Visiting The ER
When to visit the ER
When you live with chronic pain and you’re in pain a lot of the time, how do you know when to visit the emergency room? Firstly it’s important to know that you have a right to seek emergency help for your chronic pain, just as much as anyone does for their acute pain. However, it’s also important to remember that the ER is for emergencies, and it’s best to use your doctor, specialist and other resources where possible.
Before visiting the ER you should think about the following:
- Have I tried everything I possibly can to manage my pain at home?
- Have I tried contacting my doctor or specialist?
- If my pain isn’t well managed, could I advocate for/seek better treatment outside of going to the ER?
- Is this an emergency?
- Are my expectations for visiting the ER realistic?
- Is going to the ER likely to help me?
- If I’m frightened right now, are my fears grounded in reality?
- Is my life at risk?
You could consider going to the ER if the following occurs:
- If your pain is worse than it has ever been before
If your pain level is worse than you have ever experienced before, is not responding to usual management strategies and you’re unable to go to the doctor, it’s a good idea to get checked out to rule out any other causes.
- If you are experiencing any severe new symptoms
If you have a severe new symptom and are unable to see a doctor, it’s important you seek guidance to ensure there’s no other cause. For example, if you have a high fever, a severe skin rash or any numbness.
- If you are so much pain that you are simply unable to cope
If your pain is so bad that you’re unable to get up, can’t think straight or are crying out in severe pain (and none of your usual pain management approaches are working) you should go to the ER to get help.
- If you experience any ‘typical’ emergency symptoms
If you experience any symptoms for which you would usually be advised to call the emergency services (such as shortness of breath, chest pains or a fall), ensure you do so. Don’t put any serious symptoms ‘down to your chronic pain’ and overlook them.
What to expect when you visit the ER
Every country is different and each hospital can be different. These are simply rough guidelines of what you might be able to expect if you attend an ER. If you arrive at the ER via ambulance you will likely be taken straight to a bed in an assessment area where the staff can monitor you, assess what’s going on and decide how to help you.
If you travel to the ER yourself, you will first speak to a receptionist about what you’re experiencing. You will then be asked to wait in a waiting area. Bare in mind that waiting times can be very long, sometimes hours at a time. Even though this is frustrating, it’s normal as the staff try to deal with life-threatening cases as a priority.
You may be taken to a triage area which means that a nurse or doctor will evaluate you, take your vitals and ask you questions. They’ll try to establish what is going on and figure out what level of priority your health issues are. You’ll usually then go back to the waiting area until you can be seen by a doctor. Once you’re called through, you’ll be taken to a bed and the doctor will come to assess you.
Once you’ve been seen by a doctor, they’ll decide whether they can offer you short-term treatment, or whether you should be transferred to a ward for further tests and treatment. If you are discharged, your regular doctor should be informed of the ER visit including what treatment or guidance was offered. You may be asked to follow up with your doctor in the coming days.
Which treatment options you may be offered
There are minimal treatment options available in an emergency room setting for those with chronic pain. Unfortunately there is a likelihood that you will be assessed and have some basic tests performed to rule out other causes, and provided the tests are clear you will be sent home. You may be advised to contact your doctor the next day to try and access better chronic pain treatments. If another cause is identified, then treatment will proceed from there.
You might be offered over the counter treatments and painkillers for your chronic pain. Sometimes you may be offered short term, stronger painkillers to help reduce your pain. These are usually narcotics (also known as opioids) and will be given within the hospital setting. Sometimes they will be given intravenously, meaning directly into your vein.
If you are transferred to a ward, you may also be given other treatment options. You may be offered a TENS machine. This stands for Transcutaneous Electrical Nerve Stimulation. A TENS machine is a fairly small machine attached to specific areas of your body with sticky pads. The machine sends out electrical signals which interrupt pain messages to bring some relief. This isn’t painful or invasive and can be helpful in the short term. There’s also a possibility you will be offered sedatives to help you to relax and sleep.
It’s important to ask the doctor at the hospital what will happen next once you’re discharged. ER visits should be followed up with your regular doctor so that you are given more appropriate treatment and to minimise the chances of you needing to attend the ER again. You deserve to have effective treatments for your chronic pain.
Over the coming years hopefully this will become a more standard approach. This 2019 study on the topic concluded, “training ED physicians in various approaches to the management of chronic pain and connecting EDs with pain management programs to ensure appropriate follow-up care are important steps to improve the overall care of patients with chronic pain.”
