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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Ovationman
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Re: pain management for wilderness injury

Post by Ovationman » Thu Jul 31, 2008 5:15 pm

Willow bark AKA aspirin could be of use. Also for burns and aberrations Aloe Vera.

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Re: pain management for wilderness injury

Post by tilt » Thu Jul 31, 2008 6:04 pm

colinz wrote: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.
You're describing what used to be called 'psychogenic shock'. Nowadays it's termed something along the lines of traumatic-stress-response. Most literature categorizes this type of shock as an autonomic response to pain, fright or other extreme emotion causing rapid vascular dilation. Psychogenic shock is one of those things that sounds really exciting when describing a situation to others, unfortunately, to the majority of healthcare providers, psychogenic shock ranks right up there with non-specific neuralgias on the bullshit meter. It's a term used to make people feel better about themselves for passing out from pain. The act of passing out is, in and of itself, self correcting... similar to hyper-ventilating or holding one's breath until passing out.

The generally recognized forms of shock are:
1. Neurogenic
2. Hypovolemic
3. Septic
4. Cardiogenic
5. Anaphylactic

Those five sub-categories all have effects on hemodynamic stability that cannot be corrected by simply 'passing out'.

Those are the types of shock that kill. Psychogenic shock is the type of shock that makes the ER staff chuckle.

*Edited to include unintentional omission*
Last edited by tilt on Thu Jul 31, 2008 10:00 pm, edited 1 time in total.
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Re: pain management for wilderness injury

Post by ImmaMedic » Thu Jul 31, 2008 7:06 pm

tilt wrote:
colinz wrote: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.
You're describing what used to be called 'psychogenic shock'. Nowadays it's termed something along the lines of traumatic-stress-response. Most literature categorizes this type of shock as an autonomic response to pain, fright or other extreme emotion causing rapid vascular dilation. Psychogenic shock is one of those things that sounds really exciting when describing a situation to others, unfortunately, to the majority of healthcare providers, psychogenic shock ranks right up there with non-specific neuralgias on the bullshit meter. It's a term used to make people feel better about themselves for passing out from pain. The act of passing out is, in and of itself, self correcting... similar to hyper-ventilating or holding one's breath until passing out.

The generally recognized forms of shock are:
1. Neurogenic
2. Hypovolemic
3. Septic
4. Cardiogenic

Those four sub-categories all have effects on hemodynamic stability that cannot be corrected by simply 'passing out'.

Those are the types of shock that kill. Psychogenic shock is the type of shock that makes the ER staff chuckle.
Need to toss in Anaphylactic Shock to that list. Otherwise everything is pretty much spot on.

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Re: pain management for wilderness injury

Post by Paragon » Thu Jul 31, 2008 7:43 pm

Y.T. wrote: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.
Unless of course it's a poppy...

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Re: pain management for wilderness injury

Post by Towanda » Thu Jul 31, 2008 7:56 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.
Arnica gel is great for bruising and muscle soreness. Generally I am very skeptical of homeopathic remedies, but arnica gel really works. DO NOT EVER eat arnica plant parts. Straight arnica juice can be very irritating to the skin, but in gel form (usually combined with witchhazel and aloe) the stuff works wonders. Willow bark contains something very similar to aspirin and can be chewed, but look up proper doses of bark.

I don't know that I could ever pull an Aron Ralston and self-amputate a limb. I'd want something stronger than willow bark or arnica gel in my FAK for that.
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Re: pain management for wilderness injury

Post by Paragon » Thu Jul 31, 2008 8:21 pm

tilt wrote:Psychogenic shock is the type of shock that makes the ER staff chuckle.
Yeah, I know when I'm feeling a little depressed, nothing would cheer me up more than witnessing someone pass out from intense, unrelenting pain… :?

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Re: pain management for wilderness injury

Post by ImmaMedic » Thu Jul 31, 2008 9:07 pm

I suppose Lorazepam could be a medication to considered.

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Re: pain management for wilderness injury

Post by Y.T. » Thu Jul 31, 2008 9:44 pm

Paragon wrote:
tilt wrote:Psychogenic shock is the type of shock that makes the ER staff chuckle.
Yeah, I know when I'm feeling a little depressed, nothing would cheer me up more than witnessing someone pass out from intense, unrelenting pain… :?
I was kinda wondering about that myself, but then I figured I must've read it wrong. I mean, if your body is so overloaded with pain or stress that it has to shut down in self preservation, I wouldn't really think that would be chuckle-worthy. ;)
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Re: pain management for wilderness injury

Post by tilt » Thu Jul 31, 2008 10:01 pm

ImmaMedic wrote: Need to toss in Anaphylactic Shock to that list. Otherwise everything is pretty much spot on.

