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Old 11-20-2012, 06:21 AM   #1
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Advice Please. Chronic Back Pain - 4 Surgeries

We are at the end of our rope. My Mother is 77 years old and now suffers from chronic back pain. Up until her last back surgery in June 2012 she was very active and more like a 65 year old. Nothing kept her down and she is EXTREMELY tough.

I'm going to try and shorten a very long story. In June 2012 she had major back surgery and since that time her back has gotten worse almost weekly. I feel like the doctor screwed something up but have no proof. On Aug. 22 2012 she was home awaiting back surgery #5 and suffered a massive heart attack. She was rushed to the hospital and that day she coded 8 times and once was unresponsive for over one minute. She slowly recovered from that but hasn't been able to do rehab due to back and leg pain.
2 weeks ago she was home and while my Dad was in the shower she decided to feed her little dog. While in the kitchen she fell and broke her hip requiring another surgery. Today shes doing good with the exception of pain.

Here is the problem. She has just started seeing a pain management doctor and was changed from Lortab 10-325 to Percocet 7.5 every 4 hrs as needed which works great ( much better than lortab) but was still having severe pain before time for her next dose. The Doctor started her on Oxycontin 15 mg every 12 hours but now says she should only take one Percocet per day for break through pain. There is no way she can make it through the day with only one percocet. What should we do? We have explained the problem to the doctors staff and got little to no help. We talked to her general doctor and he will only write pain medication for two weeks. HAS THE WORLD GONE NUTS?

Again we are talking about a very tough and determined woman. She has already been through 4 back surgeries, both knees replaced, 2 hip replacements and through all of those she would have pain medication that was not taken 2 years later. She now has to use a walker and her walking is getting worse due simply to pain but we can't seem to get the help we need.

PLEASE give any advice you might have. Keep in mind that due to her extensive medical history its a huge problem to change doctors although the pain management Doctor would not be a problem. We are watching our Mother decline quickly and it seems the doctors don't give a damn because they are scared to write pain medication.

Thanks in advance!!!!

 
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Old 11-20-2012, 06:24 AM   #2
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Re: Advice Please. Chronic Back Pain - 4 Surgeries

Another question: is there any medication anyone would suggest that might work better than the combo shes on now? Also forgot to mention shes taking Gabapentin

 
Old 11-20-2012, 06:51 AM   #3
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Re: Advice Please. Chronic Back Pain - 4 Surgeries

First I am sorry for your mother and may God bless her.

Except for age ( i am 67) and only 2 surgeries I can relate. OK, long story short..... I wouldnt be able to go out of the house except for Methadone. It does not get me high at all....... it only relieves the pain.

I went through the lortabs, oxycontin etc and they just got me stoned for a short time. The methadone does not get me high. I also take gabapentin. My drugs dose is
90mgs of Methadone and 1200mgs of gabapentin per day.

Once again God bless.......

 
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Old 11-20-2012, 07:11 AM   #4
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Re: Advice Please. Chronic Back Pain - 4 Surgeries

Thank you so much. One monster difference I see now is the Gabapentin dosage. She only takes 200 mg and the pain management doctor said the first day that it wasn't a high enough dose.

Again many thanks

 
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Old 11-20-2012, 08:40 PM   #5
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Re: Advice Please. Chronic Back Pain - 4 Surgeries

I hope you can get her into a pain specialist who is willing to test out new treatments for her. Often it takes awhile, as most doctors only want to change one treatment/med at a time. The amount of breakthrough meds varies. Some folks get multiple doses a day, and some only get a few doses a week (like me). It depends on the doctor's comfort and the patient's pain. Doctors often argue that the patient will take as many meds as they are given.

I'd think due to your mother's age and history though, that the medications wouldn't be as much of an issue such as they would be for something with chronic pain in their 20s or 30s. The fact that they started her on a long acting med (oxycontin) is a good start. See if the doctor can take it from there and adjust the schedule (some folks need it every 8 hours...does it last her 12?) and dose if needed, increase or change any adjunct meds like the Gabapentin, adjust the breakthrough med as needed, etc.

Her pain should be tracked with each change to see what helps. Often its difficult to rate pain, but if she/you obviously sees an increase in ability for activity, that is a good sign. Her goals for pain management are a very good thing to discuss with the doctor to ensure they are are both on the same page. These meds are very individual so its not a given that they will help, even with higher doses. Its something that takes some trial & error, and for that you need a patient and willing doctor.

It is very possible he is only writing the medication for two weeks in the beginning as he wants to keep a close eye on her. Starting a new med, its possible the dose will need to be adjusted, and he may not want her to have to wait a full 4 weeks. These are good questions to ask, as often doctors don't say what is on their mind. It will be typical to need to come in for a visit and new prescriptions every 4 weeks though...these Schedule II meds can't be called in or have refills, and require the doctor to follow up with the patient.

Specifically on the breakthrough pain meds, have her report how her pain levels are and discuss it with the doctor. If her pain is still too high all day, a higher dose for the Oxycontin may be more applicable than having more Percocet. Also, it may just be at first, as adding the Oxycontin on top of taking Percocet around the clock would be a big dose increase. The amount and dose of breakthrough meds should be tailored to her pain. I'd voice your concerns and give this some time.

