I commented on a blog the other day, Headache and Migraine News Blog. I thought I would post it since patients that ask for pain meds that begin with the letter “D” always raise ER staffs’ attentions.
” I have virtually stopped giving Demerol all together for any condition. There are several reasons. First, it is very short acting. Second, it has toxic metabolites. Third, it is about as addictive as it gets. Fourth, the people that get it often go into a delirious state for an hour or two afterwards. Fifth, I have accidentally OD’d several people on it - I gave the “usual” dose of 50 or 75mg and in each case they almost stopped breathing I had to reverse them with Narcan. Sixth, there are better drugs out there - injectable Imitrex, Reglan, Decadron, Depakote, and even Morphine (which is safer, easier to titrate, and less often abused). Finally, it is a drug of choice for drug seekers who exaggerate or fake symptoms. You get the ole’ “The doctor gave me something that begins with D - yeah, that is what I want”. Some hospitals have completely removed Demerol from the formulary and they have noticed a huge drop in visits by the repeat offenders.”
Another drug that starts with “D”, Dilaudid (hydromorphone) is also popular - but I find it is much safer and produces less “high”. Thus, I give it if Morphine has failed.
We give Demerol for rigors if benadryl and atarax have failed.
Yeah, I can’t imagine anyone drug-seeking a shot of Depakote.
I’m not big on pain meds, but did once sneek a Vicodin from the bottle DH’s oral surgeon prescribed — just out of curiousity why the pharmacies around here keep getting hit for their hydrocodone and oxycontin supplies. All it did was give me a headache, so I still don’t know what the attraction is. End of experiment; I’m not trying the oxycontin.
sneak. Geez.
Our locals Loooooooooooooove Dilaudid, even though we do have Demerol on formulary.I do not recall when Demerol was used last or even asked for,come to think of it.
Its always the chronic migraine female that is sitting in a room with the lights off, sun glasses on and they say that they have been here before and need 75 mg of demerol and 25 of phenergan or 50 of benadryl and then another shot of demerol in about 1 hour. Nothing else works for them. Then you tell them you don’t give demerol, but will be happy to give them something else for pain. Then when you look at their allergy list, toradol, morphine, reglan, imitrex, motrin. I tend to ask if they are allergic to tylenol when they give me this list, if they say yes, I always say then you can’t even have percocet.
Sometimes they get up and just leave the ER. I am always nice about it, “ok, have a nice day!” Come back when your not drug seeking.
FYI–It’s not considered standard to give “real” migraineurs narcotics of any kind these days as far as I know. Reglan, benadryl, toradol. If you’re a faker, you pain will go from a 10 to a 9, if you’re real, it will almost take the migraine away.
Narcotics cause rebound headaches….
Thanks for your explanation on the subject of demerol for migraine headaches. I have had chronic migraine for 10 years now (I am 27.) I found that demerol never worked for me, but many ers used it as a the first response for migraine. I think your explanation is one of the best I have heard. It is clear and explains exactly why other medications might work better. I always appreciated it when doctors explained why they used or didn’t use a specific treatment. Thanks.
The few times I’ve had a real “wow, this can’t be normal” type headache, getting up and going to sit in a waiting room was the least of my interests. However if the day comes that it seems like a good idea to do so I would much rather have medication that makes me feel *less* out of it, not more so.
@m(2): From my experience what starts to make vicodin seem appealing is when it’s prescribed for pain it can’t handle. There’s something about that combination of inadequate pain control + mild mood altering that’s pretty dangerous, even though on its own vicodin really isn’t entertaining. I’m grateful that I had that experience (briefly, between diagnosis and scheduled surgery a few weeks later) so that I understand how it happens, but I would rather not go there again.
Nurse K, The drug that REALLY gives rebound headaches and that should be avoided at all costs in my experience is Fiorcet. It is terrible…..
I don’t have migraines, nor do I understand why anyone would actively seek Demerol for pain. It just doesn’t work.
I had septoplasty Friday morning, which is a real pain in the head. I felt great - no pain, alert, relaxed - until the anaesthesia wore off around midnight. Vicodin ES 1 tab q4-6 hours PRN was little help.The on-call surgeon told me to double up for the next few doses, which made a huge difference. No high, not sleepy, feel fine. Go figure.
re: ” have virtually stopped giving Demerol all together for any condition. There are several reasons. First, it is very short acting. Second, it has toxic metabolites.”
Though in most cases I agree with you, Demerol IMO is by far the best acting drug in severe rigors. I am liberal with the drug in those circumstances. Doubt, you see migrane patients with rigors typically.
Before I went to pharmacy school, my mom was prescribed Demerol for postop pain, and it just made her dopey and did nothing for the pain. She has always been completely mystified as to how anyone could become addicted to it.
Knowing what I do now, she was given Demerol tablets (she was already at home) and PO Demerol is little better than placebo, with a host of side effects.
I posted on “Movin Meat” as well, so I won’t add much but what I forgot to add there I will add here. All migraine sufferers are different and what works for each is usually different as well. Because we have usually tried so many things and been subject to many different courses of medications we usually do know what works.
In my most severe migraines the symptoms come on very quickly usually with no warning, by the time I make it to the ER if I do, the Toradol & Regan (zofran in my case) route will barely make a dent and I normally would have tried that at home.
Luckily my ER is aware of my situation and history and my doc has privileges so they are quick to treat with fluids, zofran and morphine. I don’t know what I would do if this was not the case.