Advocating for yourself
Unfortunately stigma means that you may face medical professionals who are less than understanding in the ER. They may be disbelieving of your pain or assume you are there simply to try and get strong pain medication. This study explains that out of a survey of 250 pain patients, “Forty-four percent of respondents felt they were treated with dignity and respect by ED staff and only 22% were satisfied with their treatment.”
If you are treated badly, remember that you can ask to see another doctor or make a complaint. You deserve compassion and appropriate treatment, just as everyone else does. Don’t settle for less than that!
You can advocate for yourself by being persistent, calm and firm (even in the face of someone who is not treating you fairly). Answer all of the questions the doctors ask you as clearly and calmly as possible, even if the questions seem strange to you. Try to understand that the majority of staff are sticking to protocols to try and keep patients safe.
Be clear in the statements you’re making explaining what you’re feeling and why this may be different to your ‘normal’ chronic pain experience (basically explaining why you’ve asked for emergency help). If you have someone with you, you could ask them to speak up for you.
If you are going through a lot, at the time you may not be able to think clearly or stand up for yourself. This doesn’t mean you can’t complain! You can make a complaint after the event if you were treated unfairly.
It can be a great idea to have a plan prepared in the event you need to go to the emergency room. Even though you shouldn’t have to ‘prove’ yourself, giving the doctors as much information as possible will help you to get the help you need. You could:
- Arrange who will go with you so they can help you to advocate for the treatment you need.
- Write down your diagnoses clearly along with symptoms you experience. If you have a doctor’s letter that shows this, even better!
- Take written details of any doctors or specialists you see regularly (including their contact details)
- Take written details of any treatments or medications you take.
- You could even take medication bottles or packages with you.
- If you are in a country where you pay for your medical treatment, take any insurance documents or payment information with you.
This article from an emergency room doctor advises writing a one page summary of your condition and “then ask your doctor’s office to put it on their letterhead with an additional list of diagnoses, allergies, recent lab tests, medications, and any treatments to avoid.” This could also save you getting any tests done that you’ve already had recently.
On your way to the ER it’s a good idea to think about how you are going to describe your pain accurately, so that you are prepared to give the doctor as clear a view as possible. For example, think about whether the pain is stabbing, shooting, or dull; consider if the pain is constant or is coming and going; think about exactly where the pain is. This will help you to give a clear answer when you are asked.
How To Cope At Home
Coping with very severe pain can be a harrowing experience, but there are some ways you can try to deal with the experience at home.
Heat and cold
Using heat and cold can bring some relief by interrupting pain signals for a short time and reducing pain. Using cold can also reduce inflammation. You could use cold or heat packs which you can buy and apply to the skin or on top of clothes. These typically last for a few hours. Alternatively you could use ice packs or a cloth dipped in ice water to provide a cooling sensation. Hot water bottles or rice packs which you heat up in the microwave can be used to generate heat.
Over the counter topical medications work to temporarily interrupt pain signals. They typically come in a gel form which you rub onto your skin or in a spray for easy application. They may cause either a cooling or heating sensation, typically accompanied by a tingling feeling. You can put this on as many areas of your body as you like at once, which can be helpful if your pain is widespread.
Over the counter pain medication
While there’s no guarantee that over the counter medication will help, sometimes painkillers or anti-inflammatories can ‘take the edge’ off severe pain slightly, making it a little bit easier to cope with.
Taking your prescribed pain medication
If you have any regular prescribed pain medication make sure you’ve taken it. If you have any prescribed medication you’re able to take when your pain is more severe (such as stronger painkiller or sedatives to help you rest), you should utilize these.
Stretching and light exercise
While of course rest is important when you’re flaring, if you can manage some light stretching and gentle movement this can help to ease muscle stiffness and alleviate symptoms slightly.
Getting your feelings out
Although it’s important to stay positive (and how we perceive and talk about our pain can affect our pain levels), it’s also important not to bottle up your feelings. Dealing with overwhelming pain is a horrific experience and it can make you feel really emotional. If you want to cry, cry. If you want to scream, scream. Give yourself that release and don’t be too hard on yourself. Sometimes once you’ve released those emotions you can refocus and start to regain control, allowing you to more effectively manage your flare up.
Using positive mantras
You could prepare some positive mantras in advance so that when you’re having a flare, you have your mantras ready. Saying your mantras out loud over and over again can be comforting, as well as giving you something to focus on. If you prefer, you could simply ‘think’ your mantras.
You can make your mantras personal to you. Mantras which are short and easy to remember tend to be the most effective. A few examples of mantras are included below:
- “This will pass, and I will get through this.”
