Hi Emmab, Sorry to hear about your mom, The docs should be doing different trials of opiates to see what she can tolerate and it's efffectiveness. If she has several months to live even the intrathecal pump is an option, You have less cognative and physcical side effects when such a small amount of opiate is delivered directly to the spinal cord.
Other options are slowly working through the different meds, she can do this one day at a time, I can't imagine tramadol being used on cancer pain but because of the halperidol, it does greatly increase the CNS depression, somnelance and other side effects. As far as strength of pain meds the normal flow would be start with hydrocodone products, then oxycodone products then morphine, Duragesic patches "Fentanyl" then methadone.
Methadone is a great pain reliever but can cause folks to nod out, one minute they are awake and talking the next they are slumped over sleeping. It can be concerning for the family to see this happen and everyones response to meth varies so widely it's usually not a starting point. If one of the other standard pain rkillers doesn't work. Getting her off the halperidol with should improve the docs ablility to safely use opiates without keeping her sedated 24/7.
The synthetic tend to be more gentale than natural opiates lke Morphine and codeine. Drugs like fentanyl that neever enter tyhe GI system because they are absorbed through skin usualy cause less gastric upset and constipation too. Unfortunately it's trial and error but an agressive hopice can run through low doses of most of these meds in a matter of a couple weeks untill they find what she tolerates best. Hopefully they find something in he first or second try ecause there is no reason to have someone suffer in thsis day and age. Addiction isn't even a concern when dealing with cancer pain that's progressive. They can simply increases the dose as she becoms tolerant to it. All these meds have long acting versions from 8 hours to 24 to 2-3 days with the patch. Even with the long acting meds always on board she may still need rescue medication when the LA med isn't sutting it. So short acting opiates are used in conjunction with LA meds to manage spikes and increases in pain. When her short acting use increases, they noramllyincrease the strength of the LA med to give her better coverage. The idea of Long acting meds is that it's easier to keep pain in check that to bring a high level down.
Good luck, Dave
PS. They also make liquid versions of Oxycodone, morphine , Dilauadid and meth if she is having difficulty swallowing, liquids tend to work faster. They also make a very potent lolipop version of fentanyl where it's absorbed through the mouth and absorbed in the GI system as she swallows the med. Thes pops are called Actiq and conatain fenatnyl. Aproved for cancer pain only but available in a wide variety of strength. The elderly don't usually tolerate large doses of any CNS depressant so doses tend to start low, but they can always increase upwards, where starting too high can be dangerous. but tramadol? Lordy... Stadol and Nubain are also options id she doesn't handle pure opiates well. These meds are combination opiate agonsit /antagonist which makes it harder to OD on them with a the antagonist effects of those two meds. Stadol is strong medicine though.
Best wishes.
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