to produce identification. They will typically say they are allergic to certain pain medications and often know a lot more medical terminology than the average consumer.

How should doctors effectively treat patients in the emergency room with complaints of pain with the hefty amount of drug seekers coming through? The answer is with common sense.

Most doctors in the emergency room have "seen it all". They have seen patients who have the medication "stolen", heard all the stories of medications being accidentally flushed down the toilet, and dealt with plenty of patients who have recently been terminated by their pain management doctor.

Most emergency room doctors will prescribe a small amount of narcotic medication for short term use. This means prescribing 2 to 3 pills per day for a duration of 2 to 3 days. Generic drugs are often utilized because they maintain pain management effectiveness that have a lower street value.

Often times long acting opioids are utilized. This version of opiates has a lower street value and a higher potential for reducing a fatal overdose. Granted, the patient can crush up the long-acting medication and abuse it, so this may not be as effective as you think. The combination medications of opiates along with acetaminophen are harder to sell and have a lower street value. Patients must be instructed about the risk of medication overdose.

Along with providing a short-term narcotic, the follow-up should be provided so that the patient can see their primary care doctor or normal pain management doctor soon after the ER visit. Detailed records should be kept because if the patient is a drug seeker inevitably he or she will be coming back to get more supplies.

It is important in this day and age to try and give patients some benefit of the doubt. One of the main reasons that a lot of patients are undertreated for their pain is the high suspicion of narcotic abuse and drug seeking. Even if the patient is slurring speech and appears high, they still may in fact be a legitimate patient. So being rational and maintaining common sense is the best approach.