pain management for wilderness injury

Discussions of the best (or worst) equipment to have on hand for use in the event of an injury during an emergency.

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colonelklink
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pain management for wilderness injury

Post by colonelklink » Sun Jul 27, 2008 8:30 pm

Well I've pretty much finished putting together my bag and should be posting pics of it tommorrow or the next day, but some survival stories I saw on TV the other day got me thinking. A lot of these stories are associated with traumatic injury in somewhat remote locations. I was wondering how you guys address the issue of pain management in a wilderness survival or "post-apocalyptic world" type scenario. Any med that would be of value in this sort of scenario is going to be a narcotic that is heavily controlled by the feds, and any OTC pain medication isn't gonna do a whole lot for someone in severe pain that is 10+ hours from civilization.

Obviously if there is a hospital nearby I would go there, and I am not the type to try and play doctor, but if I am in a remote location and myself or someone I care about is in a lot of pain I would like to be able to do something to put them at ease until help can get there. Is there a legal way to accomplish this or am I shit out of luck.

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Re: pain management for wilderness injury

Post by Ovationman » Sun Jul 27, 2008 8:50 pm

From what I know you are pretty much going to have to deal with the pain if you don't have meds. You can do things like splint the wound/dress it but in the end it will still hurt. Your best bet is to find a doc that is willing to help you plan for this event.

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Re: pain management for wilderness injury

Post by colonelklink » Sun Jul 27, 2008 8:54 pm

Ovationman wrote:From what I know you are pretty much going to have to deal with the pain if you don't have meds. You can do things like splint the wound/dress it but in the end it will still hurt. Your best bet is to find a doc that is willing to help you plan for this event.
Will doctors write prescriptions for this sort of thing? I figured they wouldn't do it because they would assume you are an addict or something.

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Re: pain management for wilderness injury

Post by Ovationman » Sun Jul 27, 2008 8:59 pm

Well I would go about it in a very conservative way like "doctor X I am out in the remote wilderness a lot and I was wondering if you thought that having a emergency supplies of critical medication might be a good idea" or something like that. Never ask for narcotics directly and especially never the names of individual narcotics. I don't know if your doctor would go with this but is worth a try.

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Re: pain management for wilderness injury

Post by BethDeath » Sun Jul 27, 2008 9:01 pm

If I was a Dr. (which I'm not but sometimes I play one...) I would tell you to buy some tylenol and suck it up.

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Re: pain management for wilderness injury

Post by mpi » Sun Jul 27, 2008 9:02 pm

mostly no, but if you have a good relationship with a physician, and aren't always asking, AND you explain the circumstances and the places you are traveling to you might be able to get something. most doctors aren't gonna take a chance with the dea pulling their license.
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Re: pain management for wilderness injury

Post by colonelklink » Sun Jul 27, 2008 9:05 pm

BethDeath wrote:If I was a Dr. (which I'm not but sometimes I play one...) I would tell you to buy some tylenol and suck it up.
LOL. I've been thinking about filling my entire bag with motrin as it seems like thats the corpsmen solution to everything.

"Doc I have athlete's foot"
"Here's some motrin, call me in the morning"
"Uh.... thanks"

I guess I'm guilty of posting a dumb question. That's pretty much the answer I expected, but I was bored and wanted something to discuss. :)

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Re: pain management for wilderness injury

Post by Paragon » Sun Jul 27, 2008 10:34 pm

colonelklink wrote:
Ovationman wrote:From what I know you are pretty much going to have to deal with the pain if you don't have meds. You can do things like splint the wound/dress it but in the end it will still hurt. Your best bet is to find a doc that is willing to help you plan for this event.
Will doctors write prescriptions for this sort of thing? I figured they wouldn't do it because they would assume you are an addict or something.
It really depends upon the individual physician, and of course the relationship that you have with him. I have a good relationship with my primary care physician, although I’ve not lived here long enough to know him well enough to have developed the trust for him to feel comfortable issuing prescriptions for Schedule I or II drugs. He has, however, been very accommodating with regard to non-scheduled medications (broad spectrum antibiotics, epinephrine, lidocaine, etc.)

My former doctor had known me for several years, and would issue scripts for limited quantities of serious analgesics for personal (emergency) use. I would as a matter of routine bring the original (expired) medications into his office whenever asking for a new script, just to confirm to him that these were not being used unnecessarily, or otherwise for any illicit purposes.

