In my knowledge and short practice in Emergency medicine and OP management, the worst pain is seen in patients suffering from neuropathies, to be exact- pain of neuropathic origin. It may be due to a nerve entrapment or nerve root compression due to fibrosis or cancer metastasis or a local invasion of tumor.
What made me give a thought about it today, is a patient who came last night. In contrary to the usual row of ureteric colic patients who come in midnight and early morning, about five patients came with various limb pains last night. Two of them had history of LBA with acute exacerbation of pain radiating to legs, another with history of peripheral vascular disease, another with arthritic pain and one girl with right arm pain.
The girl had a history of right shoulder injury three months back , now complained of radiating pain to arm. She is already under the followup of Neurosurgery and they have detected some mild compression around cervical nerve roots in MRI. She had already received a shot of Diclofenac before she came in. She was on oral Pregabalin and Tramadol-acetaminophen. She was crying out in severe pain. The family members were trying to console her. I had to give her Tramadol followed by two doses of morphine and Phenergan along with oral Gabapentin with 45 min to 60 min interval between each. I am not sure whether its due to drug's effect or exhaustion of crying for continuous 6 hours, she finally fell asleep. Needless to say then I began to worry whether these opioids are going to cause any over sedation, so I kept watch on her for some time. She was only lightly sedated. So I could finally sent her home with an oral prescription.
Definitely in a ER, you will come across so many types of pain, and a pain which is not resolved by the first and second stage analgesics is going to be a pain in your neck.
PS: Whenever I hear the term neuropathic pain, the picture that comes to my mind is the grimacing face of House MD.
What made me give a thought about it today, is a patient who came last night. In contrary to the usual row of ureteric colic patients who come in midnight and early morning, about five patients came with various limb pains last night. Two of them had history of LBA with acute exacerbation of pain radiating to legs, another with history of peripheral vascular disease, another with arthritic pain and one girl with right arm pain.
The girl had a history of right shoulder injury three months back , now complained of radiating pain to arm. She is already under the followup of Neurosurgery and they have detected some mild compression around cervical nerve roots in MRI. She had already received a shot of Diclofenac before she came in. She was on oral Pregabalin and Tramadol-acetaminophen. She was crying out in severe pain. The family members were trying to console her. I had to give her Tramadol followed by two doses of morphine and Phenergan along with oral Gabapentin with 45 min to 60 min interval between each. I am not sure whether its due to drug's effect or exhaustion of crying for continuous 6 hours, she finally fell asleep. Needless to say then I began to worry whether these opioids are going to cause any over sedation, so I kept watch on her for some time. She was only lightly sedated. So I could finally sent her home with an oral prescription.
Definitely in a ER, you will come across so many types of pain, and a pain which is not resolved by the first and second stage analgesics is going to be a pain in your neck.
PS: Whenever I hear the term neuropathic pain, the picture that comes to my mind is the grimacing face of House MD.
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