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.

Not trying to play Top Trumps , OP, but I wasn't even given paracetamol most times.

I second Buscopan. I can't remember who first told me about it but it wasn't a doctor .

I’ve had a cholecystectomy after 2 years of attacks, so yes, I’m very much aware. I also work in acute medicine. We can’t hand opiates out like sweets, and I’m not sure why that shocks you so much. You can also have genuine medical issues and display drug seeking behaviours, so even previous attacks of cholecystitis don’t prove that the OP has a current acute gallbladder, unless tests are run, which are a. Costly, and b. Time consuming, so paracetamol is offered to avoid OP having to wait for full bloods and a USS. Also,opiates can in fact make gall bladder issues worse.

It’s funny that there is another thread going on how posters prefer to attack an OP rather than sympathising.

I couldn’t believe that any A&E painkiller protocol should leave someone in severe pain. Ultimately, extreme pain IS an emergency, so I did a simple AI search: A&E protocol for severe gallstone pain and got the following:

Common A&E Painkiller Protocol

• First-Line / Preferred: NSAIDs (such as IV or IM diclofenac or ketorolac) are clinically preferred over opioids because they target the underlying inflammation of the gallbladder and reduce the risk of disease progression without causing spasms in the bile ducts. 1, 2]
• Second-Line / Severe Pain: Opioids (such as morphine) are administered intravenously if the pain is severe and unresponsive to NSAIDs, though they are used cautiously because they can sometimes cause contraction of the sphincter of Oddi. src="https://www.youtube-nocookie.com/embed/JNph8yePRVI?start=308" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen> 1, 2]
• Combination / Oral Steps (Step-down or Mild/Moderate): Paracetamol (acetaminophen) combined with codeine or co-codamol (e.g., 30/500mg) may be used. 1,
• Antispasmodics: Medications like hyoscine butylbromide (Buscopan) are sometimes given, though evidence shows they are generally less potent for biliary colic than NSAIDs or opioids. 1,
• Anti-emetics: Nausea and vomiting are frequently managed alongside pain relief using anti-sickness medications (like ondansetron or metoclopramide) via an IV drip. 1, 2]

It seems to me that leaving someone in agony with only paracetamol for pain relief is a gross failing. That kind of pain and feeling uncared for can lead to severe trauma.

OP, you have my sympathies and, in your position, I would complain to PALS.

YANBU. Contact your GP and ask for some real painkillers. I don't know if they'll be willing to give you them to keep for your next attack but it's worth trying. If not, then get in touch urgently with the first twinge. They can prescribe strong cocodamol tablets, in 2 strengths - normal para with 15 codeine or the same with 30 codeine. Dosage the same as para. Compared to otc cocodamol which has 8 codeine. Hope you get fixed soon .

Morphine is highly addictive and only given for short periods of time. Generally isn’t dispensed for discharge anymore either.

Gallstone attacks can signal a life threatening emergency on some occasions if a blockage or major infection/sepsis forms.

I developed serious complications and the doctors initial thoughts was that I had final stage liver cancer - but it was "just" 44 pregnancy gallstones - not helped by the fact (unknown to me at the time) that I don't tolerate NSAID medications.

I had severe gall-bladder attacks 20 years ago and only got surgery when I had partially obstructed and developed jaundice. But my GP had given me Diclofenac suppositories and they were very effective. Of course this was a long time ago, so I don't know if it is still a viable option. Just to add it was far, far worse pain than labour had been.

Did you go in asking for morphine/only thing that helps. Unfortunately that is a very common for drug seekers and you would quickly have been labelled as such.
Speak to your GP for some stronger pai killers to keep in hand for future attacks. As mentioned above anti-inflammatories (if you can), buscopan, possibly trampoline. Codeine better avoided as causes sphincter spasm!

Be prepared to make a nuisance of yourself, OP. The wait times for removal can be awful and it can be debilitating. I remember one week I had a gallbladder attack six nights out of seven (each lasting 6+ hours) and on the night I didn’t I had a kidney stone (which was an even worse pain). It was horrible.

Show up to the hospital if pain is uncontrolled (buscopan and 30mg codeine did nothing for me, might as well have been Smarties), morphine was the only thing that touched the sides and I still required two doses IV before the pain dulled enough. The Oramorph at home helped (but didn’t eliminate it, but made it bearable.) My entire body was shaking, my heart rate went down to 38. I will say that when the triage nurse saw me and took my vitals she instantly took me to a bed!

I contacted PALs and also went back and forth to GP, who wrote me a letter of escalation. Two weeks after that I got my pre-op and then it was removed a month after that. I know some people waiting 2+ years.