True enough, I buzzed through that post so fast earlier that I left it out. Edited for correction.
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Re: pain management for wilderness injury

Post by tilt » Thu Jul 31, 2008 10:10 pm

Y.T. wrote:
Paragon wrote:
tilt wrote:Psychogenic shock is the type of shock that makes the ER staff chuckle.
Yeah, I know when I'm feeling a little depressed, nothing would cheer me up more than witnessing someone pass out from intense, unrelenting pain… :?
I was kinda wondering about that myself, but then I figured I must've read it wrong. I mean, if your body is so overloaded with pain or stress that it has to shut down in self preservation, I wouldn't really think that would be chuckle-worthy. ;)

After seeing enough B.S. patients looking for drugs or a work excuse, you have to find humor somewhere. Believe it or not, the ER staff will laugh at things that no normal person should think is funny... ever. Example: rectal prolapse... I can't even type it without giggling.

At any rate, back on topic... psychogenic shock is a pathophysiology that correct itself as soon as the nervous system resets. This is why you can't hold your breath to commit suicide. Eventually, you'll pass out and breathe spontaneously. The same thing happens with hyperventilation. In fact, I like it when patients hyperventilate until they pass out, it makes for a quiet ride to the hospital. The systemic vasodilation will cease and the nervous system will correct the body's blood pressure as soon as it is given a chance to.
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Re: pain management for wilderness injury

Post by ImmaMedic » Thu Jul 31, 2008 10:13 pm

tilt wrote:
ImmaMedic wrote: Need to toss in Anaphylactic Shock to that list. Otherwise everything is pretty much spot on.

True enough, I buzzed through that post so fast earlier that I left it out. Edited for correction.
No offense was meant in the correction. I hope I didn't come off sounding condescending.

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Re: pain management for wilderness injury

Post by tilt » Thu Jul 31, 2008 10:39 pm

None taken. Anyone with more than 15 minutes in medicine has been exposed to peer review. I would much rather get caught on a simple omission than get dinged for missing a differential diagnosis or considering the wrong treatment/procedure...

Feel free to catch me when you can, it keeps me on my toes... which I like.
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Re: pain management for wilderness injury

Post by ImmaMedic » Thu Jul 31, 2008 10:46 pm

tilt wrote:None taken. Anyone with more than 15 minutes in medicine has been exposed to peer review. I would much rather get caught on a simple omission than get dinged for missing a differential diagnosis or considering the wrong treatment/procedure...

Feel free to catch me when you can, it keeps me on my toes... which I like.
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Re: pain management for wilderness injury

Post by colinz » Thu Jul 31, 2008 11:19 pm

tilt wrote: Those are the types of shock that kill. Psychogenic shock is the type of shock that makes the ER staff chuckle.
Cheers for the information dude. It's always good to learn more. :)

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Re: pain management for wilderness injury

Post by Psyko5616 » Sat Aug 02, 2008 8:40 pm

I have a halfway decient relationship with my general practitioner, in that he pretty much just does what I ask him to. I told him about my bug out bag and asked him for a heavy duty painkiller, so he perscribed me some 7.5/350 vicodin. I thought that was pretty cool of him, because I didn't know which would be best and I asked him about shelf life and use and he said they were all about the same shelf life. But then I tried the vicodin and it does Nothing whatsoever for the pain. So I feel kinda awkward goin in and asking him for somethin else, but I'm going to have to give it a try anyway because these pills are useless. I'd ask him about the Tramadol but I drink intirely too much (yeah I know, definately not good for disaster preperation), and I don't think that particular pill would be good on my system after the abuse I've already put it through. So I'm lookin for alternative. Any ideas? Morphine is popular in war movies, pros and cons?

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Re: pain management for wilderness injury

Post by ImmaMedic » Sat Aug 02, 2008 9:53 pm

In my opinion, any practitioner that would openly prescribe Morphine has a lot of bad things heaving his way.

Vicodin (Hydrocodone) is a solid pain reliever. One thing that I think is important and hasn't really be stressed, is being able to function with full judgment while under the effects of the pain remedies. Granted, this is like alcohol, everyone reacts differently, but there are many drugs that dramatically impair my judgment even with small doses. Just some food for thought.

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Re: pain management for wilderness injury

Post by Psyko5616 » Sat Aug 02, 2008 10:03 pm

I can't say that he would go for the morphine, I'm just looking for effective alternatives to vicodin because vicodin doesn't even dull my pain. I guess it and I are just incompatable. I keep naproxen, acetomenophin, and aspirin in my FAKs, but I do want at least one heavy duty pain killer just in case. And yes, additionally I need that pain killer to not turn my head into mush as that would be counter productive. I understand theres a possibility this wonder drug isn't out there yet, but I enjoy discussing the options.

