June 1, 2017

From the ER – Dr. Cade on Treating Pain and the Dangers of Drug Addiction

By Gabriel Cade, MD
Blue Ridge Regional Hospital

Pain is part of the human condition. We all experience pain, and we all have different relationships with pain.

Part of my job in the ED is to ease your suffering, to address your pain.

The beds aren’t bad. You might get a pillow. The blanket warmer is awesome. You want a soft drink? Well … maybe … let’s see what’s going on first. We can put some ice on that.

Or some acetaminophen, or aspirin. Maybe an IV?

Or morphine, or dilaudid (which is intended specifically for cancer patients). Those are strong narcotics. Do you need something that strong? It drops your blood pressure, makes you sleepy, slows down your breathing. I’ll need to keep a closer eye on you while we wait for your results.

Oh, good, it looks like everything’s okay.

We figured out what was wrong or at least made sure it wasn’t something serious. You get to go home. What about your pain? I think you’re going to be okay. The pain won’t last. You could rest. Keep it elevated. Put a warm compress on it. Take a warm bath.

Or a prescription for hydrocodone? It’s an opiate, like heroin. You’ve heard of heroin, right? It’s dangerous. It’s like that morphine I gave you. It makes you drowsy. Maybe you’ll stumble. It slows down your breathing. It’s addictive.

It works on the brain and physically changes your receptors. You need more to get the same result. It sort of feels good. That’s called tolerance. A little more, a little longer, and you develop dependence. That means if you don’t get it you don’t feel good. You miss it. Then you start working a little harder to get it. You buy it from someone, or steal it. You come to the emergency department for it. That’s addiction.

Addiction is common. You know an addict. They drink or smoke. They use meth or pills. Some people exercise, or shop or hoard. It’s not the thing, the substance; it’s a physiologic change in your body because of the pleasure of addiction that feeds itself. It’s more common with drugs, or, at least, more dangerous, because people die.

“Maybe just one more tonight.” Maybe you take more because you’re mad or sad, and you aren’t sure how to ask for help, so you do something impulsive. If you take too much, on purpose or by accident, you stop breathing.

If your addiction includes IV drugs, you’ll get abscesses in your skin and bacteria on the valves of your heart. Bacteria break off and block parts of your lung or your brain, and the bacteria grows in your blood or along your spine. You might get hepatitis or HIV. If you take too much, on purpose or by accident, you stop breathing.

If you make it to the ED in time we can save your life. If you don’t, you die.

I’ll be the one who tells your family – your children, parents, spouse – that you’re dead. I’ve done this more than 100 times. I always wonder how it started: how did you get your first pill? Every time I order a pain medicine or write a prescription I think about these 100 families.

When you’re my patient, I have to decide if treating your pain is worth the risk. If you have pain, I want you to come. I want to know. I want to help, but one of the ways I’ve sworn to help you is by protecting you from dangerous medicines you might not need.

Maybe I’m waiting until we have more information about what’s wrong with you, or I’m looking up your prescription history, or waiting for a toxicology screen on your urine. Whether I trust you – I’ve been burned plenty of times – I care about you and I want to help you, but addiction is a lot more important to treat than pain.

But, if you want a warm blanket, I can get that for you right now.

Gabriel Cade, MD, is Medical Director of the Blue Ridge Regional Hospital Emergency Department.

If you, or someone you know, is struggling with addiction, talk to your doctor, come to the emergency department, or call 1-800-662-HELP (4357).