Chronic Pain and Suicidal Ideation
If you tell me that that your chronic pain is so bad that you are thinking about killing yourself, then I'm not going to administer any opiates to you in the ER but I'll gladly arrange a psychiatric admission for you. You've had a sad and painful life for many years - I seriously doubt that another shot of Dilaudid is suddenly going to make your world full of rainbows and unicorns.
Once you drop the S bomb, either you're really suicidal or you are a manipulative scumbag. Either way, the administration of opiates in the ER is unlikely to be beneficial and is relatively contraindicated. I doubt they are going to give you parenteral narcotics at the psych facility, so you might as well start to come to terms with your psychiatric condition. Suicide may be painless, but manipulative "suicidal ideation" is painful for everyone involved.
Pick one - pain crisis or suicidal ideation.
You can't have both.
Once you drop the S bomb, either you're really suicidal or you are a manipulative scumbag. Either way, the administration of opiates in the ER is unlikely to be beneficial and is relatively contraindicated. I doubt they are going to give you parenteral narcotics at the psych facility, so you might as well start to come to terms with your psychiatric condition. Suicide may be painless, but manipulative "suicidal ideation" is painful for everyone involved.
Pick one - pain crisis or suicidal ideation.
You can't have both.
Labels: drug-seekers, pain
posted by scalpel at 8:42 PM
16 Comments:
Reading this originally on Google Reader-- which just shows the wording, I started singing to myself-- "suicide is painless,......"
Then I check for comments here, and what do you have as mood music?
An excellent music choice. I am still laughing.
I just wrote about that song in one of my blogs yesterday. :)
I LOVED M*A*S*H btw. I think of that show whenever I here that song. :)
Good post!
You really are inviting the crazees aren't you?
What if your QoL is so low from the chronic intense pain that you can't enjoy anything in life. The suicidal thoughts might be legitimate
Kevin-
Then the patient belongs in pain management / therapy, not the ED.
My only trip to the ED was due to a lower back injury and I was in horrible pain without the ability to lay down or barely walk. I could only form this awkward bending over "position" which would produce merely moderate pain. It was a Friday and I felt the glean of the ED staff trying to discern my exact motives as I wretched in agony. I eventually was given IV hydromorphone 3-4 times and sent home with 3-4 days worth of either hydro or oxymorphone tablets. I only mention this because I wonder if the brain produces some sort of neurochemistry that inhibits addiction in the presence of genuine pain, because I do not recall a moment of this experience as pleasurable despite my understanding that these narcotics are often sought for abuse.
I definitely agree that he does not belong in the ED, I'm simply saying suicidal ideation might not be completely bs if his pain really is unmanageble
I agree. I could imagine how chronic pain would wither one's quality of life, but once you drop the S-bomb (Good term) then off you go to psych. Period. I bet after one thorough pysch evaluation a drug seeker would be less likely to try that route again.
I'm also curious, does the actual presence of pain help not getting high off narcotics? Does the level of pain correlate to the amount of narcotics it would take to get high or does dependence just amount to total abuse over a long period of time?
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I suffer from chronic pain, more recently than a few years ago, the only time I have had to go to the ER was when I developed a migraine , soon after my neck was "cracked" by the Chiro, (never went back after that to him either) it lasted for a good 5 days, then I started throwing up and getting weak while wretching in servere pain!! I finally had to go to the ER, they took me in right away, ( BP was extremly high) they started an IV, summond a CT to make sure it was nothing else, and then I had to wait for any meds untill the scan came back!! all the meanwhile the ER doc was very sympathetic explaining to me he couldn't give me much of anything excewpt Toradol, which didn't even touch my agony!! FINALLLYYYYY I recieved a shot of Dilaudid then a few after one more shot!! he came in again and asked how I was, I smiled and said Thank You! nuff said!! that was my only trip to the ER, and I havn't had a migraine since!! THank The good Lord!! so I can see your point scalpel, and those drug seekers know exactly how to fake my condition that I really truly had!!!!! well said Scalpel, your fan, Stacy...........
I think suicide doesn't always come about due to psyciatric problems. If you are severely ill and have been for long periods of time and there seems to be no solution to the problem, suicide might seem the best net sum solution.
I was very sick a few years back. I would be okay in the morning but by 3 pm was shaking, my BP would change from 120/90 to 70/50 by the afternoon, could barely walk across a room, and couldnt lift my arms above my head as they were so weak, accompanied by waves of lightheadedness and vertigo. I think I saw about 20 different drs over a course of five months, all who thought it was endocrine, except for the two endocrinologists. I could no longer function at work or take care of my child. I was useless.
I was planning to kill myself that fall. I wanted to turn thirty. It was not a choice made out of depression, but more practical hopelessness. Why continue to burden those around me? My husband later left me as a result of being ill.
Now I am not sick-at least not like that-and I work 60 hour weeks, travel for work all the time, have two cute cuddly kids and make six figures. Oh and I also dont have suicidal urges. Funny how they went away once I could function and be a productive human being.
These guys dont belong in the ER but I can see why they end up there sometimes. Where else do you go when all else has failed?
Yeah, let's put the blame on the patient for choosing the wrong healtcare modality when they're in terrible pain. Showing up at the ED when they should be in a pain management program. Shame on them. Let them suffer.
Psychiatrist are LEGAL DRUG DEALERS. Anyone whom has experience pain knows this. The so called "cure" only enhances the "option" of death and releasing pain. It is not kind to let people live in PAIN. The body want to go................ I think your site is very immature and rather silly. The "body" talks; it tells one when to "let go". Gee I doubt I get your approval: I'm a REALIST.
What a sad thing to read. I just googled "in chronic pain and thinking about killing myself" and this is what I found. I am in chronic pain and I think about killing myself often. At least I'll know not to tell the ER that, next time I'm there. What makes you think that this poor person, who wants to die from the pain they are in, is any less deserving of pain medication because they are having a mental health crisis over it? Have you never been in sustained, life-changing pain you have no control over? You have absolutely no idea how demoralizing it can be to lose everything you value because of illness... your work, your intimate relationships, the quality of your life. Damn right, I am suicidal sometimes, especially when the pain is at its peak. What a callus post to read. And from a medical professional who should be focusing on "doing no harm". Why does it have to be either/or... I pity the patient who confesses his true feelings to you.
As a chronic pain sufferer I concur with the above poster. Why does it have to be either or but rather a combination of medical and mental health treatment.
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