Fibromyalgia

[brentoli]

BLS dispatched to injured in fall, 50 year old female fell from standing height and possibly dislocated shoulder. ALS is requested for pain management, she is saying it rates 9/10. Paitent is packaged and immoblizied in a position of comfort and pain is a 6/10. States her only history is Fibromyalgia and she takes one vailim in the morning when she wakes up. Takes a pain killer (I can't remember what this was a couple of months ago) as needed, but hasn't refilled perscription in 2 weeks. Loaded into ambulance with still no ALS arrival. Approximate 15 mile trip over rough county roads. Paitent is able to talk through the pain and all vital signs are good. Pain goes to 8/10 during the trip.

ALS arrives, inquires on vitals and current pain. Paitent states 5/10 due to the truck being stoped. Inquires on prior history and informed of Fibromyalgia.

Would you or would you not provide pain management pre-hospital to this paitent?

[ccmedoc]

Most likely, Yes...after my own assessment and report from you guys..I dont see a problem as long as all good with mentation, vitals, and allergy info..

[Ghettomedic351]

What does the history of fibromyalgia have to do with whether or not pain management should be used on a person that has fallen and dislocated their shoulder? I understand that there are several people that don't believe fibromyalgia to be a real disease, however a dislocated shoulder is a real injury.

It's becoming increasingly unethical to withhold pain medication, especially when faced with an obviously painful injury or illness. That's how it should be. There is no reason any patient should have to suffer.

Perhaps you could clarify exactly what you're looking for in regards to your scenerio. Are you asking if someone with a shoulder injury should receive pain management, or are you asking if we believe her pain to be a figment of her imagination because she has a history of fibromyalgia? Not flaming you, I'm just trying to understand your thought process better.

[brentoli]

I am just a basic, and I was wanting to see what some other reactions to this would be.

When the medic heard her prior history, he picked up all of his bags out of the ambulance, said "With her prior history I don't want to do this." And slammed the ambulance door on his way out. Interestingly enough, she had pain medication started at the hospital before we even left. I didn't know if that would be a common reaction among ALS providers, or if this guy is just nuts.

[JakeEMTP]

As a new medic, I'm in no position to question someone else's treatment, especially on an internet forum.

That being said, I wouldn't withhold pain medication for this patient." treat the patient, not the monitor". comes to mind. If she was in pain for the dislocated shoulder, that's what I'd treat.

[ccmedoc]

When the medic heard her prior history, he picked up all of his bags out of the ambulance, said "With her prior history I don't want to do this." And slammed the ambulance door on his way out. Interestingly enough, she had pain medication started at the hospital before we even left. I didn't know if that would be a common reaction among ALS providers, or if this guy is just nuts.

The Medics an idiot....Probably didn't have a clue about fibromyalgia, nor should it matter.

Online forum, hypothetical or real...this person is an :bootyshake:

[triemal04]

Limited info, but what the hell.

If there were signs of a dislocated shoulder or damage to it, then yes, pain management would have been very appropriate. If the lady appeared to be in real pn, then yeah, good idea to give some Fentanyl to her.

But...without having been there, I'm assuming the medic thought something like this: many DSI's often report that they have "fibromyalgia," and given that there is no way to prove/disprove that they have it, it creates a huge problem for anyone who can push or prescribe narcs. I've heard one or two doc's mention that people are often diagnosed with fibromyalgia because they report chronic pain with no apparent cause. The problem there is that it is extremely hard to judge how much pain someone really is in, and often times people seem to get away with drugs that they otherwise wouldn't get (DSI's).

In this case hopefully the medic actually assessed the lady first and then made his judgement, otherwise...that's just not a good idea.

[JakeEMTP]

The Medics an idiot....Probably didn't have a clue about fibromyalgia, nor should it matter.

Online forum, hypothetical or real...this person is an :bootyshake:

Ok, I'll agree with that. I was thinking it, but still being wet behind the ears, I wasn't sure if I should say it. :wink:

Tell us how you really feel about said medic, ccmedoc.

[firespec35]

My wife has fibro and I would have been pretty pissed if the medic did not give pain meds. What you all do not seem to know is there is actually a test for fibro. It is not a definative test though. There are so many points on the body that the doc presses and if you show extreme pain in so many of those spots (I can't remember how many my wife was diagnosed 7 years ago)

The fear that is with docs as well as medics is usually fibro patients are on powerful meds (My wife was on a fibro patch 50 cmg/72 hrs, Darvocet, and valium) so about the only thing that would touch her is Dilaudid. The other problem is she has recently been changed to suboxone which is a Narcotic (Buphrophenine or something like that) and Naloxone. The narcotic it is matched with does not react to the naloxone unless it is crushed and smoked or injected or if other Narcs are given.

Maybe the medic knew her as a frequent flyer or something but MMQ'ing the situation. The Medic was an ass

[backinboston]

On a side note, if the pt didn't have fibro, just the pain, you dont have to give every pt with pain, pain meds. Its cost vs benefit not treat the pt not the monitor in this situation.

When a pt really needs pain meds, you will know...

but often I just think... Pain lets you know you are still alive.... and we cant be doping up every pt with some kind of pain we encounter