The emergency department: A last resort?

Lisa had been dealing with chronic pain for years, but her medication and other treatments usually kept it under good control.  One Sunday, Lisa’s pain began getting much worse. She panicked, thinking that something really bad was happening to her and that the pain would continue to get worse.  When she couldn’t reach her health care provider she asked her husband to drive her to the local hospital emergency department. She thought someone would give her immediate help there.  Instead, she sat in a crowded waiting room for hours before talking to a busy nurse, who knew nothing about her.  Lisa had to explain her whole medical history, and was shocked when the emergency department staff questioned whether she actually needed to be given more pain medication, or any other immediate treatment.

Breakthrough pain

That Sunday, Lisa likely experienced breakthrough pain.  If you have chronic pain, you have probably had days when your pain suddenly gets much worse, even if your pain treatment plan generally keeps it under control.  This is called breakthrough pain. If possible, you should contact your regular provider to find out if you should modify your treatment plan.  But, if breakthrough pain happens when your provider is not available—like a weekend—you might feel alone and scared, making it hard to figure out what to do.

Does breakthrough pain mean a trip to the emergency department?

Breakthrough pain may be an emergency.  Unexpected or increased pain can be frightening, and it is easy to panic and rush to the emergency department.  But this may or may not be the right choice.

Why not? Isn’t that what the emergency department is for?

The emergency department is set up to deal with acute problems such as broken bones, or a heart attack, which appear suddenly and can be very serious.  The emergency department is not set up to deal with chronic health conditions like ongoing pain. In many situations, the emergency department staff may not know you, your condition or your medical history.  Don’t be surprised if they are even a little suspicious: It is their job to make sure that your symptoms are real, and that you actually need medication or another treatment right away.

A “medical motel,” not your “medical home”

Think of the emergency department as a “medical motel” – a place designed to quickly help people who are just passing through to the next level of treatment.  By contrast, your “medical home” is your regular health care provider, who coordinates all of your treatment, knows you well, and is best equipped to help you manage your pain.

As someone who is being treated for chronic pain, Lisa should have asked her medical home provider for a plan of what to do if she had breakthrough pain when the office was closed.

The last resort: when to choose the emergency department

Of course, there are times when you absolutely should go to the emergency department. Here are some examples:

  • If you have unexpected, severe side effects from your prescription medications
  • If you have extreme confusion or dizziness or other major change in your thinking
  • If you have uncontrolled nausea and vomiting and are unable to take in fluids
  • If you have unexpected, excruciating pain that is different than your usual pain, and you think needs immediate attention

Keep good documentation of your medical history, your health care providers, and your prescribed medication nearby, so you can take them with you when you go to the hospital.

The bottom line

When you suffer from chronic pain, it may seem as if you have twice as much work to do when your pain flares up and your health provider can’t be reached. You need to learn to recognize “normal” changes in your pain, how it may sometimes be worse than usual, and how to figure out when things just don’t feel quite right and you should seek medical attention sooner rather than later.  Your healthcare provider can help with this, and help you figure out in advance how you should react.  It’s almost as if you need to be more in touch, and listen closer to your body. Learning to listen to your body can be hard, but it is also a great way to take control of your health!