# Alcohol affect pain?



## babygirl2882 (Aug 17, 2007)

Haha today I had a ride along and we got 4 calls...to false alarm fires a sick person and a pretty good one. A guy was parked behind a dump truck and the dump truck back up on him. It was way out in the the hills of the super-de-duper small town right next to up so we went to assist. 

It took about 15 minuets to get out...his arm was sticking out the window and it got pined...pushed in about 4 foot. Lacerated his upper arm horizontally, with fat showing and below it (not exactly sure I didn't see it when we got there he was already bandaged.) Was thought to be a possible compound fracture. They got him in the back started Iv (saline I think?) He told them it was about a 6-7 out of 10 pain. They got him comfortable and he told them that he had two beers earlier that day and they had no effect on his driving or anything. He was given 5cc's? of morphine that didn't have any affect, so about 10 minuetes later 5cc's were given again. Still with no affect.

_Then as we got going he then said that he was a chronic alcoholic._ Thats my question, would being an alcoholic have an affect on his pain tolerance? Because the paramedic in the back said it was a pretty bad wound and he should have been in more pain because he told them that he had a very low pain tolerance and also said that he had never gotten hurt this bad before...


just to clarify I was observing only


----------



## Onceamedic (Aug 17, 2007)

Pain is an extrodinarily subjective thing...   I don't know about alcohol, but I know that some people with disassociative disorder can literally think pain away... not feel a thing.   There are others with conditions that make seemingly innocuous injuries excruciating.


----------



## Ridryder911 (Aug 17, 2007)

I agree that pain is subjective and one has to careful in evaluating it. Patients with chronic alcoholism may have medical conditions that might change or alter pain perception. Neuropathy and poor sensory perception can cause alteration. 

As well, since most medications are processed through the liver, and many alcoholics have diseased livers one has to be cautious in the amount and understanding the changes as well associated as in clotting, and other disease processes. 

p.s. doubtful the Morphine dosage was 5 cc/ml; probably 5mg....

R/r 911


----------



## babygirl2882 (Aug 17, 2007)

Ridryder911 said:


> p.s. doubtful the Morphine dosage was 5 cc/ml; probably 5mg....


 
Just curious what the differance?


----------



## Aileana (Aug 17, 2007)

In the past, alcohol was used as an analgesic, sometimes as the only anesthetic given before amputating. So yes, it does slow down the CNS, "numbing" the body, but after frequent use, the body builds up a resistance to the effect of alcohol, and if this man was an alcoholic, I doubt the 2 beers would have done much for him (well, depends on the size of the beers, I guess ). 
He may have had an underlying condition, like chronic pain (for which he was self-medicating) that could distract him from the pain or up his pain threshold, and perhaps he was on some med with a similar effect for the condition. (Sorry, I'm probably rambling a lot, just finished a 60 hour week teaching karate to 36 children...).
Not sure about this, but wouldn't the morphine and alcohol have adverse effects when used together?


----------



## Ridryder911 (Aug 17, 2007)

Milligrams is weight and ml or cc is volume..i.e fluid. One can have 2 mg (weight or amount of the drug itself) suspended in a solution (i.e. water/volume) i.e 5mg per 1 gallon of fluid or 5mg per 500 ml etc.. so on. The amount administered is the weight of the drug, not the fluid amount since medications can suspended in various forms or amounts of liquids. Unless one is ordered fluids to be administered. 

In regards of alcohol and morphine, actually both are CNS depressants and combination of both, could have potential harm. I personally is very cautious when administering analgesics with alcohol on board in the patient. It can potentiate (increase) the side effects and actions of the medication. 

R/r 911


----------



## Aileana (Aug 17, 2007)

that's what I thought at first, but wasnt sure . Would a small dosage of morphine be alright when mixed with alcohol? How much can you usually use before having it harm the patient?  Are there any safer alternatives?


----------



## Ridryder911 (Aug 17, 2007)

It is a judgement call. Dependent on the amount, the size of the patient, duration, type of injuries, etc. Some have to obtain orders before using such, some ma even have protocols not to administer analgesics with patients that appear intoxicated, where others may be able to do so. There is no exact black & white answer.