I know that many of the ER staff members have encountered one too many drug seekers and I can understand the doubt when a migraine sufferer comes in stating what does or does not work. In my case it is from years of experience and experimentation. Thank you for allowing me to share a bit of that experience here. Elle
I’ve never understood why ER docs care so much that addicts might be scamming them. Isn’t it better to err on the side of providing drugs to pathetic addicts than to withhold medication from people who really need it but look dodgy?
Simple Ed, it is illegal to obtain drugs for reasons other than what is is intended for - ie pain relief. If someone is taking it to get high, that is illegal. Others may sell the Percs once they fill the Rx. Also, it is monumental waste of our time when I am supposed to treating sick people.
I have had 5 major surgeries in the past 3 years and I had bad reactions to Morphine and Toradol. The hospital decided to put me on a Demerol Pump. It worked alot better than any of the other meds but it caused my blood pressure to go really low. I do not tolerate medicine very well, and was given the correct dosage but was overdosed. I asked them to stop giving it and just give me Tylenol. I hated that stuff…even if it did take away the pain. I wanted to be able to talk to my family and I was mentally out of it for weeks.
I don’t understand how someone else can decide what helps another person. I started having migraines when I was 14 and have been on almost every preventative possible. As far as pain…..maxalt works for a while but they always come back, imitrex injections work sometimes. I have vicoden and fioricet for home use as well. My doctor gives me demerol and vistoral (sp?) 150-200 mgs of demerol when I have tried everything else before coming in to see him. The only time I have had Toradol is when I went to an after hours clinic and they don’t dispense demerol….it didn’t even touch my migraine.
I don’t understand how you can classify all “migraine” people as drug seekers. I see my doctor and my doctor only, I even need his permission to go to the after hours clinic. I don’t even use a full prescription of vicodin or fioricet in the time before it expires, and I have had maybe 3 shots of demerol in the past year. It is a last resort for a migraine that will not go away with anything else. I don’t know exactly how it works, but it doesn’t make me feel good when I get the shots, so I don’t understand how it is addictive. It does knock me out so I can finally get some sleep, and when I wake up my migraine is gone.
I would love to be able to treat my migraines without having to put a narcotic into my system….although sometimes I don’t have a choice. For me it is either not function for a week or get a shot and be out of commission for 24 hours and then feel better.
I have suffered from migranes since I was about 8 years old and am 37 now. I now take topamax daily and have fioracet to take with flexeril when I get a migrane which isn’t often anymore. I am not a drug seeker and quite honestly would prefer to not have to take anything ever. Having a migrane is debilitating. I have only been to the hospital twice over the past year and it has been my last resort. I also was treated with the toradol, benadryl, reglan. But had to have two doses of it. No one wants to incur the costs of an ER visit or go thru that but once you’ve been in bed for days, missed work, and cannot get thru daily life what are you to do?
I made a comment on James’ blog and I won’t go as long here. I have received Benedryl and Reglan IV; depakote IV, dilaudid and phenergan, and Demerol and phenergan. By far the most effective agent was Demerol. By the time I get to the ER, I have already taken 2 doses of a triptan and an indomethacin, compazine, and caffeine suppository. I would not be a good candidate for more triptan or DHE. Toradol did nothing.
Toradol is a wonderful pain medication. I’ve never had it given for migraines but it works great for kidney pain, after surgery and once for a horrible case of strep. I can get a shot, wait a few minutes and drive home. No need to find a ride, etc. I’ve never gotten “high” but the relief has always been wonderful. I can go home and go to sleep. Eight hours later (when it wears off) the antibiotics have usually kicked in.
Nurse K,
As a health related professional, you should have learned that pain is subjective and what will get rid of migraine pain or any other pain for one person will not work for another.
I’m one of those typical chronic female migraine patients sitting in the ER when my phenegren, Axert, Benadryl, Naprosyn, Compazine, and OxyIR fails to work after having a migraine for 3 days. I’m allergic to Imitrex (causes vasospasms in my heart) and allergic to Demerol (non-stop vomiting if given).Usually Morphine and phenegran will at least knock my migraine to a level 5 so I can take my Axert and it work better.
Do you not realize that that ER visit costs me a co-pay of $125? Do you not realize you can get drugs on the street for about $20 (my ex was a narcotics cop).
Please dont label everyone w/ a migraine. You are casting judgement on a person that may indeed be in real pain and leave in real pain. Chronic pain sufferers have a higher rate of suicide. Can you imagine sitting there in pain and being denied pain meds??
TO NURSE K AND ALL OF YOU IGNORANT NURSES AND DOCTORS: To all doctors and nurses who HAVE NEVER experienced migraines before, don’t judge those who walk im the ER and need something for pain. I have had migraines since I was 6 years old! Who are you to judge to say we are faking it or not! Hydromorphone and phenergan is the only thing that knocks my migraine out. AND their is a difference between a headache and migraine! Some of you are ignorant and don’t know the difference. It pisses me off when some of you think we are drug seekers. Excuse me, drug seekers are more likely to find drugs on the STREETS!!! We migraine sufferers know what takes our pain away, so don’t judge! I am in my second year of law school and have already sued a stupid doctor that gave me toradol for my migraine after I said I was allergic to it! Needless to say, he has learned his lesson and even though I only got $50,000 out of settlement, I WAS determined to prove a point. So before you decide to become a nurse or a doctor, just remember, PEOPLE go to the ER because they are in pain! Don’t judge them either! Because of one these days, your bad judgement will either end up in court, unemployed, or yet worse! If you think everyone is drug seeking, maybe its time for you to choose another career!
I’m with you Terri, who are they to say what works best on us?! They just assume and want to be a-holes!
Nurse K, its time for you to find yourself another career, after all you’re just a nurse, not even a doctor so you can’t say what works best for pain anyway.
Eye Vay Patient A, give it a rest.