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All ED intubations should be considered potentially difficult, and going through this checklist will ensure you are optimally prepared. Pain is one of the most common reasons for patients seeking care in EDs, accounting for up to 42% of all emergency room visits. Prescription drug abuse and misuse is a growing epidemic throughout the United States, and more and more emergency physicians are encountering drug-seeking patients in daily practice. Studies have been conducted on screening tools to identify drug-seeking behaviors in chronic pain patients, but few have provided quantitative data on such behaviors in the ED. A retrospective chart review of 152 drug-seeking patients and of age- and gender-matched controls was conducted, with the authors noting several drug-seeking behaviors that were exhibited over 1 year.
The odds ratios for both requesting parenteral medication and reporting pain levels greater than 10 out of 10 were significantly higher than all others observed in the study (Table 2). Tamayo-Sarver JH, Dawson NV, Cydulka RK, et al.Variability in emergency physician decision-making about prescribing opioid analgesics.
I too have chronic pain due to many different causes from musculoskeletal pain to Crohn’s disease so I feel your pain with this stuff. I arrived at a local, affluent neighborhood, ER, and was dropped off at the door by a friend I had asked to take me to the hospital.
I knew that he had other commitments, so I assured him that I could grad a cab home, once I’d been seen. I entered the ER on my own, quite dirty, unshaven, and advised them right away that I was currently un-insured, un-employed, had no PCP, and was effectively broke. I repeatedly expressed my concern regarding the level of pain I was in; expressing that I was worried that I had hurt myself badly, and did not know how I was going to pay for it. After almost a full year of thinking I was slowly recovering, I managed to secure insurance via a new employer.
After hearing the same diagnosis from three different sources, I decided that I would have to let the specialist perform surgery.
Within the Dr’s notes, I find that he documented my extreme distress, wailing, and my concern over the injury, and how I was going to pay. Almost two years have elapsed now, since that night in the ER, and I know that the malpractice statute of limitations is approaching within weeks.
I did actually call them at one point, and was advised that they would bill me, but that I would have to pay $100.00 before even being seen.
Additionally, a medical professional, an actual Doctor, had assured me that I had simply sprained my wrist.
I recall having sprained my ankle once, but can’t recall any follow-up being required. I have approached the hospital’s patient relations staff, who promptly advised me that I am mistaken, and turned my complaint over to their Risk Management department, who has stated that their specialists do not see the injury in the original x-rays, so they will not accept my claim. If you have cancer, you would be better of treating it with medical marijuana along with your paych. I’m a new nurse, and have been reading up on determining the difference between pain seeking patients and patients truly in pain. Jane, it is actually very common for normal pain management to include narcs with Benadryl or Phenergan to relieve the possible side effects of the narc. I would also like to point out that many cases I think it is very similar to our super bugs now.
I would never say go against guidelines on any medication or give drugs against MD orders but to say that the patient is drug seeking because they are always saying it is a 10 is not justified.
Grover, MD, has indicated to Physician’s Weekly that he has or has had no financial interests to report.