R/r 911


----------



## dckiteboards (Aug 18, 2007)

possible broken ankle ???

get on scene and find PT 180lbs upstairs lying supine with a open transverse fracture, at the base of leg just above the joint.
Theres very little skin holding the foot on. Although we have Very good CSM and we splint it in the way we found it! The medics started a line, and we kept asking the PT his pain 0-10 and he was 2 to 3. Now he stated he had 3 beers and a shot. Well all the way to the hospital he was talking the whole transport/35 minutes, and his pain never went above a 3. The hospital ran a blood alcohol test prior to surg, it was a .30.

PT is out now and healing, already wrote a letter of thanks and a job well done to our director...

which that night in the ambulance he told us he was going to write one!!!


----------



## BossyCow (Aug 19, 2007)

We had a pt who took a shot to the sternum with a 6' chunk of wood in a logging accident.  He and his buddy when back to the house, where he took a shower, had a couple of shots of Wild Turkey, popped a couple of Oxycodone he had left over from dental surgery and then decided maybe he'd better call us.  His pain never got above a 3 either.  But he ended up admitted with a Pneumothorax.


----------



## blondie (Aug 31, 2007)

I've found working with patients who have been drinking can generally be a little numbed out to a serious injury. It's not uncommon either for people to not tell the truth about how much they really had to drink prior to ems arriving. 
we had a patient a few days ago who said he had 2 beers but when the hospital tested him he was 3x's over the legal limit.


----------



## MedikErik (Aug 31, 2007)

Pain is fickle... adrenline, alcohol, shock, everything can affect perception of pain. We had someone nail his foot to a board when a nail gun accidentally discharged, ripped hit foot off the board, climbed off the roof, walked to the firehouse, and said he wasn't sure but thought he needed to go to the hospital. Said it wasn't bothering him too much. 

Then you have the person who just stubbed his toe and is convinced he's going to die. It takes all kinds...


----------



## EMTmetzger (Sep 12, 2007)

i agree, he could have been lyeing about how much he accually had.  iv'e heard of other things that can reduce your censory to to pain. i read somewhere that athleats in indurance sports (such as swimming or running) have pretty high pain tolorance because of the lactic acid that builds up durring prolonged activity.  me as a swimmer can back that up.  also adrenalin will do it too.


----------



## njcoldone (Sep 17, 2007)

There seems to be two sides to this coin.  As noted there are times that consumption of adult beverages can alter the effect of meds. (adversely also) but the underlying real problem is that 1) unfortunately some ems responders become judgemental and do not provide proper care with compassion --we've all heard these stories. 2) alcohol (or other recreational drugs) tend to mask injury or illness that may be critical . This is where that sense of "something is just not right" feeling  and your training come into play.


----------



## Corl-Grove (Sep 18, 2007)

*Alcohol always inhibits pain*

Everyone always only has two beers. I just want the same size glass the next time I go on a bender. 

I agree that a chronic alcoholic may have neuropathy which should deaden nerve receptors but treat the symptoms if you have a patient who has pain medicate it to the best of your ability.

Take care, and be safe


----------



## malakai1911 (Nov 8, 2007)

EMTmetzger said:


> i read somewhere that athleats in indurance sports (such as swimming or running) have pretty high pain tolorance because of the lactic acid that builds up durring prolonged activity.



A minimal amount of lactic acid builds up during exercise, and is quickly cleared (buildup that doesnt go away? lactic acidosis). As such, any soreness felt from that would be short lived. Without seeing a study to indicate otherwise, I'd be hard pressed to believe perception of trauma based pain would be diminished as a result of repeated lactic acid exposure from exercise.


(Also, any pain you feel the day after a workout is DOMS, not caused by lactic acid.)


----------



## So. IL Medic (Nov 9, 2007)

EMTmetzger said:


> ii read somewhere that athleats in indurance sports (such as swimming or running) have pretty high pain tolorance because of the lactic acid that builds up durring prolonged activity.



Generally, the pain tolerance has been attributed to CNS endorphin release and the gate control theory of pain in which a inhibitory opiate link at the spinal cord cuts in and blocks the pain at that level.


----------



## So. IL Medic (Nov 9, 2007)

Aileana said:


> Not sure about this, but wouldn't the morphine and alcohol have adverse effects when used together?



Alcohol potentiates morphine's effect of CNS depression which can lead to increased risk of respiratory depression.


----------

