A&E refusing to give more than paracetamol when I’m in horrific pain

[Wonderingmummy]

I found out I’ve got gallstones, I need it out but I’ve been put on a waiting list. I’ve also just had a baby which can apparently trigger the attacks.

I had an attack 4 days ago, called 999. The worst pain I’ve ever been in, rolling around the floor at hospital. They refused to give me any more than paracetamol and I was just left to it. 6 hours later, it passed and I was told to go home.

I’m still thinking about it, and it’s annoyed me that more wasn’t done. Do you think I’m unreasonable to expect more? When the inevitable happens and I have another one, I already know my A&E will refuse to help and I want to advocate for myself better.

Are you medical? Or is that AI generated?
I have been a GP for almost 30 years. And the consequences of opiates addiction are just horrific, on the whole far worse than the cause of use. And addiction can happen very quickly and is very idiosyncratic.
I am very wary of opiates professionals and personally.

Oh, I'm so sorry.

I had my first attack while pregnant (horrific) and they really kicked off just after birth. The pain is unbelievable, as you know. I was misdiagnosed three times before told it was gallstones, which i had guessed.

Thinking about it, I was never given painkillers during an attack (I went to OOH, walk in centre, GP and eventually A&E who then told me it sounded like gallstones and referred me to same day surgical unit for a scan) I think I presented in A&E three times with gallstones (the second time the GP told me to go at the time of an attack to get my bloods done) The third time I presented I had a stone stuck and ended up with pancreatitis and jaundice, i was admitted so fast and was told I was very unwell. I was offered painkillers on this occasion but ironically, I wasnt in much pain so declined. The meal that set that off was a ... sweet potato. It totally ruined my life and my post partum experience, I was having attacks all the time and the fear of an attack took over my life. I had my operation (referred quicker after the pancreatitis) 4 months PP and it was a blessing, I have had no issues since.

I would ignore the people talking about asking for morphine etc, you cant describe that level of pain to someone who hasnt experienced it. I gave birth with absolutely no medication and gallstones were worse, as they came on completely randomly with no end in sight. I couldn't find anything that helped, I would also be sick during attacks. I would get in the bath and then immediately get out, get in bed then lie on the bathroom floor etc. The main way I sat was on the toilet leaning over my exercise ball I'd used during pregnancy, i liked the coolness on my skin as I would drip with sweat during an attack.

I would seriously consider taking out a loan to go privately for your operation, especially now with the increase in gallstones due to WLIs. Otherwise it just feels like youre just left waiting to get worse (pancreatitis)

Do you know the signs of pancreatitis? You should always go straight to A&E if youre experiencing any. So, clay/pale poo, dark wee, yellowing of the skin and eyes, pain that lasts longer than a usual attack, there will be more but I've forgotten them now. My pancreatitis started on the Monday, I went to the GP on Wednesday but was largely ignored (I am too good at putting on a brave face and I hate it) and went to A&E Friday, where i was admitted.

I will say it is traumatic, being terrified of eating food, never knowing when an attack might happen, second guessing every pain, wondering if youre going to be up for hours that night, just the sheer pain itself, the possibility and worry of it turning into something more. It really took over my life.

I was given zapain, anti sickness medication, another painkiller (maybe cocodamol) and buscopan from the GP, none touched the pain even slightly. I even tried random things like apple cider vinegar, but same (it was disgusting to drink but I would have tried anything!)

I am so sorry you're experiencing this when you should just be enjoying your baby. Please consider going private if its an option at all. If not, ring the surgeons secretary every few days, tell them the situation (new mum) and ask if there are any cancellations as there absolutely will be. Just keep on and on. Good luck x

Pain is one of the most difficult conditions to manage. Expectations are very unrealistic. The evidence for benefits for most treatments are far outweighed by the significant risks. Its not that we dismiss it but throwing opiates at people willy nilly is extremely poor medicine. Unfortunately "learing to live with it"/pain management is the only current truly safe answer.
Please do some reading around opiates harm before you post such nonsense.
DOI I have had gallstones and anal fissure and suffer awful menopausal joint pain so I do get it.

And i had mine out in 2003 and have had no issues since.

Flushing regimes are a total myth. https://www.thelancet.com/journals/lancet/article/PIIS0140673605663738/fulltext

I tried to report the flushing bollocks to MNHQ as misinformation (which they have a reporting category for). Apparently it doesn't break talk guidelines to peddle such snake oil nonsense.

Yanbu op! I was given codeine in A&E when I had my gallstones attack. And I was sent home with a further 20 tablets (ish, I think) to be taken if I had further attacks. I did use them maybe 4 or 5 times in my 5 month wait for surgery.

@BurnoutGP ,

‘Pain is one of the most difficult conditions to manage. Expectations are very unrealistic. The evidence for benefits for most treatments are far outweighed by the significant risks. Its not that we dismiss it but throwing opiates at people willy nilly is extremely poor medicine. Unfortunately "learing to live with it"/pain management is the only current truly safe answer.’

I am not medical but I do have a (hard) science degree, so I am more than capable of reading research etc.

My experience of pain management on the NHS is mainly from family members and it’s not been good.

It has often been due to falling through the cracks in the system. With my son, he was caught between ortho/paediatrics/pain management and with my mother, managing cancer at home, it was just getting people to visit and prescribe. The net effect, though, is that they were left in unmanaged pain for quite a bit of time (one in agonising spasm at night, as paediatrics were needed to prescribe diazepam, and they never quite made it to the ward).

You use the word ‘safe’ but how do you define that? Not leading to risk of addiction and death? What about PTSD? Does dying in pain matter, as opposed to risking death through overuse of opioids, when that is the patient’s express wish.

