Hi all, I am new to this forum. My mother is 81 and suffers from arthritis, osteoporosis and scoliosis (curvature of the spine - 'S' shaped). She recently had a new knee and although being very frail, she sailed through the op. She was on a Fentalyn patch 100mg with Fentanyl lozenges for the breakthrough pain, Amitriptyline 10mg and about 6 other drugs for various things. Whilst she was in the convalescent hospital, they decided that because she was on the highest patch dose and still in pain around her neck and shoulders, that they should take her off the Fentanyl and put her on slow release morphine. She was put on 60mg morning and evening together with 20g breakthrough up to 4 times per day together with paracetamol and Amitriptyline 10mg. She was very sleepy but managed to keep awake when she had visitors and if she needed to do anything. However, once she was back home, within a couple of weeks she was getting pain in her side. The doctor said it was sciatica and put the Amitriptyline up to 20mg. She became even more sleepy but then started to list over to one side. It became difficult for her to eat and drink so we had to get her a beaker. She was still in a lot of pain and her doctor then put her on liquid morpine 10mg along with all the others. By now she was in a drugged stupour and could not look after herself. I managed to get her into her little cottage hospital. The doctor there also prescribed Valium on top of everything. Now bearing in mind that my mother is 81 and weighs around 6stone, she became so zonked out she couldn't even stay awake long enough to eat or form a sentence. Yesterday, she was so bad she was like someone in a coma. I spoke to her nurse who told me she was being taken off the liquid morpine, the valium and one dose of the amitriptyline to see if they could wake her a bit. When she does come round, she indicates that she is still in pain, so all these drugs are not doing the job.
I have never experienced anything like this, I feel so useless and my poor mum has gone from a very sharp minded lady with a frail body to a zombie over night. She seems like someone who is near the end.
Sorry to have rattled on so much but I just had to let off some steam. Also can too much morphine be fatal?
YES!!Too much morphine or any narcotic can be fatal. It supresses the breathing. I don't know if the valium is such a good idea. My grandmothers doc took my grandma off valium when the put her on liquid Morphine (I think it was called Roxinol) because he didn't want her to sleep too soundly and forget to breathe. She was also on the patches. But she was in very poor health and did not have long to live, so the circumstances are different so it might be ok for her so I don't want to say that it is the same in your situation. It can't hurt to ask, and I am sure someone else here might have different thoughts about it. My grandmother, who had esophagial cancer, went very fast and was in a lot of pain. I was so frustrated at how drugged whe was but was still in pain so I can relate with your frustration. It took a while to find a balance and by that time she passed. I was terrified everytime I gave her meds, that it would be too much. I called the poor nurse every time I gave her something, afraid it was too much. I couldn't understand how this 80 pound woman who wasn't eating, could tolerate those doses. But she did. You know, one thing I found out by accident, is one day they didn't fill her morphine in time for the weekend and replace it with Liquid percocet, which they had made for her. I thought it wasn't going to do jack, but suprisingly, it did AND she actually got an appetite and was the most lively I had seen her. So we kept her on that until she passed. You just never know...
I have watched more than my fair share of family members go through this type of thing, and unfortunately it is trial and error, just as it is for most of us because we are all different. Just keep trying, you will find the right combination soon and she will feel better. It just takes some time and patience. It is hard because you feel like you are turning your loved one into a guniea pig, testing on them and watching them feel crappy, but at a point you will begin to see what is working and what isn't and then she will be feeling a whole lot better.
I hope she feels better soon. Good luck!
Yes, as wheninrome1313 stated...too much of an opiate can depress the entire breathing process! So, it's good to be careful.
One thing to take into account is the whole "geriatrics" concept. I always HATE calling people "old", but when treating elderly people--medications can act differently than younger people expect.
What you've stated about your Mother's (a word that deserves CAPITALIZATION) medications doesn't make complete sense to me. BUT...I don't have and/or claim any sort of professional knowledge. In fact, I would be thrilled if I had 1/12 of ANY knowledge that would be helpful!!
There is a little bit of medication info that might help, but please know that I am 37--even though my Systemic Lupus and Lupus Anticoagulant make me feel older! FIRST OF ALL, common knowledge on this board says that fentanyl is approximately 70 - 100 times more potent than morphine. But, I think that is referring to an exact mg to mg (or mcg to mcg) basis. When it comes to morphine--many people take long-acting morphine. The fentanyl patch is absorbed (I think--and someone correct me, if I'm wrong) on a mcg (microgram) basis. The fentanyl lozenges (brand name Actiq) are measured in micrograms, also! I still assume that the reason behind this is due to the common knowledge "fact" that fentanyl is 70 - 100 times stronger than morphine.
