Visiting The Er For Chronic Pain
How to reduce stress and suspicion when seeking chronic pain medications.
Youâre a chronic pain patient who takes several prescription narcotics to control your symptoms. Then one weekend, excruciating pain lands you in the emergency room. There, a doctor grills you about your medications, in part to make sure that youâre a legitimate pain patient, not someone seeking drugs. What can you do to help the ER doctor to believe you?
Itâs not always easy to tell chronic pain patients from drug-seeking patients, says Howard Blumstein, MD, FAAEM, president of the American Academy of Emergency Medicine and medical director of the North Carolina Baptist Hospital emergency room.
Patients with chronic pain visit the ER for various complaints, he says. âSome of these patients have demonstrable disease, like sickle cell disease or chronic pancreatitis. I think that physicians are more likely to give them the benefit of the doubt when they come in and say they have pain.â
âOther patients are prone to have problems that you can never objectively demonstrate, like chronic back pain and chronic headaches,â he says. âWe just have to take their word for it. You canât look into anything and tell whether or not theyâre actually having pain.â
Regardless of which group patients fall into, Blumstein says, âthere are some patients who, because of their behavior or their frequent visits, still get labeled as being addicted to drugs or abusing drugs.â
You Recently Injured Your Back
If you are in a car accident or other serious event, its common practice to get your back and neck checked out but many people dont realize they can sustain serious injuries from less drastic events. If your pain is far more than youd expect, if it feels worse over time instead of better, or is incredibly painful, get it checked out, even if you think its minor, Dr. Anand says. Whenever you directly injure your back its possible to have a spinal injury. Another possibility is a pathological fracture where a tumor has weakened your spine and then it fractures during a relatively small event, he explains. Sometimes this type of back pain is the way people learn they have cancer, he adds.
> > > Tight Hips Try This
There are several ways to stretch and strengthen your hip flexors. One way to do this is to stand up straight, with your legs hanging over the edge. Lift one knee toward your chest and then relax it over the edge of the table. If you have tight hip flexors, youll lift your leg to your chest, while if your hip flexors are too loose, the leg will remain relaxed.
You can test the strength of your hip flexors by doing simple movements. For example, you should be able to lift your knee to your chest and pull it toward your chest. You should also be able to hold it to your chest without the help of your arms. Insufficient exercise and sitting can cause weak hip flexors. However, they are not the only causes of weak and tight hips. There are some medical conditions that can affect the function of the hip musculature, such as osteoarthritis, spinal surgery, and cerebral palsy.
There are two common types of hip flexors: the anterior and posterior hip. These muscles are located in the hip joint and help the knee rotate. If your flexors are weak, you may have a problem with your psoas. If you have this condition, consult your doctor as soon as possible. The goal of treatment is to avoid activity that can put pressure on the area. But if youre not able to do this, your physician may prescribe medications.
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When To Go To The Emergency Room For Back Pain
Back pain is a very common problem that affects almost everybody. It may be a simple and common complaint among many, but there are times when back pain becomes a symptom of a serious underlying condition. So how do we know if our backache warrants a visit to the emergency room?
The most important thing to do during an occurrence of a back ache is to monitor the symptoms. Can you tolerate your pain? Does the quality of pain resemble soreness, fatigue, or ache? Was there an actual identifiable cause such as engaging in a high-intensity sport a day or two before the onset of pain?
If you answered yes to any of these questions, its highly probable that you are experiencing muscle spasm or muscle fatigue. In such a case, it would be prudent to get in touch with your doctor, but a trip to the emergency room may be unnecessary.
If however, your backache becomes intolerable and is accompanied by other symptoms such as persistent stiffness, tingling sensation, or numbness, you may need to be provided with highly specialized medical attention or an urgent procedure conducted in an emergency facility.
Here are the common causes of backaches that require emergency medical care.
Slipped disc In between the individual bones that comprise the spine are rubber-like cushions called discs. They prevent each bone of the spine from coming in contact with each other.
Other Locations:
List Of Sciatica Signs And Symptoms
Sciatica is frequently associated with one or more of the following:
- A sharp pain that makes walking or standing up close to impossible
- Pain that radiates down one leg and also into the foot and toes
- Leg pain experienced as tingling, searing, or burning
- Chronic pain frequently affecting only one side of the buttocks or leg
- Pain that gets more intense due to prolonged sitting but may become better as soon as you lie down or start walking.
- Weakness or numbness, or difficulty when trying to move the foot, leg, or toes
- Irregular and irritating pain, or can also be consistent and incapacitating
- Symptoms that depend on the location of the pinched or irritated nerve
It is rare for sciatica to cause any damage to the tissue or sciatic nerve permanently. However, these symptoms may trigger whenever you cough, sneeze, or change positions. Some of them will trigger if you have a particular condition. For example, if a person has spinal stenosis, walking long distances or bending the body backward can cause excruciating back pain and other symptoms. If you have a lumbar herniated disc, then leaning forward will cause lower back pain.