Also you are defending a practice against the NICE guidelines and against most A&E protocols for the OP’s condition. I mean, of course, there may have been particular factors which applied to the OP, but this automatic leap to defend not relieving severe pain (rolling around in agony) doesn’t seem right to me.

Thats not the automatic leap. The OP never answered the question as to whether she went in demanding/stating "morphine is the only thing that helps". A drug seeking red flag.
Palliative and post op pain are different. However the opiates crisis in the US was driven by unsafe and random prescribing of high dose opiates POST OP. There's plenty of evidence.
Really I am jot being harsh but good medicine also involves being safe and careful.
However I am now of the age and burnt outness where I am getting very tired of trying to do the right thing when people with little knowledge/social media/demanding/entitlement/complaints etc and will give people what they demand. If they dont want my extensive training and experience then so be it.

The gallbladder social media groups get these idiots every so often too, shilling their AI help books. And it annoys the hell out of me as people in pain are obviously desperate and it just preys on that. I am a total sceptic and even I found myself clicking on links, because I was just so miserable with it.

@BurnoutGP ,

I do sympathise somewhat with what you are saying, but you do also seem to be coming from a slightly narrow-minded perspective when it comes to ‘safety’. How unsafe is severe pain to you? I know I cannot expect you to put your extensive education and experience down in a simple post. However, it does seem to me that pain management is an under researched and studied branch of medicine (probably because pain is not a medical risk under one way of looking at things), and that there are more options than most doctors know. Pain management teams in hospitals seem to have a bigger tool kit available to them.

For instance, in my son’s case, poor pain management meant he didn’t move properly for over a year due to fear of pain, despite loving sport. Rehab was extremely hard. How do you weigh this, for instance, in your prescribing decision process?

I know what happened in The States and I am not playing down addiction. However, how many patients who you did prescribe opiates for ended up addicted?

Yep, me too! It's deplorable.

I find that very hard to believe. Everyone i know has been discharged with paracetemol with instructions to visit GP for something stronger if necessary.

I was given zapain, anti sickness medication, another painkiller (maybe cocodamol)

Quick heads up that Zapain IS co-codamol (30/500 in my case). I've been using that 2-4 times a day for quite a few years now, so am very familiar with it.

I've noticed a few people mentioning Diclofenac being prescribed. I used to be prescribed that for my severe back issues and it worked very well, but got told it was no longer available for GPs to prescribe and was moved on to Naproxen instead which barely touches the sides on a bad day.

I think the one thing I am interested about re pain (well one of the many things) ais that they still ask you to rate pain out of 10. I mean, how would I know??

There are studies that show older patients, women and people of some Asian backgrounds underplay pain. And also studies that show that female pain and symptoms can present differently.

I think my years of gallbladder pain were ignored It took 12 years before anyone even scanned me and that's because DH came to my GP with me) because I probably tried to 'put on a brave face' and because the pain I reported wasn't 'in the right place'.

Like the PP above, so many of my symptoms they were focusing on (BP, cholesterol, 'gastritis') disappeared when my GB came out.

I also agree about the trauma - particularly the fear of eating.

Just ETA, I was the one upthread who didn't even get paracetamol!

My GPs keep telling me NSAIDs are very bad for stomachs.

Yeah I also reported it and got told the same :/

Interesting.

My gallbladder started playing up in my first pregnancy at about 36 weeks, I was so unwell, could not stop burping and vomiting and ended up being admitted to hospital and being put on a drip. Then developed a raging chest infection they thought may be pneumonia. Baby and I were both OK, but at the time it was not picked up as gallbladder related.

It wasn;t until the acute incident 3 weeks after giving birth that I was diagnosed. The scan showed what the radiographer described as "sand" in my gallbladder rather than one or two big stones.

SOme women appear to be very sensitive to the ups and downs of estrogen/progesterone when pregnant and post-partum. Estrogen also affects how your body processes cholesterol which forms the stones. It's not something I was ever warned about when pregnant.

I don't really think it is reasonable or humane to expect a person in severe pain to wait the 12 plus hours this would take to see if it worked.
Maybe after the pain is controlled initially, but not before!

We prescribe the stuff - it's between the midwives and the patient which bits they take. There is a surprising amount of variation in how much pain relief women need postpartum - a lot genuinely do seem fine after a c-section/repair with just the simple stuff even once what we've given in theatre wears off. Some need more though and there are almost always some options prescribed. Not all of the pain relief options are appropriate in the post-partum period though and there are some risks/benefits that are different to those for other painful conditions.

Was after my 3rd that I had really bad after pain that required painkillers. First two, I just felt like I had worked out.

This, I’m afraid. ⬆️

I had gallstones too, resulting in gallbladder removal, so I do completely understand the horrific pain. In the meantime, while you’re on the waiting list, to limit the attacks, stick rigidly to a diet where you eat nothing with more than 5% fat - sounds hard but it’s do-able & it’s the only way - it saved my sanity.

My worst attack ever seemed to be triggered by pasta with tuna.

Totally agree.

I suspect that once your gallbladder is inflamed, then anything can affect it badly. Wheh I had it, it was like Russian roulette eating a meal.

It's not going to happen though. You need to help yourself more. Keep your fat intake in the green. I found leaning over something with an edge like a soft footstool when an attack started kept it bearable and no hospital needed. Not very dignified and no good once it really got going. But jamming an edge under the ribs at the start and staying there until the worst of it was over helped.

Even lying in bed, bent over a pile of pillows. Definitely not dignified.

Can you afford to get it taken out privately? The rise in fat jabs has pushed up the numbers needing gallbladder removel.