Can you imagine? I'm actually getting to a point. If your Mother is still hurting (from the hideous conditions she has), why would they reduce the pain relief medication(s)?
Now, others on this board have pointed out that different opiates place themselves on different portions of the pain receptors. If you could take fentanyl, hydromorphone, and oxycodone--they would relieve pain on different portions of the nerves (pain receptors). This is probably why different medications relieve different types of pain.
HOWEVER...AND THIS IS A REALLY BIG HOWEVER...I don't understand why a physician would mix opiates (at reasonably high doses), amitriptyline (a trycyclic that makes a person sleepy by itself), and Valium (another reasonably potent medication [a benzodiazapine]) in someone who is 81. Don't misunderstand me...I am extremely tolerant to everything it seems. But, I am 37 and have been on practically everything since my early 20's! I started Pain Management in 1996, so I'm used to taking a great deal of medication.
People who are approaching older age have a changing physiology--they react differently to medications. Some people don't need as much "stuff" to help them. BUT...I get the feeling that your Mum's doc was still concerned with the pain around her neck and shoulders. After all, she was Rx'd the fentanyl patches and lozenges--the strongest opiates available. So, maybe the physician thought something else (like the Valium, which is a benzodiazapine that should relax muscle tension--around the neck and shoulders) would help that.
Please expect many better responses! This board has members who know a great deal about Pain Management of all sorts. So, keep checking to see what others come up with. We wish you the best.
P.S. I don't mean to offer excuses over and over, but I apologize if I've given poor information and responses lately. Unfortunately, I enjoyed the pleasure of a "right basilar skull fracture" that occurred on June 1st of this year. Truly...the recovery is exceptionally slow! PLEASE PARDON ME CONCERNING THE MANY ERRORS I CONTINUALLY MAKE, OK? For this forgiveness, I am thankful.
First of all Jon: don't worry! Your grammar and such is a thousand times better than mine. And I can only speak for myself. Sorry about the skull fracture...can I ask how it happened? Not fun at all.
OK back to the thread. Unfortunately I know exactly what you're going through.
I dealt with these same issues with my mom who passed away this past Easter.
The adult family home where she lived kept giving her lorazepam to 'calm her down'.....the result....zombie mommy!! I had to repeatedly ask them not to give it to her unless she was trying to escape(we went through a period where she didn't know where she was and thought she needed to get home to my dad who died in 1990).
She also was on the patch and morphine and still in pain. The drowsiness did go away(which could happen for your mom...if she's not way overmedicated).
The amitriptyline is actually used as a sleep aid for people with nerve(and other) pain. This takes a few weeks before you can wake up in the morning without being completely groggy. I agree with the others that the amitriptyline and the valium together seems like overkill. It does take awhile to get the correct dosage that will work. Everyone is different and everyone reacts to meds differently.
I hope your mom's doc is experienced with geriatrics?! My mom's previous doctor had no experience with the elderly and used my mom as a guinea pig. We quickly dropped her and found a new doc that seemed to know what she was doing and had a large number of elderly patients that liked her.
My mother broke her back in a fall and was put on the patch with dilauded for breakthrough. They started her low and slowly increased the meds until she had less pain(she was never completely pain-free) that she could tolerate without being a total zombie. Maybe she could try oxycodone which is actually energizing?(at least for me)
Sorry that this is so long. I hope I helped a tiny bit. I know how hard it is to take care of your mom. It's hard to know if you're doing the right thing. Is this hurting or helping? Sometimes I couldn't answer that question. when my mom started actively dying she seemed to be in more pain so we upped her morphine(they added this when the dilauded didn't seem to work). We didn't increase it by much but I did worry about it suppressing her respirations(which were already slowing) but I didn't want her to die in pain.
It's just so so hard to know what to do. Do you have someone you trust that has experience with the elderly? Is there any sort of social worker or advocate for the elderly that you could talk to? I hope I've at least let you know that you are not alone and feel free to post anytime. I understand.
Take care, Mush
Again...sorry this is soooooo long.
undiagnosed lung and back pain after pneumonia in '03, tmj, migraines,(two failed surgeries for) Kienbock's disease
Thanks for all your replies, it does help to speak to people who have had similar experiences.
Went in to see my Mum today and there was such an improvement. They had cut out the Valium and reduced the Amitriptyline. She was still dopey but awake and able to hold a conversation. She managed to walk to the toilet with her frame and had even had her hair done. the pain is the same but at least she is back in the land of the living. She even managed to eat some soup from a bowl with a spoon. She spilled a bit but on Monday she had to be fed with a beaker and was barely able to swallow. I feel so much better.
Thankyou for listening to me and for your advice.