Pain is an unpleasant sensory and emotional experience that all of us have to deal with at some point. While mild to moderate pain can often be managed at home, severe or persistent pain may require emergency medical treatment. But how do you know when your pain has reached the level where a trip to the hospital or emergency room is warranted? Here is a guide on determining when to seek emergency care for pain.
What is considered severe pain?
There is no definitive threshold for when pain is considered severe enough to necessitate an ER visit. The experience of pain is highly subjective and individual. However, according to most medical experts, you should consider going to the emergency room if:
- Your pain is ranked 7 or above on a scale of 1-10.
- The pain is the worst you have ever experienced.
- Over-the-counter medications and home remedies do not provide any relief.
- The pain is acute – it comes on suddenly and rapidly worsens over a short period.
- The pain is accompanied by worrying symptoms like chest pressure, difficulty breathing, neurological changes, etc.
As a general guideline, if your pain is so severe that it is difficult to think, speak or function – it’s time to seek emergency care. A pain level of 8-10/10 that persists despite medication or flares up frequently is a red flag.
When is chest pain an emergency?
Chest pain should never be ignored or underestimated. While it often ends up being nothing serious like heartburn, chest pain can sometimes indicate life-threatening medical crises like a heart attack, pulmonary embolism, aortic dissection, etc. Emergency care is especially crucial for chest pain if:
- The pain feels like a heavy pressure or squeezing in the center of the chest.
- It radiates to the back, left arm, shoulder, neck or jaw.
- It is accompanied by shortness of breath, sweating, dizziness, nausea.
- It does not go away with rest or nitroglycerin tablets (if you take them).
- You have risk factors for heart disease like smoking, obesity, family history, etc.
Even if your chest pain ends up being due to something like acid reflux or muscle strain, it’s always better to get checked out quickly given the risks. Call emergency services immediately if you experience severe chest pain.
When to get emergency care for abdominal pain
Sudden or severe abdominal pain can have many possible causes – some of which can rapidly escalate into an emergency if left untreated. Go to the ER right away if you have:
- Very severe or persistent pain rated 8-10/10.
- Pain accompanied by vomiting, fever, weakness, dizziness.
- Worsening pain despite trying home remedies.
- Distended, rigid, or tender abdomen.
- Blood in your vomit, urine or stool.
- A possible abdominal injury from trauma.
Severe abdominal pain may be due to appendicitis, pancreatitis, bowel obstruction, ruptured organs from injury, or other conditions requiring surgery. Early treatment significantly improves outcomes.
When is head pain an emergency?
Though most headaches are not dangerous, sudden and severe head pain can signify a medical emergency like hemorrhage, meningitis, stroke, aneurysm, or brain abscess. Seek emergency care for head pain if:
- The pain is extremely severe – rated 9-10/10 in intensity.
- The headache comes on very suddenly, like the “worst headache of your life”.
- The pain does not respond to any medication.
- It is accompanied by confusion, seizures, vision loss, weakness, etc.
- You have a head injury preceding the headache.
- You develop a fever and neck stiffness along with the headache.
Such “thunderclap” headaches require urgent evaluation to rule out potentially catastrophic conditions like hemorrhage or stroke. Call 911 or visit the ER immediately in such cases.
When should back pain be treated as an emergency?
Back pain is a very common and usually benign problem. However, in some cases, back pain can signal a spinal emergency requiring prompt medical care. Red flags include:
- Excruciating or crushing back pain, especially if rated 8-10/10.
- Sudden onset of pain after injury or accident.
- Pain radiating down the legs, feet or groin region.
- Numbness, weakness or paralysis in the legs.
- Loss of bladder or bowel control.
- Fever, nausea, confusion accompanying the back pain.
Such severe back pain may be caused by a vertebral fracture, herniated disc, abscess, tumor or cauda equina syndrome compressing the spinal nerves. Delaying treatment can lead to permanent disability, so call 911 or go to the ER right away.
When should you visit the ER for pain after surgery?
Having some pain after surgery is expected. But worsening, uncontrolled or new pain after surgical procedures should not be ignored and can indicate complications. Go to the ER promptly if you have:
- Sudden, severe pain that is getting rapidly worse.
- Unrelenting pain not eased by pain medications.
- Excessive swelling, redness around the incision.
- Bleeding from the surgical site that does not stop.
- Foul-smelling drainage from the incision.
- Fever over 101 F along with the pain.
- Chest pain, trouble breathing after anesthesia.
Such postoperative pain may be due to hematoma, infection, pulmonary embolism or other problems that need urgent attention to prevent further issues. Notify your surgeon, but go to the ER if the pain seems life-threatening.
When should acute injury pain be seen in the ER?
Most minor cuts, sprains or bruises can be managed initially at home with first aid and over-the-counter medicine. However, some injuries cause severe pain warranting an ER visit. Seek emergency care promptly after any trauma or accident if:
- You have severe, persistent pain rated 8-10/10.
