But to what extent is physical pain part of the normal experience? Should we no longer be giving pain medications at all because all pain is part of the human experience? Saying “hey man, I know you’re in a lot of pain because your leg was just amputated but you’re human and pain is good for you” doesn’t sit right by me. Patients experience pain differently and have different pain tolerances. A fractured arm on patient A may have no to minimal pain while on patient B it may be the most painful experience they have had.
We all live with the daily aches and pains but, I’m fairly sure, no one is suggesting that we treat those with pain medications. Your post makes it seem as if you believe any provider who treats any form of pain is doing a disservice to their patient.
I'm curious as to what exactly about my post it was that you interpreted as meaning that I don't think traumatic amputations should receive pain medicine, or that providing any form of pain management is doing a disservice? That follows what I actually wrote about as well as the nonsensical claim made earlier in this thread that some of us would "sit and watch you suffer for their own perverse enjoyment" just because we think fractures can generally be adequately managed with BLS interventions.
My comment was less about acute pain management in general and more about the attitude of "I want to not feel it". No one likes pain. Pain has no utility aside from signaling us that something is wrong, and severe acute or chronic pain that goes untreated can become a pathology of its own which contributes to a myriad of problems.
However, experiencing pain at times is normal and to be expected, and being unwilling or unable to cope with that to any degree is a maladaptive behavior and should not be encouraged, which is exactly what we do when we treat any degree of pain as an emergency and use the patient's subjective report of comfort as a primary metric for the quality of the care that we provide. Rewarding maladaptive behaviors with highly addictive drugs has predictable consequences, and it is known that an unusual degree of anxiety over pain is in itself a predictor for chronic pain syndromes and medication dependency.
Even though this is clearly more of an issue and consideration in other settings, I don't think that means EMS gets a free pass here. Do we want to at least try to be part of the solution to one of the most pressing problems in healthcare today ? Do we want a seat at the table? Do we want to be seen as clinicians? Then let's start acting like it and realizing that pain is very complex, psychology is a big part of the pain experience, and that pain management can and should and at least sometimes consist of more than just slamming doses of the same drugs that are closely related to a massive problem with chronic pain, record numbers of addictions, and that directly cause the deaths of more people these days than any other non-natural cause. But, as long as we can't appreciate nuance and can't discuss complex issues like this without ascribing evil motives and putting words in each other's mouths, I don't have much hope for our ability to do that.
Just to be clear, because apparently these disclaimers are necessary here: I
do give opioids, I
would give pain medicine to someone whose leg was amputated, and I
do not get perverse enjoyment from watching people suffer. Yes, it is possible for those things to be true while at the same time believing that pain is rarely an emergency and opioids should not always be seen as the be all / end all of pain management.
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pubmed.ncbi.nlm.nih.gov