New research on drug-seeking patients in the ED has worked to quantify how frequently several strategies are used by drug-seeking patients to obtain medications.
Emergency physicians vary widely in prescribing patterns and often have difficulty assessing patients’ level of pain. Drug-seeking patients accounted for 2,203 visits to the ED, averaging about 14.5 visits per patient per year. These were the most predictive of drug-seeking behavior, while a non-narcotic allergy was less predictive. Emergency department frequent user: Pilot study of intensive case management to reduce visits and computed tomography. Clinical inquiries: is there a well-tested tool to detect drug-seeking behaviors in chronic pain patients? Emergency management of chronic pain and drug-seeking behavior: an alternative perspective. Grover’s comment about the need of further research in the field of pain is very germane.
My major concern is that ED doctors might be operating under the delusion that it’s somehow possible to determine whether a patient is truly in severe pain or whether they are faking it in order to get high. I’ve had Acute Myloid Leukemia before and fighting that was a cake walk compared to fighting chronic pain from degenerative disk disease. Now one thing I want to point out is someone who is physically addicted to narcs are going to be in pain, so they are not in essence lying about their pain.
Are we going to not treat patients that have a resistant bug because they more than likely took ABs inappropriately. The Pediatric Drug Chart, Eigth Edition makes it easy for physicians, medical students, paramedics, EMTs, nurses and NPs to look up correct pediatric drug doses in the field.
There may also be reluctance to provide pain medications due to concerns that patients are trying to obtain prescription drugs for non-therapeutic purposes. Grover and colleagues performed a case-control study examining the relative frequency of various drug-seeking behaviors in drug-seeking patients as compared with all ED patients. For the control group, patients accounted for 315 visits to the ED, which is an average of 2.1 visits per patient per year. However, the odds ratio for a non-narcotic allergy was greater than 1, and was still a behavior that was more commonly used by drug-seeking patients than the control group. I have 2 herniated disks and there have been times that the pain gets so horrible that I just couldn’t take it anymore. ED doctors must come to the realization that a considerable amount of harm can come to those patients who are really in pain but the doctor walks into the situation with the belief that he will be able to apply a well set rule which he either believes is foolproof and is confident that he can tell the fakers from those truly in pain from the substance abusers trying to get high. Almost all doctors seem incapable of understanding what chronic untreated pain can do to a person’s mind. Patients in the drug-seeking arm reported their pain level as 10 out of 10 more often than control group patients (Table 1). For other studied behaviors, the confidence intervals were too wide to allow the authors of the study to meaningfully interpret the data.
On the other hand, patients with narcotic abuse and dependency often exaggerate pain complaints in order to get their desired medication. It is very well documented that over use of Tylenol can cause liver problems but since it is not an NSAID it shouldn’t cause stomach ulcer or stomach bleeding problems like ibuprofen or aspirin.
If a patient with severe chronic pain walks into an ER its because they have wrestled with making the decision to seek help knowing that he might be branded with the title “narcotics seeking behavior” which will do considerable harm to the patients state of mind all for the sole reason of worrying about letting a substance abuser fool the doctor into giving them narcotics for recreational use.
Being dismissed as being “weak minded and not able to suck up the pain” is an absolutely horrible thing to put on a person who has suffered as much as I have.

Also, when a person goes to the ER it’s because their pain has become too much for them to handle on their own. Of course they will hurt because they are detoxing from the drugs we gave them and we did not order a consult for pain management or someone who can work through this secondary issue. Additionally, drug-seeking patients occasionally complained of pain levels greater than 10 out of 10, while the control group had no instances of these events.
Chemical dependency can become a major motivating factor for patients to seek emergency care. The damage to the psyche can be so severe as to cause the person to commit suicide or at least make an attempt. You then need to take into account the fact that anybody who is in pain wants not to be in pain and the faster the better. Drug-seeking patients were also significantly more likely to request medications parenterally.
Unfortunately, it’s nearly impossible to definitively determine if they’re seeking care in an attempt to get medications for non-therapeutic reasons.” The current literature on drug-seeking patients consists largely of small studies, according to Dr.
Nothing on the face of this planet is worth risking that from happening merely so that the doctors ego doesn’t get bruised by allowing himself to be fooled.
Please don’t judge us too harshly because people like myself who live with chronic pain want our pain to go away as soon as humanly possible. 500 mg acetaminophen = Vicodin while 325mg of acetaminophen= norco and 300 mg of acetiminophen= xodol. I tell the dr that what my condition is and that even though yes I am being treated for pain at that moment the pain is just too much for me to handle and that my medication isn’t helping as much as it should.
They’ve always been great well with exception of one dr but everyone else has been great. When we with chronic pain go to an ER then you can be certain that we’re at a level of desperation for the pain to stop that we are willing to endure the terrible irritation of waiting in an ER. I’m not saying you are not in the pain you are in but being as consistent and accurate with the info you give plays a big role in how they view you from the start. They always give me pain treatment and usually do an x- ray to make sure I didn’t hurt myself in some way and may not know it. Next, I will say that I like the approach of reporting them as a means to waste their time. It’s a well-established fact that anxiety magnifies the perception of the pain that someone is experiencing. They certainly have no problems playing games and wasting ours and we are still forced to pay in the end for a service that wasn’t acceptable for us and we all know how precious their time is to them just by how much of a hurry they seem to be in and interrupting patients and having a rushing type of attitude constantly so I do like that method of retaliation. For the record, I was not trying to attack you in the first half of my response, just trying to inform you and maybe help find a reason why they may be so hard pressed to give you something stronger. I had an ovarian cyst and I was driving while I was driving I had such sharp pains that I had to pull over so I was close to the ED and I went in and told them what was up . It infuriates me cuz I came for pain relief and I could sit at home in pain for free without dealing with childish games that I have to combat and fight about which makes my pain and blood pressure skyrocket! So I came to my hometown ED and they were awesome, I had been awaiting surgery for this issue however they got me on IV pain meds .
They did a ultrasound and what the other ER failed to treat and could have been dangerous was that my ovary had been tortioned and it was in a dangerous position.

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