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When Stomach Pain Is An Emergency
Stomach pain can sometimes be caused by a life-threatening condition. Some examples are:
- Bowel obstruction, which is when food or waste blocks the intestine
- Bowel perforation, which is a hole in the intestine that leaks food material
These emergencies usually cause pain that feels extreme. Your stomach pain may be urgent if:
- You are pregnant
- Your pain started within a week of abdominal surgery
- Your pain started after a procedure in your stomach area, such as an endoscopy
- You have ever had surgery on your digestive tract, such as gastric bypass, a colostomy, or a bowel resection
- Your pain started shortly after an abdominal trauma
- Your abdomen is bruised or rapidly expanding
Even if you don’t have these symptoms, get help if you feel unusually severe pain.
Sometimes stomach pain is mild at first but gets worse after a few hours. You may also develop other symptoms. Get help right away if you have any of these symptoms along with stomach pain:
- Extremely hard abdomen
- Inability to have a bowel movement, along with vomiting
- Pain in neck, shoulder, or between shoulder blades
- Vision changes
If you have these symptoms, call for an ambulance or have someone drive you to the emergency room. You should not “wait and see” or take medicine for the pain. Get help right away.
When Should I Go To The Er For Sciatica Pain
When someone suffers from a pinched sciatic nerve, it can be tormenting. Sciatica sufferers often deal with back pain or leg pain, and sometimes even weakness, tingling, and numbness join in. It frequently starts as achiness in the lower back, then the pain spreads towards the buttocks, and down through the back of the leg. The streak of pain usually affects only one leg.
Sciatica is not a medical diagnosis but rather a symptom of an underlying medical problem. Here are some possible causes or conditions that stem sciatica from happening:
- Neck or head injury
- Lumbar disc treat or herniation
- Degenerative disc disease
- Tumors growing on the nerve roots of the spinal cord
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When You Should Go To The Er
Sometimes back pain just can’t wait. For example, if you were in a major car accident, or fell from a dangerous height, you want to check for any fractures, ruptures, and dislocations. And while it’s rare, lower back pain can be a symptom of more serious neurological issues, infection, cancer, and other worrisome conditions.
So get to an ER ASAP if any of these situations are true for you:
- Have back pain associated with serious trauma
- Have cancer or have a history of cancer
- Have HIV/AIDs or are taking immunosuppressive drugs
- Have trouble going to the bathroom or can’t hold your urine or stool
- Are experiencing neurological dysfunction like leg weakness or numbness
- Lose sensation around the groin area
- Have a fever in associated with your back pain
- Have back pain that’s worse when lying down
How Long Will You Sit In The Waiting Room
The length of the average ED visit for back pain is around 5 hours. Depending on the other cases that come in that day, you may sit for three hours without being seen by a medical provider.
For someone with back pain, sitting for that amount of time feels uncomfortable, worrying and frustrating.
We know pain is increased by fear, worry and uncertainty. If you suspect something bad is going on and no one can reassure you otherwise, it is very hard to relax and move normally. This guarding and compensation is very normal to see in people with back pain, and unfortunately it can cause your pain to feel worse.
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Other Conditions That Cause Back Pain In Older Adults
We often see a range of less serious but still painful spine conditions in seniors. Most patients with these conditions will not require surgery. Physical therapy, medication, injectable anesthetics, or a combination of treatments usually can control symptoms.
- Degenerative disc disease, which can cause whole spine pain, and lumbar arthritis, which usually causes low-back pain, commonly develop with age and are considered wear-and-tear conditions.
- Sacroiliitis is an inflammation of the joints that connect your spine and pelvis. This condition can cause pain in the low back, glutes, and upper legs.
- Ankylosing spondylitis is an inflammatory arthritis that causes patients spines to become inflexible, resulting in a continual hunched forward position and spine pain.
- We also check for adult degenerative scoliosis and kyphosis, spine-curving conditions that can result in back pain and weakness in the lower extremities.
How Urgent Care Providers Can Help
Urgent care providers are a step below going to the emergency room. They often provide cheaper care for routine matters such as lower back pain. Choose an urgent care provider with good reviews, as they can vary a lot in their service.
The belief that they are inferior and designed primarily for people without insurance is no longer accurate, but still, many are not accredited. There are excellent ones as well as those that want you out the door as quickly as possible.
If there is no urgent care provider available, it is OK to go to the emergency room. However, note that your insurance might not cover the cost if they decide it wasn’t enough of an emergency.
An urgent care provider may refer you to a specialist or tell you to make an appointment with your doctor when they are available. Typically, they only provide “first line” care. However, a good urgent care provider can give you a preliminary diagnosis of what is going on.
For many cases of lower back pain, all you need is a quick check-up and possibly a prescription for a stronger painkiller.
