ColumbiaDoctor Point of View: Integrative Medicine in the ER

Why I Don't Rush To Treat Patients With Pain Meds

October 4, 2013

Working in the ER is fast paced, with, unfortunately, too little face time devoted to each patient. While I may spend time “backstage” reviewing the patient’s medical history and test results, or making phone calls to consultants, the time I get to actually sit down and speak one-on-one with the patient is often short. However, one way I’ve been able to practice integrative medicine with my patients is during (usually painful!) procedures.

Since starting a regular yoga practice years ago—and never being one to take any medications unless I absolutely have to—I’ve been exploring using with my patients what my yoga teachers have taught me about moving through challenging asanas.

It’s undeniable that narcotic pain medications or anti-anxiety drugs can  make a procedure more comfortable. I’m all for putting a patient at ease; it can make the procedure safer and prevent spikes in stress levels for the patient. But instead of giving medications as a first step, can I instead effectively use techniques I’ve learned from my yoga teachers with my patients, most who have never step foot in a yoga class?

The answer is an overwhelming yes.

1. Prepare the patient with meditation.

I frequently turn out the lights in the room and ask patients to close their eyes and try to sit quietly in this space prior to the procedure, while I gather supplies. I encourage the patient to withdraw from the senses as much as possible. While patients may not be able to reach the depths of true meditation, I find they are always calmer and feel more ready for the procedure.

2. Encourage ujjayi breathing.

I was performing a spinal tap on a patient, which entails sticking a needle between the bones of the spine to extract spinal fluid. Not exactly pleasant, right? The patient was extremely anxious (rightfully so!), but before giving him an anti-anxiety medication, I coached him through ujjayi breathing. After I finished the procedure, he asked me, “Doc, did you do it yet?”

3. Reduce chaos with soothing voice and touch.

One of the best tools for maintaining calm during a difficult asana is to focus on my teacher’s gentle voice (and my breath) instead of panicking or getting frustrated or angry. I've put many a dislocated shoulder back into place without pain medication by simply making small, slow movements with the patient’s shoulder and speaking to the patient in a calm, soothing voice. Before we know it, the shoulder is back in its rightful place, and I haven't used drugs or brute force.

4. Emphasize practicing non-resistance.

The more the patient resists me during a procedure, the more anxious he or she becomes—and ultimately the more painful the procedure is. I remind the patient of this and use the above three techniques to create a moment of serenity.

5. End with savasana.

After the procedure, I have my patients lie down in savasana before they leave the ER.

By using these techniques instead of systemic medications, I also save the patient time. There's no waiting for the drowsiness from medications to wear off before a patient can safely leave the ER, and the patient can usually be discharged immediately after savasana. My hope is that these methods will help patients transition back into their lives as if nothing had happened, in the same way that we move from one pose to the next without “hanging on.”

Scientific evidence may still be needed. But anecdotally, I can tell you it works.

Again, this is the beauty of integrative medicine. I usually still inject pain medications locally. If the patient needs or wants systemic pain medications, I certainly don’t refuse them, but I still complement these medications with this practice.

What have been your experiences during medical procedures? I'd love to hear your comments below. The next time you need to have a medical procedure, ask your doctor or dentist if he or she will spend a few minutes trying these techniques first before defaulting to drugs.

This post originally appeared on MindBodyGreen's website.


Helen Ouyang, MD, MPH, is an assistant professor at Columbia University Medical Center, where she works full-time as a practicing emergency physician. She also co-directs the International Emergency Medicine Fellowship and is an affiliate faculty of the Harvard Humanitarian Initiative, specializing in human rights and humanitarian assistance. She is an avid yogi and is keen on promoting wellness with her patients in the emergency room, as well as when she is working in conflict and disaster settings. Dr. Ouyang earned her MD from Johns Hopkins and her MPH from Harvard and completed her emergency medicine residency training at Harvard, at the Brigham & Women's and Massachusetts General Hospitals. She enjoys writing about health, wellness, and complex humanitarian emergencies and has contributed to the Lancet, the Philadelphia Inquirer, the Huffington Post, and Parade Magazine, in addition to numerous academic journals. She lives in NYC when she is not working overseas.