When approaching your physician, simply outline whatever medical training you may possess, and explain to him/her what your preparedness interest is. In my case I am occasionally camping/backpacking in very remote wilderness locations, where outside medical assistance or evacuation could literally be several days away. Understanding that hiking out 50+/- miles on a comminuted fracture of the tibia or with a severely dislocated shoulder may be a necessary matter of survival, most physicians realize a bottle full of 500mg acetaminophen isn’t going to help much.

Some basic/intermediate knowledge of pharmacology can be very helpful as well, in that the analgesic effect of many less potent Schedule II or III drugs can be significantly increased when taken in combination with common OTC medications. For obvious reasons I will not cite any examples of such combinations here...

Whatever medications you end up acquiring, I would strongly caution you to think very long and hard before ever considering dispensing them to another individual. The medications that I maintain are for my own personal use during an emergency, as without proper medical training and an intimate knowledge of another individual’s allergies or other medication interactions, one could easily do more harm (i.e. serious injury or death) than good.

Jim

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Re: pain management for wilderness injury

Post by Flying Lead » Tue Jul 29, 2008 8:19 pm

+1 on above.
Depends on the doctor and your history with him/her. If you have seen them for several years and have never had a history of pain pill use or similar drugs, most will give you some if you ask. "I will be on my own in a remote area for several days and falls or other semi serious injuries worry me. Can I have just 3 to 6 low dose pain pills for self rescue purposes." They may give you some. Something like a light narcotic will put the average person in La-La land if they rarely take them. Going into a doc-in-a-box or emergency room asking for them will get you a note on the chart saying you're a pillhead. A regularly seen physician in the way to go.
I've had to take pills back to the drug store to swap out because I had walked around so much they were turning to dust from rattling around in the bottle. And they have come in handy before.
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Re: pain management for wilderness injury

Post by Ovationman » Tue Jul 29, 2008 8:43 pm

Something that should also be added is that some non narcotic drugs could be useful to have. Toradol for example is a powerful NASID used for treating a wide range of conditions. Most docs I would assume be more amenable giving out non narcotics.

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Re: pain management for wilderness injury

Post by JIM » Wed Jul 30, 2008 5:42 am

Disclaimer: The following is just for information. Get your doctors opinion first and READ the link at the bottom with side-effects, etc.

Tramadol is an opioid, but not a controlled substance. You can just get it with just an Rx prescription. It can be given orally, rectally, IM or IV for mild or severe pain.

http://www.drugs.com/tramadol.html" onclick="window.open(this.href);return false;
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Re: pain management for wilderness injury

Post by tilt » Wed Jul 30, 2008 8:09 pm

I've never seen anyone die from pain.

Treatment in the field should be limited to course correction to avoid loss of life, limb or eyesight.

Pain does not cause death, ergo there is no compelling reason to course correct it in the field.

Being injured is bad, but being injured AND stoned is probably worse.
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Re: pain management for wilderness injury

Post by colinz » Thu Jul 31, 2008 5:05 am

tilt wrote: I've never seen anyone die from pain.
Neither have I, but I have seen a serious case or two of shock brought on by pain. And shock DOES kill. ;)

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Re: pain management for wilderness injury

Post by That German Guy » Thu Jul 31, 2008 6:20 am

colinz wrote:
tilt wrote: I've never seen anyone die from pain.
Neither have I, but I have seen a serious case or two of shock brought on by pain. And shock DOES kill. ;)
Not to mention that pain, depending on it's severity and location, can make mundane but essential tasks impossiblem like when my tonsillitis prevented me from swallowing even water.
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Re: pain management for wilderness injury

Post by tilt » Thu Jul 31, 2008 6:30 am

colinz wrote:Neither have I, but I have seen a serious case or two of shock brought on by pain. And shock DOES kill. ;)
Exactly what kind of shock are we talking about here?
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Re: pain management for wilderness injury

Post by colinz » Thu Jul 31, 2008 8:05 am

tilt wrote:
colinz wrote: Neither have I, but I have seen a serious case or two of shock brought on by pain. And shock DOES kill. ;)
Exactly what kind of shock are we talking about here?
Delayed psychological shock in both instances caused the persons involved to collapse a fair time after the initial injury occured.
One was after a bee-sting (in a non-allergic person!), and the other was after a wrenched shoulder. Both were on the same outdoors excursion.

