Pain Management for TN in the Emergency Room – Presenter Dr. Jeffrey
Cohen From the Conference in 2006
Avoid the Emergency Room unless there is no other choice. Take medications as
prescribed and do NOT self medicate. Strongly consider having that procedure so that
maybe you won’t have that crisis. There may be a special medication for a situation.
Have documentation from your doctor that is treating your pain on letterhead what the
condition is. Have the doctor call the ER ahead of time so that he can let them know
everything.
I have on my notes that, “Propylene glycol is what is put into anti-freeze”. Fosphenytion is
better-tolerated and best to use. It is a prodrug that is metabolized to phenytoin and
administered parenterally for the treatment of seizures.
IV Keppra is for people who are allergic to Dilantin and is not metabolized in the liver.
Sumatripitan is used to treat migraine headaches.
Have a plan. Use eye drops like what the eye doctor uses “tetracaine”. This is white,
water, soluble, crystalline solid used mostly as an anesthetic.
I asked if the medical department looks at the Medical Alert Bracelet or am I just wasting
my money? Yes, and you MUST keep it up to date. You can call or go on-line to keep.
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Marlene Brenner (San Diego Group member)
Sometimes TN leaves us for no reason. It runs in cycles and when it comes back it
comes back fast and sharp. When it goes away we usually go off our med’s, or cut
way back, then we end up in the emergency room.
When this happens most ER drugs do not work. Opiates do give temporary relief.
What ever you do, don’t wait, get to the ER. We think that our meds will take care
of it, they won’t, not until they have been built up in your blood stream again. You
need to get it taken care of as soon as possible.
Have a written plan with your doctor and how to proceed. I have talked to my doctor
about how to double and triple my medication in case it starts coming back. I do
have a plan whether it will work or not I don’t know, but I have a plan. We have to
follow the prescribed doses as close as we can possibly can to what our doctor’s
have prescribed and tend to think that I can take a little less. Don’t change your
meds on your own!
The reason I have switched doctor’s is that it becomes unsettling when your
insurance plan changes or changes doctor’s. You have to go with the flow.
Coping skills:
When I lowered it and what the symptoms were, because if the symptoms started
up again I wanted to know at what level I was OK so the doctor could brig me back
to that level. If the pain becomes unbearable then we go to our list, and we either
call our doctor, go to the ER. Keep in mind that the ERR people are not versed in
TN and will not know what is really needed. You have to be able to explain to them
what you have ad what is happening. If you can’t do this you should have someone
with you who can do this for you!
When you leave the ER:
ER staff should review current medications with you including non prescription
meds that may be causing drug interactions and possible over use or toxicity.
These are some of the things that you can do, they are not for maintenance, but
they can break the cycle; morphine, this can last for three to four hours and they
start to work in ten to fifteen minutes, dilantin, works in about 15 minutes, the ER
physician can order an intravenous injection, or do a local which will last for about
four hours.
Your doctor should be informed about the ER visit and how it was resolved.
You should also be given a maintenance plan when being discharged.
While none of these are long term answers, they can help with acute pain. It will
take time again to build up new doses of oral medication in the blood stream while
deciding whether to stay on higher and higher doses of the oral meds, or seek
another procedure to help out with the problem.
I will keep a copy of this in my purse and I have given a copy of this to my mother
and to my husband in case that something happens that I can not talk for myself.
Return to Home Page
Cohen From the Conference in 2006
Avoid the Emergency Room unless there is no other choice. Take medications as
prescribed and do NOT self medicate. Strongly consider having that procedure so that
maybe you won’t have that crisis. There may be a special medication for a situation.
Have documentation from your doctor that is treating your pain on letterhead what the
condition is. Have the doctor call the ER ahead of time so that he can let them know
everything.
I have on my notes that, “Propylene glycol is what is put into anti-freeze”. Fosphenytion is
better-tolerated and best to use. It is a prodrug that is metabolized to phenytoin and
administered parenterally for the treatment of seizures.
IV Keppra is for people who are allergic to Dilantin and is not metabolized in the liver.
Sumatripitan is used to treat migraine headaches.
Have a plan. Use eye drops like what the eye doctor uses “tetracaine”. This is white,
water, soluble, crystalline solid used mostly as an anesthetic.
I asked if the medical department looks at the Medical Alert Bracelet or am I just wasting
my money? Yes, and you MUST keep it up to date. You can call or go on-line to keep.
Back to Home page
Marlene Brenner (San Diego Group member)
Sometimes TN leaves us for no reason. It runs in cycles and when it comes back it
comes back fast and sharp. When it goes away we usually go off our med’s, or cut
way back, then we end up in the emergency room.
When this happens most ER drugs do not work. Opiates do give temporary relief.
What ever you do, don’t wait, get to the ER. We think that our meds will take care
of it, they won’t, not until they have been built up in your blood stream again. You
need to get it taken care of as soon as possible.
Have a written plan with your doctor and how to proceed. I have talked to my doctor
about how to double and triple my medication in case it starts coming back. I do
have a plan whether it will work or not I don’t know, but I have a plan. We have to
follow the prescribed doses as close as we can possibly can to what our doctor’s
have prescribed and tend to think that I can take a little less. Don’t change your
meds on your own!
The reason I have switched doctor’s is that it becomes unsettling when your
insurance plan changes or changes doctor’s. You have to go with the flow.
Coping skills:
- Don’t panic. Try to have a sense of control
- Prioritize what needs to be done
- Communicate with others
- Do relaxing exercises/imaging/anything to take your mind off the pain
- Light exercise
- Rest/naps
- Stretching (gentle)
- Distracting activities
- Reflect—what caused it to come back, what helped, reevaluate. In the
beginning I kept a log and I wrote down every medication and what my
symptoms were. And when I changed my medication what my symptoms
were.
When I lowered it and what the symptoms were, because if the symptoms started
up again I wanted to know at what level I was OK so the doctor could brig me back
to that level. If the pain becomes unbearable then we go to our list, and we either
call our doctor, go to the ER. Keep in mind that the ERR people are not versed in
TN and will not know what is really needed. You have to be able to explain to them
what you have ad what is happening. If you can’t do this you should have someone
with you who can do this for you!
When you leave the ER:
ER staff should review current medications with you including non prescription
meds that may be causing drug interactions and possible over use or toxicity.
These are some of the things that you can do, they are not for maintenance, but
they can break the cycle; morphine, this can last for three to four hours and they
start to work in ten to fifteen minutes, dilantin, works in about 15 minutes, the ER
physician can order an intravenous injection, or do a local which will last for about
four hours.
Your doctor should be informed about the ER visit and how it was resolved.
You should also be given a maintenance plan when being discharged.
While none of these are long term answers, they can help with acute pain. It will
take time again to build up new doses of oral medication in the blood stream while
deciding whether to stay on higher and higher doses of the oral meds, or seek
another procedure to help out with the problem.
I will keep a copy of this in my purse and I have given a copy of this to my mother
and to my husband in case that something happens that I can not talk for myself.
Return to Home Page
| In the Emergency Room!! |
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