Beardsell - Pain and Suffering in the ED
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Transcript of Beardsell - Pain and Suffering in the ED
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