Have you ever treated/transported a patient who was in sickle cell crisis? Even early in crisis, they may not actually look like they're in pain, yet their pain level is 10/10 or even "stepped on a Lego" level pain. I'm saying their pain level really is that bad and you'd never believe it because of how they look. Then you get the labs back that show they're in crisis...Personally, I do not treat these patients unless they're showing physiological signs of pain. I feel like it is my duty to give pain medication to those that obviously need it. I also feel it is my duty to ensure I am giving pain medication when it is indicated. Just because someone tells me they are hurting does not mean I will instantly give out pain meds. I have several close physician friends and they all state that this is a disease that has gained enormous prominence for all the wrong reasons over the past several years. It also seems to be a trash can diagnosis in which physicians will call a patients problem fibromyalgia simply because they've ruled out a handful of other problems.
Personally, I do not treat these patients unless they're showing physiological signs of pain. I feel like it is my duty to give pain medication to those that obviously need it. I also feel it is my duty to ensure I am giving pain medication when it is indicated. Just because someone tells me they are hurting does not mean I will instantly give out pain meds. I have several close physician friends and they all state that this is a disease that has gained enormous prominence for all the wrong reasons over the past several years. It also seems to be a trash can diagnosis in which physicians will call a patients problem fibromyalgia simply because they've ruled out a handful of other problems.
Sarcoidosis, Sudden infant death syndrome, and Bell's palsy are also diagnoses of exclusion.
Not taking sides here, just point out that all of those have physical findings. Sarcoidosis has a large number of them, SIDS has a dead body, and Bell's is usually fairly obvious.
I think people's issue with Fibromyalgia is that not only is it a diagnosis of exclusion, there are no objective tests for it. Heck, there are barely diagnostic criteria.
Edit: On topic, more and more chronic pain patients are on pain contracts that prohibit them from receiving narcotic medications from ANYONE but a certain doctor. These patients are sometimes subject to blood/urine tests to determine if they have consumed anything besides their prescribed medications. This includes acute flare ups of chronic conditions. We may think we are doing our patients a favor giving them fentanyl/morphine, but if they violate their contract they may lose all of their pain medications. I know it sounds inhumane, and some people here are going to say "who cares, I'm giving them meds anyway", but it is something to seriously consider.
Does anyone (or can anyone per protocol) use Versed (midazolam) alone for pain management without coupling it with a narcotic?
Personally, I do not treat these patients unless they're showing physiological signs of pain. I feel like it is my duty to give pain medication to those that obviously need it. I also feel it is my duty to ensure I am giving pain medication when it is indicated. Just because someone tells me they are hurting does not mean I will instantly give out pain meds. I have several close physician friends and they all state that this is a disease that has gained enormous prominence for all the wrong reasons over the past several years. It also seems to be a trash can diagnosis in which physicians will call a patients problem fibromyalgia simply because they've ruled out a handful of other problems.
Not taking sides here, just point out that all of those have physical findings. Sarcoidosis has a large number of them, SIDS has a dead body, and Bell's is usually fairly obvious.
I think people's issue with Fibromyalgia is that not only is it a diagnosis of exclusion, there are no objective tests for it. Heck, there are barely diagnostic criteria.
Edit: On topic, more and more chronic pain patients are on pain contracts that prohibit them from receiving narcotic medications from ANYONE but a certain doctor. These patients are sometimes subject to blood/urine tests to determine if they have consumed anything besides their prescribed medications. This includes acute flare ups of chronic conditions. We may think we are doing our patients a favor giving them fentanyl/morphine, but if they violate their contract they may lose all of their pain medications. I know it sounds inhumane, and some people here are going to say "who cares, I'm giving them meds anyway", but it is something to seriously consider.
Have you ever treated/transported a patient who was in sickle cell crisis? Even early in crisis, they may not actually look like they're in pain, yet their pain level is 10/10 or even "stepped on a Lego" level pain. I'm saying their pain level really is that bad and you'd never believe it because of how they look. Then you get the labs back that show they're in crisis...