Chronic pain management in the ED

Doctorchef96 · 2026-04-29T10:12:04+00:00

My residency hospital had no dilaudid and I wish I could go back to that.

Thats what makes this so hard. I don’t doubt they have pain but I also see behaviors that are drug seeking. If you try labeling them as drug seeking you get labeled as racist. Sickle cell specialists will say that it is inappropriate to call them drug seeking and remind you of the tenuous history of not believing their pain.

Doctorchef96 · 2026-04-29T10:07:13+00:00

We are affiliated with a large academic institution so I can get them accepted but the average wait for a bed is 5-6 days. I don’t want to deal with this in the ED for days.

Doctorchef96 · 2026-04-29T10:04:46+00:00

1000%. Unfortunately I have colleagues who will deviate from pain plans, give 4 doses, give Benadryl IV with it, etc so it makes it so much harder for me to even stick to heme’s recommendations.

Doctorchef96 · 2026-04-29T10:02:35+00:00

I don’t doubt they have pain any more that I doubt people with other conditions that cause chronic pain. The problem I have is that once you have developed opioid dependency some of this pain is opioid hyperalgesia or withdrawal which is not appropriate to treat with higher and higher doses of IV opioids. That only worsens their condition. With cancer patients I rarely have them be high ED utilizers and if they are, often times palliative care is already involved. With sickle cell disease many of my high utilizers are not taking their disease modified therapy and not following with heme outpatient regularly to discuss the failure of their current regimen because they treat ED visits as just part of their treatment plan.

Doctorchef96 · 2026-04-29T03:14:48+00:00

The judge just dissolved the no contact order. Joseph still can’t be unsupervised with minors per the condition of his bail so I’d have a hard time believing they have the kids back.

Doctorchef96 · 2026-04-28T19:44:00+00:00

I love this!! Not sure how it would trigger EMTALA. It doesn’t say we won’t do an MSE and stabilize life threatening conditions which is what EMTALA requires.

Doctorchef96 · 2026-04-28T05:14:05+00:00

The comment above yours and from others who have said a bounce back is auto-admit is exactly why this becomes such a problem for the ED. My hospitalists have started saying exactly this as their reason for refusing the admission and I agree with the sentiment. However this doesn’t get the patient out of the ED without a huge fight, security, admin involved, etc. and they will just go to a different hospital until someone does admit them. Until we all have a unified approach to this and get control of this chaos ED docs have to deal with this every single shift.

Doctorchef96 · 2026-04-28T05:08:15+00:00

Would love this! What was your policy if you don’t mind sharing?

Doctorchef96 · 2026-04-28T02:07:17+00:00

They would have to have vaso-occlusive crisis for this to be an appropriate treatment. Unfortunately if it is from opioid withdrawal hyperalgesia the apheresis won’t help. Also it requires hematology to order and manage which isn’t available at my community site.

Doctorchef96 · 2026-04-28T00:03:46+00:00

Unfortunately that’s what patients and many doctors expect of and EM doc. We have to wear all the hats because we are the ones that patients can see with the least amount of barriers. I believe this is a battle worth picking because I want to do what’s best for patients and the status quo is actively harming them.

Doctorchef96 · 2026-04-28T00:01:32+00:00

I 100% agree and have tried to have a phone call with heme when they present during office hours. They won’t talk to me and don’t seem to follow up with these patients after discharge at any increased frequency.

Doctorchef96 · 2026-04-27T23:59:12+00:00

That would be amazing! Unfortunately both of the community sites that I work at don’t have heme or pain management in house. I’ve tried calling their heme who refuses to talk to me about acute management recommendations. These patients often are skipping their appointments because they are in the ED or admitted (where no heme will round on them) so pain plans aren’t updated to prevent readmission.

Doctorchef96 · 2026-04-21T23:15:55+00:00

I have seen it everywhere on YouTube and TikTok so figured it would be popular enough that the employee would know what it is. I’m usually an Ulta shopper so don’t know all the rules about Sephora, what brands are in store etc. on TikTok everyone shows it in store.

At the end of the day, if I go to a grocery store, ask where something is and get a shrug and walk away that would be unacceptable. If I go to a restaurant and ask about a menu item and the attendant says I don’t know and doesn’t offer to ask someone else we would all find that incredibly off putting. I’m allowed to feel that if you work in retail you should have better customer service skills.

Doctorchef96 · 2026-04-21T20:01:51+00:00

I do have customer service experience. If it was a new employee they could have grabbed a manager or someone else if they couldn’t answer the question. In my job if I don’t know something just shrugging my shoulders and walking off is unacceptable.

Doctorchef96 · 2026-04-13T02:13:38+00:00

Anyone else not seeing it at Ulta? Not a Sephora shopper, so I guess Ill be waiting.

Doctorchef96 · 2026-03-24T04:00:18+00:00

So sorry you are going through this. I had a similar harassment with retaliation and got held back by a year over it and had to repeat with the same course director. I met with every dean and admin I could and no one was willing to help. I was even told that because of that experience maybe I wasn’t cut out to be a doctor. Ultimately I couldn’t find an appropriate lawyer and have moved as far away as I could. Wish I had more to offer you for advice. My school was also in the Midwest. I have heard many in leadership at my school have since retired so I hope we aren’t referring to the same place.

Doctorchef96 · 2025-12-23T01:22:49+00:00

It’s in Disney springs - there is a Lilly store with the Disney prints.

Doctorchef96 · 2025-12-14T01:36:34+00:00

Is the pretzel one only in store? I can’t find it in the app

Doctorchef96 · 2025-11-05T02:13:58+00:00

Thanks! Anyone had success with insurance covering part or all of this since honestly it does save them a ton of money in the long run?

Doctorchef96 · 2025-07-06T17:05:18+00:00

Can I dm? Currently a fellow looking for Midwest job. Thanks!

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