On call this past weekend, I was paged to the post-partum floor to evaluate a young woman who had vaginally delivered a healthy baby boy 16 hours ago. Her chief complaint? Intractable back pain.
[Background: She had delivered 2 babies aided by an epidural block in the past, and complained of back pain during this pregnancy, which she totally attributed to her previous epidurals. She admitted to no previous social or drug abuse history in the past. When she arrive to our hospital in labor, and it was determined that she could have an epidural, the CRNA covering OB tried multiple times, unsuccessfully, to insert one. Both the nurse anesthetist and the anesthesiologist were unable to locate the epidural space. She had what is known as a “difficult back” in our business. She went on to deliver naturally.]
But now, despite 4 Ibuprofens, 2 Tylenols with Codeine, and 2 Percocets, she was still complaining of back pain. I was summoned to see her.
Her pain was completely localized to where her needle punctures were (lower lumbar back), and the area was painful to touch. No redness, no swelling, no bleeding, and no pus was observed. She had no numbness, tingling, or weakness in either lower extremity. She denied headache, stiff neck, or blurred vision. She ambulated in the room without difficulty, and had encountered no problems voiding or moving her bowels.
She claimed to have back pain throughout her pregnancy, but not like this. When she told me that she wanted something liquid like Morphine for the pain, I blinked. When she said that that’s the only thing that helps her when she has bad pain, I blinked twice. Then she told me that Morphine is what they gave her once when she came to the hospital with bronchitis. Blink. Blink, blink.
Direct quote: “I just want to feel knocked out. None of those other drugs are helping me.”
If her pain persists or worsens, she will undoubtedly undergo some radiologic studies and a neurological evaluation. But how does the presentation of her symptoms and her story strike you?
I always believe my patients until given reason to believe otherwise. I do not doubt AT ALL that this woman’s back was sore. But she received enough pain medication to relieve the pain of several patients, IMHO.
I left her room feeling saddened. She did not receive her “liquid pain medication” as requested, only more pain pills to carry her throught the night, and some feeble reassurance on my part that we would take good care of her and get to the bottom of her pain.