- “I am strong, I am powerful, I am brave.”
- “I will be ok, I can do this.”
- “I am not alone.”
Being in so much pain is a very distressing experience. Your stress levels will be soaring and it’s likely that you’ll be afraid. If you can, engaging in some mindfulness can be a great way to ground yourself and calm your emotions. You could listen to a guided meditation while lying in bed (this might even help you to fall asleep and get some rest).
A guided progressive muscle relaxation (PMR) session could help you to relax your muscles and ease some of your pain. You could have some meditation audio picked out in advance so you’re prepared for a flare. Don’t worry if you’re not able to follow along perfectly; sometimes just the act of listening to a calming voice and knowing you’re doing something to try to take control can be enough to make you feel comforted.
Even if you don’t feel up to listening to a meditation, you can use mindfulness skills to help you feel calmer. Use your senses (trying to focus on things other than your pain). Think about what you can see. What colours are around you? What objects are in the room?
Consider what you can smell. What you can hear? Are there noises from outside or from elsewhere in your house? What can you touch? Perhaps you can feel a soft blanket over you or your mattress beneath you. .
Massage can often provide some pain relief. You could ask a loved one to give you a gentle massage if they feel comfortable doing so, or you could use a self-massage device. I have a massage mat which you simply lie on top of and it gives a gentle massage: I find it eases pain greatly.
Although it can feel impossible to distract from such severe pain, trying to take your mind off it (even just enough so that your focus is not solely on the pain) can really help. Use any distraction that you can think of. You could listen to your favourite music; watch TV; talk to a loved one or do some arts and crafts.
Once the severe pain starts to pass and you can think straight again, use this horrible pain experience to revamp your approach to pain management and relief. Consider a pain therapy program like ours (app download links dotted around this post) so that you can really understand all factors that increase pain, and develop new strategies to deal with pain. From short-term techniques such as distraction and meditation, to physio, mindful movement, and CBT.
Things To Remember
Just like positive mantras, there are a few things that you can remind yourself of when you’re in a lot of pain to fight fear and reassure yourself.
The sensation of pain itself can’t kill you
Even though it feels awful, and sometimes it might feel as though you’re dying, the sensation of pain in itself can not kill you. It does not have that power.
This will pass
Flares will pass. You are not going to feel this way forever. This pain will ease. It’s important you remember that, even when it feels like it’s impossible. Remind yourself that this will pass.
Chronic pain doesn’t equal damage (even when it’s severe)
While acute pain means that there’s damage within your body, chronic pain does not. Chronic pain is like a faulty alarm system, sending out pain messages even when there’s no threat or ‘reason’. So even if you’re experiencing severe pain, it doesn’t mean there’s severe damage.
Flares don’t mean your condition is worsening
It’s important to remember that just because you’re having a flare in symptoms, it doesn’t mean that your condition in general is worsening. It doesn’t mean that any progress you’ve made on your chronic pain recovery journey is invalid. It does not mean you’ve failed! It’s simply a bump in the road, and once it’s passed, you’ll be able to resume overcoming your chronic pain.
Life can be beautiful
Sometimes when you’re in a great deal of pain it can understandably put you in a very negative mindset. It can be hard to see anything positive. It’s really important you remind yourself that life can be beautiful, and that there are lots of positives in your life despite your chronic pain.
There is hope
Finally, never forget even in the darkest of times that there is hope. There are ways to avoid a pain flare and visiting the ER. There are many chronic pain treatments with scientifically proven results which can help you to reduce your symptoms and live a full life. If you haven’t been able to access them yet, now is the time to start looking. There are ways you can self-manage your pain and live well in spite of your chronic pain.
- Rebecca N. Small, Yaadwinder Shergill, Steve Tremblay, et al, (2019), “Understanding the Impact of Chronic Pain in the Emergency Department: Prevalence and Characteristics of Patients Visiting the Emergency Department for Chronic Pain at an Urban Academic Health Sciences Centre”. Canadian Journal of Pain, Volume 3, 2019 – Issue 1, Pages 106-113
Todd, K. H., Cowan, P., Kelly, N., & Homel, P. (2010). “Chronic or recurrent pain in the emergency department: national telephone survey of patient experience.” The western journal of emergency medicine, 11(5), 408–415.
Amy Baxter, MD, FAAP, FACEP, (2019), “Communicating What You Need in the Emergency Department”. Practical Pain Management.
Please note: This article is made available for educational purposes only, not to provide personal medical advice.