To treat your low back pain, an urgent care provider will:
Review your medical history
ERs and urgent care providers don’t have access to your regular file, so be prepared to give them information that may seem unrelated. They may ask about your stress levels or general wellbeing, but this does not mean they think it is “just anxiety.” They ask because tension and stress can lead to muscle tightness, which can cause back pain.
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Why Go To The Emergency Room For Lower Back Pain In San Antonio
The back is a large area that comprises muscles, bones, joints, nerves, and other tissues, each of which is subjected to strain and stress throughout the day. Even simple actions like long periods of standing or sitting or sleeping on a flimsy mattress can cause strain that can increase the chance of back pain. Of course, some causes of back pain are far worse, including degenerative diseases like arthritis, overuse issues like herniated discs, and traumatic injuries like car accidents and slip-and-fall accidents. Having a back pain diagnosis exam at the first sign of back pain is the key to helping symptoms resolve as quickly as possible as well as preventing future or more severe damage.
When Back Pain May Be A Medical Emergency
The underlying causes for most occurrences of back pain are non-emergent, but the intense pain and related symptoms often elevate anxiety and prompt a visit to the emergency room . While back pain is typically treated in a primary care setting or by a musculoskeletal specialist, physicians are often cautious and look for warning signs of neurologically impairing or life-threatening causes. These causes are rare, but if present, they are considered a medical emergency and warrant immediate treatment to preserve back and/or leg function.
Though rare, acute cauda equina syndrome is a serious medical emergency. It usually requires immediate medical attention. Watch Cauda Equina Syndrome Video
Back pain is considered the most common musculoskeletal cause for emergency room visits and typically involves individuals aged 18 to 65 years.1,2
This article provides a comprehensive guide to when back pain may indicate a medical emergency and the associated red-flag symptoms to watch out for.
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Come To The Emergency Center If You Have Severe Back Pain
There is a tendency for people to tolerate their back pain because they may not understand the potential for real problems that can come from it. While back pain can be temporary and mild, it is always a good idea to pay attention to the signs of something more. Remember, if the pain is unbearable, there is a reason for it, and the best thing to do is make an emergency visit to avoid further complications.
If you have back pain symptoms that appear to be an emergency, do not hesitate to come to The Emergency Center right away. The Emergency Center provides up to 23 hours of Observation and offers 24/7 care with NO WAITING. Visit our freestanding emergency room in San Antonio, to get the care you need, or call us at 210-485-3644 for more information.
You Have Symptoms Of A Blood Clot
The American Society of Hematology says that while blood clotting is a normal bodily process, sometimes clots can form inside of blood vessels and not dissolve naturally, which can become a dangerous situation.
When an abnormal blood clot forms in a vein, it can restrict the flow of blood to the heart and cause pain and swelling as blood becomes blocked behind the clot. This is called deep vein thrombosis and typically occurs in a major vein in the legs, and less commonly in the arms, pelvis, or other large veins. In some cases those abnormal clots can dislodge and make their way to the lungs, called a pulmonary embolism, where they get lodged again and block blood flow.
Clotting that occurs in the arteries, on the other hand, is usually caused by atherosclerosis, or a hardening of the arteries due to plaque deposits. When clots show up in the arteries, they can restrict blood flow to the brain or heart, leading to a stroke or heart attack.
Dr. Fallieras says blood clot symptoms aren’t always obvious, but often include unilateral leg swelling pain, sometimes with chest pain, cough, or shortness of breath if it spreads to the lungs. According to the ASH, other symptoms of blood clots can depend on where the clot is located .
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Get Your Medical Questions Answered At Bass Urgent Care
If your lower back pain persists or worsens after trying these five home remedies, contact one of our medical experts at BASS Urgent Care. Do not simply live with your back pain. Solutions exist, and we want to help you experience much-needed relief. For questions, please give us a call at 350-4044.
When To Go To The Er For Back Pain
An ER visit is recommended when back pain indicates a medical emergency. An emergency is characterized by the probability of a serious adverse event or an incident that may result in a permanent disability. For back problems, the red-flag symptoms and signs that may indicate an emergency typically start suddenly and include some combination of the following:
- Sudden loss of sensation in one or both legs, the groin and genital area, and/or the anal region
- Inability to walk or stand
- Inability to control bowel movements
- Difficulty in passing urine or uncontrolled bladder movements
- Sudden, intolerable pain in the lower back and/or leg
- Back pain that radiates to the abdomen in front
- Loss of consciousness
- Back pain that follows a trauma, such as a fall, sports injury, or car accident
- Sudden back pain with known risk factors for a fracture, such as osteoporosis
Many of these symptoms relate to spinal cord and/or cauda equina problems in the lower back, severe damage to a spinal nerve, or organ-related damage, or a possible fracture. It is important to evaluate and treat these symptoms and signs urgently to avoid permanent tissue damage and disability.
If any of the above symptoms are experienced, visiting the ER right away or calling 911 for assistance is advised.
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