Pain & Suffering in the EDIain Beardsell (@docib)

Consultant in Emergency MedicineUniversity Hospital Southampton

Associate Editor (Social Media) EMJ

SMACC = Sexy

Trauma

Airway

Cardiac Arrest

ECMO

Euboxia

Pre Hospital Care

Echo

Top Gun

Poison

Gadget

DogmalysisBurns

Glycocalyx

Emergency

Neuroprotection

BleedingDamage Control

Starvation

Danger

Sepsis

Airway

Airway

Pain & Suffering in the EDIain Beardsell (@docib)

Consultant in Emergency MedicineUniversity Hospital Southampton

Associate Editor (Social Media) EMJ

Chronic Pain in the EDIain Beardsell (@docib)

Consultant in Emergency MedicineUniversity Hospital Southampton

Associate Editor (Social Media) EMJ

Mrs PBPC – Exacerbation of chronic back painHPC – Chronic pain since RTC 40 years ago– No new neuro symptoms– “I can’t cope doctor”– “Please help me”

Mrs PBDH– MST 120mg bd– Oramorph PRN– Pregabalin– Amitryptilline– Baclofen– Diazepam PRN– Dorsal Column Stimulator

Mrs PBO/E:– No abnormal neurology– PR “normal”

Plan– “Analgesia”– AWBR

No one wants to be a patient in an ED

Pain = Suffering

Acute pain is necessary

Chronic pain ≠ Acute Pain

Predisposing factors• Psychological and physical abuse in childhood• Social exclusion• Catastrophizing• Social standing• Post pubertal women

What we say matters

Fabricated Illness ≠ Chronic Pain

Chronic pain is real suffering

What can we do?

Back to Mrs PB......

Chronic pain is real pain

The physiology is different to acute pain

Listen. Manage expectations. Make a plan.

With thanks to Peta Beardsell for giving her full consent and @emmanchester, @_Nmay and Dr Cathy Price for guidance and advice