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Old 11-15-2012, 04:09 PM   #1
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Unhappy My brother has major problems with pain management

Hey there! This question is not about me, but about my brother. About 2 years ago, after exhausting all other treatment options, my brother underwent a spinal surgery to correct a 10mm bulge in his back. The surgery didn't work and left him in more pain than before. He has been on heavy duty pain meds since then. The problem is that he goes through his meds very quickly and they have a 50/50 chance of working on some occasions. One major problem is the fact that he had gastric by-pass 18 months before the spinal surgery to try and loose weight to see if that would help. In short, the meds sometimes don't work because they aren't absorbing (he actually chewed up an oxycontin, swallowed it and it did nothing for him). My concern is that he is needing more and more pain meds to try and control the pain and it is making him angry and he is becoming violent toward our elderly parents (who he lives with because he can't work) because of the pain. He has a wonderful pain doctor who wants to put him on a pain pump in about a month or so, and i think it will help emensely. I am just wondering if there is anywhere my brother can go where they can manage his meds until he gets his pain pump?

 
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Old 11-15-2012, 05:40 PM   #2
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Re: My brother has major problems with pain management

I had gastric bypass 2 yrs ago and it has DEFINITELY complicated all my meds (not just pain meds)... the whole "malabsorption" issue makes everything work differently and I've noticed that meds tend to be fast in, fast out.

Prayers going up for your brother.

 
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Old 11-15-2012, 08:16 PM   #3
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Re: My brother has major problems with pain management

Sorry he is having so many problems. I hope the pump works for him. It likely won't be as easy as he was told though...it has to be approved by insurance (usually involves a psych eval and some waiting time), you have to respond to a trial (greater than 50% relief...not everyone gets this), insurance has to approve the surgery, that needs to get done, then it takes months to taper up the pump dose to get relief, etc.

Does he have a pain specialist managing his meds? Do you believe he has an addiction problem, or is just that he is desperate for relief (which can actually mimic addiction)? I say that as chewing a time release med is a sign of abuse, as it using up meds faster than prescribed. One thought I have is that there are two pain meds which come in a patch form (absorbed through the skin, not the digestive system), Fentanyl and Buprenorphine.

Although I don't believe in mentioning meds by name in most cases, I'd suggest your brother discuss his pain with his doctor, and ask if there is some way to bypass the stomach due to the issues from the gastic bypass. That may move to a suggestion of a patch. Has his doctor tried treatments besides or in addition to the pain meds? Sometime to help his mood (anxiety and/or depression?) in the mean time may also help. Counseling can also be helpful for those with chronic pain. Best wishes.
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Old 11-20-2012, 01:05 PM   #4
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Re: My brother has major problems with pain management

I thank you for the reply. My brother is certainly looking for relief from the pain. I mentioned the chewing up of the meds to show how badly his meds are being absorbed. He is just trying to get away from the pain. He has a wonderful doctor who has been beside him and really encouraging him this whole time. as for the patch, he tried that but had a horrible time with hair issues (he had to constantly shave to get the patches to stick and sometimes they wouldn't work if he didn't shave close enough). I was just wondering if anyone knew of a place where he could stay and get help while he waited to see if the pump would work.

 
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Old 12-04-2012, 12:19 PM   #5
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Re: My brother has major problems with pain management

Hi Jenwahh, Ive had a pump for about 9 years, Like the other poster said, It takes months to get through the psych testing and then hopefully he will have a sucesful trial, even then they start you low and it took a good 6 months to get my pain back down to where it was with orals only I didn't have the cognative effects that orals cause.

As far as a place to send him off too, while he is being a jerk, other than Jail for domestic abuse, he needs to learn to deal with his feelings in a better way. Nothing happens fast in the CP world. The docs figure we have lived with it for years and will continue to live with it for years, so their really isn't a quick fix or a place to send him other than to slap some sense into him and explain having pain or being disabled or handicapped doesn't give someone a free pass on being a jerk.

Im more concerned about your grandparents than your brother, They give him a place to stay and he repays them with abuse. It's time to have a heart to heart and explain they dont have to do a thing for him and he may end up being removed from the situation and the cops aren't going to care what his pain level is. If you are the only one seeing the abuse and that knows about it, you have a greater duty to protect your grandparents than you do to find an answer for his pain in the next 30 days why he waits for a consult, psych test or trial. From consult to implant took me 6 months because the first trial failed due to a SPF leak caused by the cath. So I waited 3 months and did another trial, then it took about 8 weeks to get it scheduled and another 6 months adjusting it to a level that was effective. You can do a lot of abuse in 12 months and your looking for the one month cure for a lifetime problem that professionals have a tough time dealing with.

The bottom line is he will always have some degree of pain, so he can always use pain as an excuse for any behavior that others find offensive. The psych term is secondary gain. I had 3 fusions and went 8 years before any pain med was prescribed other than short term post op and I didn't abuse my family. He isn't experiencing anything anyone else in pain doesn't. We all take meds sometimes that seem to do nothing for the pain, sometimes pain winds up beyond any meds ability to bring it quickly down again, even with a pump.

He needs to learn to cope instead of lashing out, A PM psychologist can teach him techniques like self hypnosis, guided imagry, bio feedback or even yoga breathing techniques and once he realizes he can actually control his BP, blood flow rate and brain wave activity simply by concentrating it may dawn on him that he also has control over what comes out of his mouth as far as the abuse. It sounds like he has given himself permission to be a jerk and you are trying to make excuses for it. The techniques he learns will help him get through the tough times but Somebody needs to tell him he wont have a place to stay if he continues to be abusive.

There aren't any fancy hospice settings for people with back pain. The closest you will find is a drug rehab where they will tell him he can learn to live with the pain he has. Being in pain or sick is never a reason to abuse the meds your given or abuse the people careing for him.
Im sorry, but abusing elderly family because he is in a foul mood, depressed or in pain just doens't sit well with me and if you tolerate it now what makes you think a pump is going to change a thing if he happens to have a bad day or thinks they should be adjusting his pump faster or in greater incremenets. He has already given himself permission to cross that line. Untill there is a consequence he will continue to cross it. I get your trying to be understanding of his situation, but there is no situation in which abusing the elderly is acceptable or explainable
Good luck, Dave

Last edited by Shoreline; 12-04-2012 at 06:58 PM. Reason: spelling

 
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