I know that you have already made the trip and I hope you are better. Going to the ER and asking for anything is a short path to a Tylenol and a kick back into the parking lot. IMHO the chain of command is the ER gets you through the night. If your lucky, to your next appt w/primary. Your primary will decide if you are a candidate for Pain Management. Only in PM will you have access to meds that have real theraputic power. Even then these guys have it all figured out pretty good. Your relief may never reach the level you want. You remember the commercial where the guy sits in front of the big speaker with a glass of wine in his hand and the speaker is blowing his hair back? Not going to happen. Just a suggestion, don't tell your primary that pain is driving you to depression. Don't use the word, let him use it. There are many clinical markers for depression and if he is any good, he will be trying to make up his own mind. If you feel like slinging snot and screaming then sling snot and scream. Honest feelings and real-life conditions in your home. Please don't sling snot and scream, I was trying to make a point. I don't know of anyone that has leap-frogged the chain of command. Good Luck, Ken in Texas.