Pain Control During and After Your Emergency Department (ED) Visit

Pain is a common reason many people come to the ED. Pain can be caused by injury, illness, sickness, disease or surgery. People feel pain in different ways. Many things can affect how you feel pain and to what level you feel pain. At times, pain is just a small pest and other times it can affect you in many ways. Pain can keep you from sleeping, eating, and being active. Pain can also make you feel afraid or depressed.

Pain control is a key part of your care in the ED. Finding the cause of your pain and controlling it can improve the results of your care. You must take an active role in a plan to control your pain.

Pain Control in the ED
The main goal in the ED is to find out what’s wrong with you and to provide emergency care. We want you to be as comfortable as possible during your visit, but before we can give you any pain medicine, a doctor must see you.

The doctors and nurses will work with you to find the best and safest way to control your pain. Tell us about treatments that helped you in the past. We try to provide timely pain control during your visit.

You are the only one who knows how bad the pain is. There are no tests or scans to measure how much pain you have. Pain can be a sign of a problem. We want and need to know about it, what it feels like, and how it impacts you.

Many things can affect your pain control.

• Thoughts

• Feelings

• Emotions

• Behavior
  

We may use these natural methods to treat your pain:

• Cold pack

• Heat pack

• Distraction

• Education
  

Ask What to Expect

• Should you expect a lot of pain with your injury, illness or treatment?

• What are your pain control options during your ED visit?
  

Discuss Pain Control Options

• Talk about pain control methods that have worked well or not so well for you before.

• Talk about any concerns or fears you may have about pain medicine.

• Tell your doctors and nurses about any allergies to medicines you have.

• Ask about side effects of pain treatments.

• Talk about medicines you take for other health problems, and over the counter or herbal medicines.

“Measure” Your Pain
We may ask you to describe how bad your pain is. Rate your pain on a scale of 0-10, with 10 being the worst pain. We may use other pain scales that use words and scales using colors, faces or pictures for children.

Tell us where and when it hurts. Tell us if you can't sleep or do things like dressing or climb stairs. The more we know about your pain, the better we can treat it.

Words to Describe Pain

• aching

• dull

• sharp

• bloating

• numbing

• shooting

• burning

• pressing

• soreness

• cramping

• pressure

• stabbing

• comes and goes

• pulling

• radiating

• throbbing

• tightness

• constant

• searing

• cutting
  

Make a Pain Control Plan
We will work with you to treat your pain in the ED. We will talk about a realistic pain control goal during your visit. For example, to reduce your pain enough to get through a test such as a CT scan.

You may or may not need prescription or over-the-counter pain medicine. We will explain the different kinds of pain medicines and how to use them safely for your type of pain.

Make sure you understand the plan for pain control after you leave the ED and who to call if you have any questions or problems.

Chronic Pain
Chronic pain takes a toll on your body, mind, and soul. You may feel like you have little control over what’s going on with your body. There is no magic pill or cure to relieve chronic pain. We want to relieve pain and suffering yet do no harm. Pain relief from opioid shots lasts only a short time. After this time, you may notice your pain increase and return more often. Using short-term or “rescue” opioids can increase stress and disability.

The ED is not the best place to manage chronic pain. The best way to manage your chronic pain is to work with your primary care doctor. This involves learning more about how to prevent the pain and what treatments you can use at home. In the ED, we will check to make sure there isn’t a new problem causing your pain. You and your primary doctor may need to work with a pain specialist to set up a plan that meets your needs.

Managing Your Pain
There are many ways to manage your pain. There are medicines that can be used to relieve pain. There are also other ways to treat pain without taking medicine. Your doctor will work with you to create a plan.

Pain Medicine
There are many medicines that can treat pain. They include:

• Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDS), and acetaminophen (Tylenol)

• Opioids (narcotics)

• Other medicines, such as local anesthetics
  

NSAIDs and Acetaminophen (Tylenol)
These are given for mild to moderate pain or on top of medicine with opioids for severe pain. These medicines decrease the sensitivity of the nerves to pain and reduce swelling. Options include:

• aspirin

• ibuprofen (Motrin, Advil)

• Naprosyn (Aleve)

• acetaminophen (Tylenol)
  

These medicines do not need a prescription. There is a limit to how much you can take of each of these. Taking too much acetaminophen can cause liver problems. Aspirin, ibuprofen, and Naprosyn thins the blood and can cause nausea, stomach bleeding, or kidney problems.

Opioids
These are narcotic drugs given for moderate to severe pain. They require a prescription. They block pain sensation in the spinal cord and brain. These may be prescribed as pills, suppositories, IV injections, injections near the spinal cord (spinals or epidurals), or patches. The goal is to use the smallest amount to control pain. Options include:

• morphine

• hydromorphone

• codeine

• oxycodone

• fentanyl

• others
  

Side effects may include:

• drowsiness

• nausea

• constipation

• slowed breathing
  

Constipation is a very common side effect when taking narcotic pain medicines. It can include hard stools or not having a bowel movement more than once every 2-3 days. If you have a history of constipation or become constipated, talk to your doctor or nurse about ways to prevent or treat it. You should have a bowel movement every day or every other day.

Other Medicines
There are many other types of medicines that can help relieve pain. Many of these medicines (certain antidepressants, anticonvulsants, and steroids) are very helpful when treating certain types of pain.
Local anesthetics are numbing medicines can provide short-term relief when placed on the skin or injected under the skin.

Non-Drug Pain Control Methods
There are many other ways to reduce pain. These methods can work for all types of pain.

• Cold or warm packs

• Distraction can be as simple as watching TV or reading a book, or as complex as a recording that instructs you on activities to perform

• Music

• Imagery uses your imagination to create mental pictures or situations to help reduce your pain

• Deep breathing
  

Just as with medicine, all the methods listed above may not work for you. Try a few methods, both alone and together to see which work best for you.

Pain Control Plan at Home
You will receive discharge instructions which include your pain management plan. A pain management plan lists all the ways to reduce your pain. Your plan may include a list of medicines and other non-drug treatments. If you are prescribed pain medicine, we can only give you a limited supply to manage your pain until you can see your regular doctor. You should know which doctor or clinic to contact for follow-up care or questions after you leave the ED.

Be sure the plan makes sense to you. You must be able to both understand and follow it. There is no one plan that works for all people. What works today may not be the best plan in a week or a month from now.