Mom (78) has been in and out of hospital and rehab facilities for months now -has back pain due to compression fractures-she also had covid. She’s very frail and has a feeding tube now-muscle atrophy and osteoporosis but no other chronic condition.
She’s in a group home assisted living facility now-and she is starting to walk again and dress herself but she complains constantly of pain. They tried gabapentin and she is using Tylenol-and on an anti anxiety drug. I fear that she has built up a tolerance to norco (opioid) and needs more. They offered her morphine- I don’t like the idea of my mom being on morphine and I’m not ready for my mom to be addicted to pain killers. However, many have suggested she already is addicted. Is it really fair of me to suggest she not be put on morphine?
I think she has built up a tolerance to the norco and it’s just not working anymore. She has asked for morphine multiple times when she leaves the hospital and first enters rehab-it’s very typical-and they don’t give it to her (they did in the hospital).
I really like the care she is getting and the place is very communicative -this was not the case previously. they asked me if it is ok to give her morphine-they are involving me in the decision process.
Her primary care doctor won’t prescribe any more opioids-she is concerned about addiction. She is no longer using her primary care doc since she is now Under the care of the assisted living doc.
She has been through a lot- she fell from the hospital bed the very first time she was in the hospital-this led to a lot of her current issues. She’s been uncomfortable for months-and depressed.
Does it really matter at age 78 whether she is addicted to pain meds? Is the goal just to make her comfortable and happy? She doesn’t have cancer or any underlying condition. She used to be on very little medication prior to this whole experience. My personal approach is less medication, fewer tests, minimal doc visits-but this is me and my approach to health care for myself-is it really fair to use this approach for my mom?
Although 78 may be old for some people many, many seniors are living well into their 90's so she could have many years ahead of her, I think I would be focusing more on getting a consult from a spinal specialist to see if there is anything that can be done to treat the root cause - I've learned here that there are treatments (Vertebroplasty and kyphoplasty) that can be used to stabilize the spine in some cases.
I agree treat the root cause. Physical Therapy might help.
There are certain antidepressants that are used specifically for folks in chronic pain; in addition to seeing a spinal specialist to see if her back can be better stabilized, consider seeing a geriatric psychiatrist and/or a pain management specialist who can coordinate with her other doctors.
I would discuss the pros and cons of getting on morphine with your mom.
To be placed on Morphaned is used for dying patients to try to keep them as comfortable as possible.
If that is not the case and she wishes to continue living, then I would switch to her having therapy, massage, using a heating pad, sitting and sleeping with her feet propped up. Ect.
If she has no major health problems then she could live another 20 years but not on Morphine!
Tall to the Dr again, Di your Homework and let your mom make an informed decision as it is her life.
She may want to live linger and agree to not take pain pills for a month and do other things instead and see how it goes.
It is cost effective and many times is the 1st drug used for chronic pain.
Does it really matter if someone is addicted to a medication if it works? We talk about addiction to opioids, but leave out all the other addictive meds. My granny was addicted to a med, and when the doc changed it all hell broke loose - we argued and my stance was "Who cares - at her age what harm is it really doing?" The doc relented and put her back on the med.
Your mom should be as pain-free as possible. I fractured my back in three places and can tell you back pain has an effect on quality of life and I do not worry about being addicted to the opoid - better to be addicted and comfortable than not addicted and totally miserable!
My mother also had immense pain due to very bad arthritis. After she broke her hip, it added to her pain. She couldn’t communicate her pain in words because of her dementia and instead lashed out and became aggressive. She was in an assisted living and then in nursing home. The facility first prescribed Tylenol 1000 mg 3 times a day, and Gabapentin 600 mg 3 times a day. It worked at first but she was still wincing in pain. The facility recommended methadone. I first didn’t want to put her on that but did agree after talking to doctors and nurses at the facility. They started off with 1 mg two times a day and reduced it to .5 after she was getting too sleepy. Eventually it was increased to 5 mg two times a day and her body got used to it in her system. After she was on it for a while, we noticed a tremendous difference, she was calm and comfortable and a lot happier than before. It took a lot of trial an error because she could not tell us what was wrong. I finally accepted the methadone and happy I did. It is so hard to accept these drugs, but sometimes they do work wonders.
Maybe you could ask about methadone instead of morphine, which is much stronger.
My best to you.
Reading below I agree with some injections at a pain management clinic to start with. My dad had terrible trauma to his back, had injections and was fit with a wonderful supportive back brace that he loved. Her back needs to be immobilized when she is up and moving. The best of luck to you and mom. My dad also was on anti anxiety meds and a mild anti depressive that helped.
Having my mother on methadone gave her two years of a comfortable life. There were no adverse reactions for her. I know it is different for each individual. I was happy to have had her pain free for those two years. She still would have been here if it wasn't for the Covid virus that took her away in May.
It is a personal decision and as long as you can trust the people who are taking care of her.
Does your mother speak to you about how long she wishes to fight on hard to live ? Did she want tube feedings? (I live in such terror someone would force me to go on with them that it is clearly written in my advance directive that I refuse them and all forms of artificially administered nutritions). Does she express and exhaustion with the constant pain of living now with no relief in site? Are you considering hospice care at any point for her? For me this sounds an utterly fearsome way to go.
If your mother always expressed a wish to go on at any cost, and still does, then I understand. Some people will tolerate any amount of pain to live. Most, however, will not.
I am so sorry for your Mom. If her doctor is speaking, at THIS point, about addiction please request a pain control specialist consult at once. This is the wrong doctor for her. Also consider palliative care, hospice consult may be an option in the near future.
I am so dreadfully sorry. When I started in nursing we did not control pain when we feared its relief might hasten death. Thank goodness this is no longer the case. I could stand ANY amount of blood, guts, sputum, and such, but when my patients writhed in pain I could not relieve it made me dizzy and ill. I have ZERO fear of death, but I know what pain is, and I dread it.
Find a provider who will work with your mother to lower her pain levels. She will be a new woman. Good luck.
Does Mom have a Pain Management Doctor??
If not, it might be worth a conversation with her ALF.
Because of the "opioid crisis ", PCP's will not give pain meds on a long term basis.
They refer chronic pain patients to Pain Management.
Best wishes!!
They are very addictive and you have to keep getting stronger and stronger does. It can be fatal.
Have you tried using electro therapy like Dr. Ho. ? Many of moms elderly friends use it, mom uses it as do I with great relief. It is very easy to use.
It could be that depression or anxiety are factors at play, if so that requires different medication, but would still help with the pain.
As others have mentioned, once she’s in morphine, if she reaches a tolerance point, what does she go to next? What if she bounces back and lives another 10-20 years? Not unheard of.
I would ask for a Pain Management consult.
the opportunity" :)