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Re: pain management for wilderness injury

Post by Murph » Thu Jul 31, 2008 9:59 am

Wilderness Pain Killer? There's a Canadian method:

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Re: pain management for wilderness injury

Post by MJS8725 » Thu Jul 31, 2008 1:23 pm

Murph wrote:Wilderness Pain Killer? There's a Canadian method:

Image

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Re: pain management for wilderness injury

Post by zXzGrifterzXz » Thu Jul 31, 2008 1:34 pm

colonelklink wrote:
BethDeath wrote:If I was a Dr. (which I'm not but sometimes I play one...) I would tell you to buy some tylenol and suck it up.
LOL. I've been thinking about filling my entire bag with motrin as it seems like thats the corpsmen solution to everything.

"Doc I have athlete's foot"
"Here's some motrin, call me in the morning"
"Uh.... thanks"

I guess I'm guilty of posting a dumb question. That's pretty much the answer I expected, but I was bored and wanted something to discuss. :)
If its stupid and it works, then it isn't stupid. :wink:

I also keep a couple single serving bottles of Jameson in my aid bag too. Strong kinds of hard alcohol has all kinds of great uses.
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Re: pain management for wilderness injury

Post by crypto » Thu Jul 31, 2008 1:51 pm

JIM wrote:Disclaimer: The following is just for information. Get your doctors opinion first and READ the link at the bottom with side-effects, etc.

Tramadol is an opioid, but not a controlled substance. You can just get it with just an Rx prescription. It can be given orally, rectally, IM or IV for mild or severe pain.

http://www.drugs.com/tramadol.html" onclick="window.open(this.href);return false;
For the record, Tramadol (brandname Ultram) fuckin WORKS.

It's my drug of choice for pain management. It's kind of expensive, but seeing has how it's not schedule II and works as well as any painkiller short of oxycontin, I'd say it's a no-brainer. I've got a 50-count bottle in the BOB.
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Re: pain management for wilderness injury

Post by Paragon » Thu Jul 31, 2008 2:51 pm

crypto wrote:For the record, Tramadol (brandname Ultram) fuckin WORKS.

It's my drug of choice for pain management. It's kind of expensive, but seeing has how it's not schedule II and works as well as any painkiller short of oxycontin, I'd say it's a no-brainer. I've got a 50-count bottle in the BOB.
Really, all the research that I did on it indicated that it was somewhat weak (although I do keep some in my aid bag as an intermediate analgesic).

I woke up with a pretty significant headache a few months ago, and had been fighting some acute lower back pain for a for a few days as well, so I opted to "test drive" it (100mg) just to have a better sense of its effect. I had not previously ever taken one, but it was prescribed by a doctor (who had only seen me once shortly after we moved here) for pain because its abuse liability is much lower than that of other opioids. It's actually available as an OTC pain reliever in many countries outside the US.

It seemed to help the headache, although didn't really have any measurable effect on the back pain. I didn't notice any of the usual side effects (lightheadedness, dizziness, drowsiness, or sedation) that I generally have when I've taken Oxycontin (Percoset/Oxycodone) or Vicodin/Hydrocodone.

As far as cost goes, keep in mind that it's listed on Walmart's $4.00 prescription program.

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Re: pain management for wilderness injury

Post by ImmaMedic » Thu Jul 31, 2008 4:19 pm

The best pain solution is proper splinting in my opinion.

If you have a doctor willing to prescribe you medication for the purpose stated in the thread then I would say it's worth looking into.

As mentioned, Toradol is a GREAT medication for pain management.

Keep in mind, depending on weather, cryotherapy(ice packs, ice, snow) along with proper splinting will be the best solution in my opinion.

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Re: pain management for wilderness injury

Post by Y.T. » Thu Jul 31, 2008 4:30 pm

just a thought on this... if you're in a wilderness situation and either your FAK is empty/insufficient or you no longer have one because we're totally PAW at that point, learning the local plants and herbs can help. For example, there are several plants that yield an anesthetic result when crushed or chewed. Some are natural analgesics. While that's not going to be on the same level as a strong narcotic, it might help alleviate the pain to a manageable degree.
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Re: pain management for wilderness injury

Post by thelight » Thu Jul 31, 2008 5:01 pm

Y.T. wrote:just a thought on this... if you're in a wilderness situation and either your FAK is empty/insufficient or you no longer have one because we're totally PAW at that point, learning the local plants and herbs can help. For example, there are several plants that yield an anesthetic result when crushed or chewed. Some are natural analgesics. While that's not going to be on the same level as a strong narcotic, it might help alleviate the pain to a manageable degree.
Clove oil comes to mind, though it works much better in the mouth than on skin.
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