No advice but really feel for you OP. I put up with this until my attacks were lasting 12 hours and then other symptoms for another 12.
The only tIme I did present in A/E - in extortionate pain, vomiting, pyrexial and having rigors, I was treated appallingly by nurses. It was very traumatic.
Eventually I saw a surgeon who was helpful and caring and admitted me to a ward.
I'm a nurse! I've never felt so ashamed of my profession.
On a positive note, when I eventually had surgery, loads of other symptoms disappeared with my gallbladder, It was like a miracle!
I hope you get sorted soon - even morphine didn't touch the pain. It's a strange pain in that respect - it responds to nothing and you just have to wait for it to go.

What do you mean by 'till they pass'?

Thank you everyone. I do appreciate this is AIBU so I’ll get all sorts of replies and I take everything on board, I am.

I’m 3 months pp , had an awful HG pregnancy and now I’ve had these awful attacks. I’ve only found out they are gallstones this week, so now I am more aware and I’ll take lots of your tips on board. Honestly, they feel like you are dying hence the 999 calls!

No but they could give it her while she is in A&E, or codeine or something.

Trouble is, they can't just hand stuff out, it has to be prescibed and there is sometimes a wait for that. I have been in at various times for pain - appendix, chest pain and have always been given something. Chest pain is a fun one because they happily give you codeine until they decide you aren't actually having a heart attack then discharge you with nothing (I have had pleurasy and gastritis in the past both of which were very painful).

I also had gallstones, while mine were manageable, I was in hospital with someone who had been there for several days because she was in too much pain to send home so that can happen too.

I hope you get sorted soon OP.

Codeine gave me a bile duct spasm and that really was the worst pain of my life. While you’re waiting for gallbladder removal, cut out all fat, pastry, fried food, butter, dairy. I also couldn’t tolerate garlic, onions, tomatoes . Eat small amounts of lean, plain food little and often.

opioids definitely do form part of the the treatment for biliary pain. A small subgroup of patients don't get on with them but most are fine. Prescribing for post-partum women (particularly if they're breast-feeding) can be more complicated, and codeine is not a standard option in this context in the UK. Going to have a guess that if the OP was rolling round the floor then they weren't in a bedspace and that may well be the thing that limited the options - that really just reflects that the NHS is in a pretty dire way re. capacity rather than that no on that shift cared. It's worth getting in contact with the surgical team each time it happens... if it's regular enough/ interfering with caring for a new born it may well get the operation done sooner.

A&E rarely give pain medicine as they get an awful lot of addicts (and addicts can be really convincing) and they cannot guarantee what else they have took and how it could react.

In fact there is only 3 categories of medications you can deliberately go to A&E for if you are 'in need' which are:

1. Asthma medication
2. Insulin
3. Anti-psychotics

I had morphine on prescription 10 years ago when waiting to get mine out. Things may have changed since then though. I found fizzy juice helped me at times. It made me burp or puke which seemed to relieve the attack.

It’s not inevitable to have another attack - it can be managed by careful diet. Eat very plain bland fat free foods. Try figure 8 movements while kneeling if you get attack. Discuss pain relief but you are pregnant, I tolerated gallstone pain while pregnant on paracetamol because I was concerned about impact on baby.

I’m not pregnant

My hospital love giving out pain relief, strong stuff if they have to

Anything that gets the patient to say "yes xyz has resided a bit" so they can say "Great!! Fuck off home"

till the attack passes

A+E stabilise you. Long term medication is the job of the GP.

Wow! There speaks someone who has never experienced this level of pain.
I called 111 and they called an ambulance out for me so yes, you do go to A&E for this level of pain.

I also went to A&E during the worst gallstone attack and got the most helpful advice. The dr told me that gallbladder pain starts way before an attack kicks. Taking pain meds when it kicks off is too late. You want to take them before it even starts. She told me to take paracetamol regularly, every day, whether I felt the pain or not, to stop it getting a hold. You have to treat the paracetamol as your preventative medication until you get your surgery.

I was sceptical but desperate, so started taking it 4 x a day. I didn't have another attack in the 4 months until I got the surgery.

I was given oramorph when I was in A&E with a gallbladder infection. I was in hospital for 3 days and they kept offering it even after my pain was settling and I said I didn't need it anymore. It is very much a thing for gallbladder pain. Which, I agree is absolutely the most painful thing I've ever experienced.
I found codeine based painkillers useless and apparently some people don't benefit from them at all and I'm one of them. So once I got home it was ibruprofen and paracetemol.
I was advised to keep my diet below 3% fat and that really did seem to help keeping the attacks down until I could have the op. You have to check labels quite carefully as it's surprising how much fat some stuff has in it.