- The pain keeps worsening instead of improving.
- Pain is accompanied by bleeding that won’t stop.
- Suspected broken bones, dislocated joints, head injury.
- Injury causes loss of consciousness, confusion, vomiting.
- Inability to use or bear weight on affected limb.
Trauma from falls, motor vehicle accidents or contact sports can cause internal bleeding or organ damage. Bone fractures also often require realignment by a doctor. Seeking prompt ER treatment can prevent complications and long-term issues.
When should chronic pain patients go to the ER?
Those living with chronic pain conditions like arthritis, migraine, endometriosis, etc. typically learn to manage flares at home. But worsening chronic pain may warrant an ER visit if:
- Your pain rapidly spikes to 8-10/10 in severity.
- It becomes extremely debilitating and unmanageable at home.
- It is accompanied by worrying new symptoms like chest pain.
- You experience side effects like excessive nausea from pain meds.
- You are unable to keep any food or fluids down due to pain.
- OTC and prescription meds provide no relief.
While ERs focus on acute issues, they can provide strong pain-relieving injections and medications to help control a severe chronic pain flare until you can see your regular doctor. Don’t downplay your pain – seek help if it becomes overwhelming.
What about non-pain related reasons to go to ER?
While pain is a major reason people visit emergency rooms, other acute symptoms and conditions also require urgent ER care, like:
- Difficulty breathing or shortness of breath.
- Symptoms of stroke – weakness, vision loss, difficulty speaking.
- Heavy bleeding that won’t stop with pressure.
- Severe allergic reactions with swelling and difficulty breathing.
- High fever over 104 F, especially with confusion or stiff neck.
- Sudden, temporary loss of consciousness.
- Possible heart attack – chest pain, sweating, pain down left arm.
- Seizures – especially if lasting more than 5 minutes.
The ER can quickly run tests and provide life-saving interventions for such acute issues. So whether it is pain, breathing issues, bleeding or other worrying symptoms, don’t delay seeking emergency care if you think you need it.
What information should you have handy when going to the ER?
When you visit the emergency room in distress, having some key information handy can help streamline the process and improve the care you receive. Try to bring:
- Health insurance card and photo ID.
- List of current medications and doses, medical conditions.
- Information about your pain – when it started, location, severity, etc.
- Details about any accident, injury or trauma preceding the pain.
- Contact information for your primary doctor or specialist.
You can write these down or store them on your phone for easy access when you are coping with severe pain. Having your medical history and emergency contact details readily available allows ER staff to quickly initiate appropriate treatment.
What should you ask the ER doctor about pain treatment?
When you go to the ER in acute pain, asking the right questions can help you better understand your situation and ensure optimal relief. Important questions to ask the treating physician include:
- What do you think is causing my pain?
- What tests or scans will you do to make a definitive diagnosis?
- How will you manage and treat my pain while I’m here?
- What medications will you give me for pain relief?
- How long will it take for the pain medication to start working?
- What side effects or risks do the pain medications have?
- Do I need to be admitted to the hospital or can I go home?
- What warning signs or symptoms should I watch out for after discharge?
- What follow up will I need after leaving the ER?
Don’t leave until you fully understand your diagnosis, treatment plan, follow-up needs, and have achieved adequate pain control. Ask questions if anything is unclear.
What are the different ways ER doctors treat pain?
Emergency rooms have access to powerful medications and tools to rapidly alleviate severe pain. Treatment options may include:
- Oral analgesics – OTC pills like acetaminophen, NSAIDs or prescription opioids for moderate pain.
- Topical anesthetics – Creams/sprays applied on skin to numb areas before procedures.
- Local anesthetic injections – Shots of lidocaine, bupivacaine near nerves or injuries.
- Nerve blocks – Injections of numbing medication into nerves or spinal areas.
- IV pain medications – Opioids, ketamine, steroids injected into the bloodstream.
- Sedatives – Anti-anxiety drugs or propofol drips to calm anxious, distressed patients.
- Regional anesthesia – Epidurals, spinals to numb larger regions of the body.
The specific medications or interventions chosen will depend on your diagnosis, pain severity, characteristics and response to initial treatment. The goal is to get you comfortable rapidly using a multi-modal approach.
Conclusion
Deciding whether to visit the emergency room for pain is not always straightforward. However, severe or persistent pain that impairs your ability to function or threatened your health needs urgent evaluation. Trust your instincts – if your pain seems like a medical crisis, don’t wait and suffer at home. Call 911 or have someone drive you to the nearest ER where trained specialists can quickly assess you, provide pain relief, order critical tests and initiate life-saving treatments if necessary. Getting emergency care promptly for extreme pain can help prevent complications and long-term consequences – and provide much-needed comfort.