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Re: pain management for wilderness injury

Post by ImmaMedic » Sat Aug 02, 2008 10:31 pm

Psyko5616 wrote:I can't say that he would go for the morphine, I'm just looking for effective alternatives to vicodin because vicodin doesn't even dull my pain. I guess it and I are just incompatable. I keep naproxen, acetomenophin, and aspirin in my FAKs, but I do want at least one heavy duty pain killer just in case. And yes, additionally I need that pain killer to not turn my head into mush as that would be counter productive. I understand theres a possibility this wonder drug isn't out there yet, but I enjoy discussing the options.
How do you fair with Codeine? Codeine is a very modest, but effective medication, and often times paired with hydrocodone provides a very effective management of pain.

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Re: pain management for wilderness injury

Post by Ovationman » Sat Aug 02, 2008 10:43 pm

Psyko5616 wrote:I can't say that he would go for the morphine, I'm just looking for effective alternatives to vicodin because vicodin doesn't even dull my pain. I guess it and I are just incompatable. I keep naproxen, acetomenophin, and aspirin in my FAKs, but I do want at least one heavy duty pain killer just in case. And yes, additionally I need that pain killer to not turn my head into mush as that would be counter productive. I understand theres a possibility this wonder drug isn't out there yet, but I enjoy discussing the options.
What kind of pain is this? There are other RX options for treating pain beyond straight opiates depending on what it is.

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Re: pain management for wilderness injury

Post by DryGrain » Sun Aug 03, 2008 12:09 am

ImmaMedic wrote:I suppose Lorazepam could be a medication to considered.
Are benzodiazepines effective in pain relief? I was under the impression that they were an anti-anxiety medication. Then again, UrTheMedic. :wink:
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Re: pain management for wilderness injury

Post by ImmaMedic » Sun Aug 03, 2008 12:35 am

DryGrain wrote:
ImmaMedic wrote:I suppose Lorazepam could be a medication to considered.
Are benzodiazepines effective in pain relief? I was under the impression that they were an anti-anxiety medication. Then again, UrTheMedic. :wink:
Eh, I wouldn't imagine them being useful for pain. I was referring to the psychological shock that was mentioned earlier. :D

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Re: pain management for wilderness injury

Post by Psyko5616 » Sun Aug 03, 2008 3:04 am

Ovationman wrote:
What kind of pain is this? There are other RX options for treating pain beyond straight opiates depending on what it is.
Headaches and sore muscles have been my test pains. Admitadly only 1 drug has ever worked on my worst migranes and thats Duradrin (beautiful beautiful duradrin), but the sore muscles I really did expect to be helped by the vicoden and they weren't effected at all.
ImmaMedic wrote:
How do you fair with Codeine? Codeine is a very modest, but effective medication, and often times paired with hydrocodone provides a very effective management of pain.
I think that I was on codeine as a kid when I crushed and had a pin put in my knuckle, and it was extremely effective, but that was over a decade ago, so I'm not sure if thats what it was or not. I'll have to ask my doctor about that one.

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Re: pain management for wilderness injury

Post by Towanda » Sun Aug 03, 2008 12:22 pm

For migraines, try basil steam. To about a pint of boiling water, add 3-5 drops of basil essential oil (start with 3, work up to 5 if needed) or 1-2 tablespoons dried basil or one small-to-medium handful of bruised basil leaves and stalks (maybe 2-4 stalks with leaves, depending on the size of he plant). Put the container of water and basil on a table, tent the container and your head with some cloth (a dish towel is good) and inhale the steam for 15-20 minutes or less if your headache is gone sooner.
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Re: pain management for wilderness injury

Post by MtnRescue » Tue Aug 05, 2008 8:42 pm

In a nutshell . . . no.

Benzodiazepines, which I believe have been correctly labeled above as psychotropic drugs, affects the mind and are “mood altering.” They are not known for their analgesic properties and are generally used as tranquillizers and to relieve anxiety. Caution should be exercised when taking benzos since they are addictive. For this reason, their use in the treatment of pain is questionable.

Benzos, when used for the treatment of pain, are typically prescribed for the following:

1. the treatment of anxiety that is secondary to chronic pain;
2. the treatment of sleep-related problems due to pain;
3. the treatment of muscle spasms; or
4. prescribed to improve the effectiveness of opiate drugs.

DryGrain wrote:
ImmaMedic wrote:I suppose Lorazepam could be a medication to considered.
Are benzodiazepines effective in pain relief? I was under the impression that they were an anti-anxiety medication. Then again, UrTheMedic. :wink:
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