21 October 2008

Works like magic

I saw a member of the medical staff the other day. It was one of our pediatricians, and the poor guy had a kidney stone. Being a typical doctor, he had self-diagnosed himself in the office and tried to treat himself at home. It didn't work, and he wound up going into his clinic's urgent care for pain control. He got the VIP treatment there: over 200 mg of Demerol! In an opiate-naive person! But to no avail: his pain continued to crescendo and was absolutely untouched by the medicines. We got the call that he would be coming over and that he would probably need to be admitted on and put on a PCA.

When I saw him, I had to feel bad for him. He was sprawled on the gurney, ashen and covered in sweat. He was completely exhausted, but he just couldn't stop writhing, to the point that he was halfway off the bed.

I reviewed his papers, and noted with a little surprise that he had not been given any toradol. I suggested that we give it a go, and the physician-patient readily agreed. I think he would have agreed had I suggested bloodletting, he was so desperate for relief. I put the order in, along with the other usual stuff, and went off to see the next victim.

Half an hour later, I stopped in to check on him. The transformation was amazing. He was sitting up in bed, pink and comfortable, hardly recognizable as the pathetic wretch I had seen before. He had a look of incredulity on his face. "I just didn't know toradol could do that," he marveled. "I knew it was a good pain releiver, but I always figured that Demerol was stronger, and when the Demerol didn't work, I figured nothing would." He rated his pain as a two.

It was a pretty satisfying encounter, and he went home singing our praises. For the life of me, I have no clue why the urgent care didn't give him toradol. It's the first-line drug for kidney stones, IMO. I don't know why it's so effective. I think it has something to do with its prostaglandin effect causing smooth muscle to relax, which eases the pain of ureteral obstruction (biliary obstruction, also). I've previously written about the efficacy of toradol in folks with intractable pain due to kidney stones, even in drug seekers, and for migraine headaches. So I apologize if I'm sounding like a broken record, but man, it's a great drug. And it's profoundly satisfying when it works as it should.

60 comments:

  1. "Toradol is the shiznit, I don't mean to sound like a broken record" he says as he sips from his Roche coffee mug...

    Just teasin' ;)

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  2. I have been playing the "what is going to fix my migraine game" since April of this year. Right now prophylactic Topamax has me mostly in control.

    For some reason, after fifteen years of triptans they have mostly stopped being effective...strange goings on, but I have also had gastric bypass and am wondering if that has anything to do with it - although the nasal spray doesn't seem to be effective either.

    Anyway, I did end up in the ER on one weekend about two months in after seeing the doc on Friday and the prescribed Fioricet did nothing. They gave me Toradol and it worked just like you said. I went from literally smacking myself in the head for relief to sitting up and smiling in a few minutes.

    My question - is Toradol or anything like it available in prescription or is it only something injectable in the hospital? I don't love being on Topamax every day, especially since I am still getting way more headaches than I want. I used to get one a month (the day before my period) and on the Topamax I am controlled to one every ten to twelve days.

    Sorry this turned into a giant story. I love your blog and I always pay attention to stuff about migraines because I HATE thinking that docs want to throw drugs at me or not treat me because they think I want drugs. I just want to take the right thing to be able to work and be a mom. And that Toradol was magic, but I obviously can't go in for a shot of that every time I have a headache. :)

    P.S. Love your blog. I have been reading for a couple of months.

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  3. I love toradol. Happily I have only encountered it once, but when I did it was night and day just like your pediatrician patient here.

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  4. Toradol is wonderous in post-op patients too.

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  5. Toradol is great. I was recently in the ER with pyelonephritis. The pain had me writhing (the 103.6 fever didn't help). With the toradol shot my pain went down to a minor ache.

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  6. You're going to start a Toradol-seeking trend.

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  7. You not a broken record. This needs to get out more. My hubby has migraines in the 'retch-puke-narcs-don't-touch' type. Toradol is one of the few things [along with ketoprofen] that really works. To the point where our PCP wrote us a script and I'd IM him with 30 mg [repeat once 2 hours] at home in an effort to head them off before the ER. Worked 90% of the time.

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  8. news to me.
    If I remember right, I remember the boys from EM:RAP saying that stuff was bad news. good post

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  9. just to be a opposing viewpoint i threw my back out last year writing a prescription, i guess i was leaning wrong and I had someone in labor so i asked for no narcotics, plus i had never taken narcotics before that in my life ... it did nothing and I ended up going from mso4 to dilaudid to get pain relief and I had to that day never had surgery and never received opioids in my life.

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  10. I have severe back pain at 25 years old, and whenever I have break through pain, I always ask for Toradol at the ER since I'm already taking MS Contin. Works like a charm!

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  11. Unfortunately, I am also a sufferer of debillitating migraines to the point of having TIA's resulting in lesions on the brain. I have also been in chronic pain from 3 ripped tendons in the shoulders (rotator cuffs). There isn't an NSAID on the market that has been effective for either the pain or migraines. FINALLY, after 8 years of this and 3 surgeries later, I am on the following "pain" management meds: Lidoderm, Lyrica, Percocet 10/325, and Duragesic 50mcg/h Patch. Make no mistake, this is a massive amount of pain medication but finally, I am getting some relief. Unfortunately, tho, the side effedt are horrendous. Lyrica causes double vision, Percocet and Duragesic cause physical unstableness. I sure wish someone inthe industry would address those of us with a high tolerence to medication and a very low threshold to pain.

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  12. I have seen the wonders of Toradol on kidney stones. But the new PA where I work wouldn't use it cuz he didn't want to be "that aggressive." He didn't think it would work anyway. I tried to tell him that you can almost daignose kidney stones with it but to no avail...what does an experienced RN know against a new PA???

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  13. I was hit by a mortar, IED and rear ended by a semi truck that I was escourting during OIF. C3 to T2 fusion C4-C5, L2 to S1 pick your poison 120mg morphine daily. The VA gave me a shot yesterday and for the first time in over 5 years I was pain free. I had no idea how much pain I was in untill it was gone. This medication is a miracle for me. Yes I will ask for it from now on.

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