Pain relief is an exercise in patience unfortunately. Increasing the dose too much too fast can be dangerous. With her age and condition, as any doses are changed, beware of symptoms such as excessive sedation and breathing problems, which can be a sign of overdose, and can occur quickly in older folks with compromised health. Best wishes.
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Old 11-21-2012, 05:26 AM   #6
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Re: Advice Please. Chronic Back Pain - 4 Surgeries

Quote:
Originally Posted by tortoisegirl View Post
I hope you can get her into a pain specialist who is willing to test out new treatments for her. Often it takes awhile, as most doctors only want to change one treatment/med at a time. The amount of breakthrough meds varies. Some folks get multiple doses a day, and some only get a few doses a week (like me). It depends on the doctor's comfort and the patient's pain. Doctors often argue that the patient will take as many meds as they are given.

I'd think due to your mother's age and history though, that the medications wouldn't be as much of an issue such as they would be for something with chronic pain in their 20s or 30s. The fact that they started her on a long acting med (oxycontin) is a good start. See if the doctor can take it from there and adjust the schedule (some folks need it every 8 hours...does it last her 12?) and dose if needed, increase or change any adjunct meds like the Gabapentin, adjust the breakthrough med as needed, etc.

Her pain should be tracked with each change to see what helps. Often its difficult to rate pain, but if she/you obviously sees an increase in ability for activity, that is a good sign. Her goals for pain management are a very good thing to discuss with the doctor to ensure they are are both on the same page. These meds are very individual so its not a given that they will help, even with higher doses. Its something that takes some trial & error, and for that you need a patient and willing doctor.

It is very possible he is only writing the medication for two weeks in the beginning as he wants to keep a close eye on her. Starting a new med, its possible the dose will need to be adjusted, and he may not want her to have to wait a full 4 weeks. These are good questions to ask, as often doctors don't say what is on their mind. It will be typical to need to come in for a visit and new prescriptions every 4 weeks though...these Schedule II meds can't be called in or have refills, and require the doctor to follow up with the patient.

Specifically on the breakthrough pain meds, have her report how her pain levels are and discuss it with the doctor. If her pain is still too high all day, a higher dose for the Oxycontin may be more applicable than having more Percocet. Also, it may just be at first, as adding the Oxycontin on top of taking Percocet around the clock would be a big dose increase. The amount and dose of breakthrough meds should be tailored to her pain. I'd voice your concerns and give this some time.

Pain relief is an exercise in patience unfortunately. Increasing the dose too much too fast can be dangerous. With her age and condition, as any doses are changed, beware of symptoms such as excess
ive sedation and breathing problems, which can be a sign of overdose, and can occur quickly in older folks with compromised health. Best wishes.
Thank you so much for your reply. VERY informative and gave me some good tips for helping her.
Another quick question that I'm trying to research. Mother has slept with oxygen for the past few years but never had a need for it during the day. Since her back problems and heart attack she has been forced to use oxygen 24 hours a day. Her 02 levels drop into the low to mid 80's within 10 minutes of being off her oxygen. Test and xrays have been performed but everything came back normal. The cardiologist says nothing with her heart attack caused the low oxygen level and that everything looks great.

My question is could the oxycontin or percocert be causing the low levels? If so we really have a problem.

 
Old 11-21-2012, 09:21 PM   #7
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Re: Advice Please. Chronic Back Pain - 4 Surgeries

Yes I think opiates can cause an issue with oxygen levels and breathing, from what I've heard. In fact, due to my opiates and the fact that I mentioned I had some issues sleeping & waking up un refreshed, my pain specialist referred me to get a sleep study to ensure that I was breathing sufficiently when I was sleeping, etc, especially since I'm on methadone (which is specifically known to contribute to central sleep apnea for some folks). No issues found for me, except the reason I am fatigued is I don't get REM sleep...no wonder.

They also tell me to look out for issues like sedation and breathing issues with med changes or dose increases...and I'm in my mid 20s and don't have any major medical issues (just several different pain conditions). For older folks and/or those with pre existing heart/lung problems, these meds should be dealt with very cautiously. I wouldn't think it unreasonable actually to admit her to the hospital while getting her on a steady dose to ensure proper monitoring (just my opinion though).

Have you specifically told the doctors that this started after she started on the Oxycontin and they didn't link it? Goodness. Even if that wasn't linked up for them, due to her age and history they should be closely monitoring that to begin with, but as soon as something like that is mentioned, the first thing they should look at is what meds had changed.

Breathing issues during the day are often multiplied at night, so this is something to get her seen for to get the doctor to see if there is a connection. That may involve tapering her off the meds to see how that affects her 02 levels. Unfortunately this may hinder her being able to increase the dose (or even stay on the meds). Sometimes different meds are better, but they could also make the problem worse. Something to test out under doctor supervision.

Its often a balance of relief and side effects. We never shoot for anywhere near 100% relief to begin with though (50% is often considered a realistic goal). Those are relatively low med doses, but I've heard effects can be heightened with age. Thank you for looking out for her! Best wishes.
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