Pain on Paul Nystrom

Persistent and Severe Pain

Wed, 03 Jun 2026 00:00:00 +0000

Pain is a frequent complaint that brings patients to the ER. Abdominal and chest pain are some of the most common. I often get asked by patients, usually at the end of a negative abdominal or chest pain workup, when they should come back.

This is difficult to answer. The older the patient and the more chronic medical problems they have, the higher the chance that something significant is causing their symptoms. The younger and healthier they are, the lower the chance, but diseases and disasters don’t exclude anyone 100%. Everyone knows a story of someone, often young, dropping dead with no warning. Is it likely when you are young and healthy that you can ignore most symptoms? Yes, but there are no guarantees.

Context Matters

Wed, 27 May 2026 00:00:00 +0000

More than one patient has come to the ER with blue, purplish, or black skin. At first glance, it appears that there is a lack of blood flow and it’s obviously very disconcerting. My colleague recently had a young lady like this who was rushed from triage to a critical care area as it appeared her legs did not have any blood flow. They were blue.

Google blue or purple skin and you will be hit with all kinds of scary information that makes you think you are on the verge of death. But it turns out, context matters.

Pain is Temporary

Thu, 26 Feb 2026 00:00:00 +0000

I think that’s one of the hardest things for patients to understand. Kids in particular have a hard time with this. I had to relocate a dislocated shoulder for a 15-year-old girl who was in a lot of pain. She had dislocated her shoulder during swimming practice. She was very anxious, but she was also very anxious about us placing an IV or giving her pain medicine before we pulled on her shoulder. Her shoulder was clearly hurting. The sooner we can get it back in place, the better.

How's That Working For You?

Sun, 07 Dec 2025 00:00:00 +0000

People are very unwilling to let go of their opinions. I see this most commonly when it comes to abdominal pain. I have many discussions with patients about abdominal pain. I do large workups for abdominal pain regularly. Many of the patients I see have already had extensive workups by gastroenterology— they’ve had blood tests, cameras shoved down their throats and up their butts—but no one has any answers. I have patients with ulcerative colitis whose GI specialists tell them that diet has nothing to do with their disease. It is baffling to me that this became the standard teaching for most of the GI doctors I’ve interacted with. How is it possible that things going wrong in your gut are not related to what you put in your gut? It seems like the most intuitive thing imaginable, yet we ignore it.

Fixed Mindset

Wed, 05 Nov 2025 00:00:00 +0000

I spend more and more time with patients talking about their medical problems that are not emergencies. The vast majority of the time, any actual emergency condition is ruled out very quickly. Occasionally, a critical diagnosis is found after quite a long time in the ER, but that’s the exception rather than the rule. So once the actual emergencies are no longer part of the discussion, we can focus on other things.