It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Pain Management Message Board

  • Help with Mothers chronic pain-PLEASE

  • Post New Thread   Closed Thread
    Thread Tools Search this Thread
    Old 09-17-2005, 08:49 AM   #1
    Tammy Garber
    Newbie
    (female)
     
    Tammy Garber's Avatar
     
    Join Date: Sep 2005
    Posts: 2
    Tammy Garber HB User
    Help with Mothers chronic pain-PLEASE

    I am asking or your advice. I am a nurse of 30 years trying to take care of my parents. My mother has been a prescription pain addict for 50 years. she has been rehabbed X3. She was completely clean for a number of years and then form osteoporosis began to have back problems. she has had several surgeries and has shrank from 5'8 to 5'2. Thie spring she had bilateral total knees and she has fibromyalgia.Because of her history she requires a ton of medication. She has been on a fentanyl patch, then to Kadian with IR Morphine for breakthrough pain and now she takes---240 mg oxycontin 3xs a day and about 70 mg Hydrocodone in 10 mg increments for break through pain. The problem is, she is still in pain. She never sleeps more than one hour at a time.I feel like there has to be a better way. She is 70 years old and otherwise healthy.Any ideas , I would greatly appreciate. Also does anyone know of a locking programable pill dispenser?

     
    Sponsors Lightbulb
       
    Old 09-17-2005, 10:04 AM   #2
    mike j
    Junior Member
    (male)
     
    mike j's Avatar
     
    Join Date: Jul 2004
    Location: Seattle
    Posts: 49
    mike j HB User
    Re: Help with Mothers chronic pain-PLEASE

    Tammy
    let me first say this I'm very proud of you for taking care of your folks.
    methadone is the first thing that comes to mind .I would talk to her doctor I assume she has a pain management Dr. as well.I would get both of them together and tell them your concerns.

    If your mom is doing okay I would leave her alone.I had it aunt and uncle who both died of cancer .At the end of their lives their daughter had some concerns about medication. The doctors listen to the daughter over her parents. They suffered tremendously. Their daughter now regret what she's done. It was a lot easier to cut off her parents Pain medication.because of fear of the DEA. And state licensing boards,Lawsuits.
    I will share this with you.I suffer from chronic pain as well. It killed me to watch this fiasco. I did share some of my medication with my aunt. She begged me for help. I could not get anybody to listen to me. The hospice nurse could not believe what was going on.

    I know people will condemn me for sharing my medication with my aunt. I will never sit back and watch suffering. The drawback is we don't know how much somebody is suffering.

    I still have nightmares about ,Homer and Maydee suffering. Their daughter is in therapy and has tried to commit suicide. I'm not turn to scare you. Make sure you have good support. I'm sorry about being so personal. I don't ever want any family to go through this experience .

    Please take care of yourself as well. I hope this help you.
    mike
    __________________
    Mike j

     
    Old 09-17-2005, 10:39 AM   #3
    wolfmarket
    Inactive
     
    Join Date: Sep 2005
    Posts: 201
    wolfmarket HB User
    Re: Help with Mothers chronic pain-PLEASE

    Why would you suggest that your Mom is an addict? There is a huge difference between addiction and dependence. Us CP'ers get dependent on our meds which means that if they are stopped abruptly, we go through withdrawal.

    Addiction is a social and psychological disease where the person takes the meds just to get high. Most Cp'ers, who follow the directions of the doctor, do not get addicted.

    If the meds are improving the quality of her life, she is merely dependent. If her life quality is destroyed by the meds, she is an addict.

    Please, this distinction may not mean anything to you and it is easy to throw the "A" word arround, but for us CP'ers who face discrimination every day, it is a big deal!

    Thanks
    Alan

     
    Old 09-17-2005, 08:30 PM   #4
    NYFUSED
    Veteran
    (female)
     
    NYFUSED's Avatar
     
    Join Date: Mar 2003
    Location: STATEN ISLAND, NEW YORK
    Posts: 312
    NYFUSED HB User
    Re: Help with Mothers chronic pain-PLEASE

    ditto with Alan........................


    Lori
    __________________
    lami L4-5, ACDF C5-6-7, post. lami-foraminotomy c6-7, staph infect. revision acdf c4-5-6-7 new c4-5 2004. STILL IN PAIN 24/7

     
    Old 09-18-2005, 06:07 AM   #5
    feelbad
    Senior Veteran
    (female)
     
    Join Date: Dec 2003
    Posts: 10,122
    feelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB User
    Re: Help with Mothers chronic pain-PLEASE

    there are some other options for her that she should really give an honest try.First of all, is she being seen at an actual pain clinic?if not, she reallt needs to get into one.If she is already there,what other options has she tried or been offered?Using something like the morphine pump(which can also contain other meds besides morphine)or the spinal cord stimulator.as you are already aware of, your mom is on an etremely high dose of opiates and they are still not controlling her pain.When looking at that aspect alone it would really indicate that her type of pain will probably never really respond well to any narcotics and there fore she really needs to get creative with her pain doc about trying some "out of the box" type therepys and with other meds besides narcotics or in place of narcotics entirely.There is a rather new med on the market(the name currently escapes me right now but i am certain someone here remembers it)it is actually created from sea snail venom.This,from all that i have been hearing on it,is working rather well on some patients who had not responded to much of anything else before they went this route.it is delivered through an intrathecal pump like the MS one I mentioned above.In extreme cases,a NS can go in and surgically cut a nerve or nerves to actually deaden that innervated area where the most severe pain is being generated. these are the types of pain control methods that I was kind of referring to when i said "out of the box".methadone,as someone else mentioned above is also another option.you really need to get on the net here and do some intensive research on pain control options.There are many many different,more obscure things that some people are currently using that are not given much advertising.These are the meds and therepys that your mom may need in order to actually find relief.hopefully you will be able to actually find something that will finally give her and you some peace.i know this is soo very hard for you having to deal with all of this,but just remember, we are always here for you and you can come here anytime you are needing a little support or just to vent,K?as a mother, i have to really commend you on all that you are trying to do for your mom,really.unfortunetly there are many children out there who would not be doing what you are for a parent.very sad but unfortunetly true.Hang in there and please keep us all posted on how things are going,K?Good luck in your quest.marcia
    __________________
    3-22-01,herniated C-6-7
    11-20-01,placement of hardware for failed fusion
    9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

     
    Old 09-18-2005, 10:30 AM   #6
    wolfmarket
    Inactive
     
    Join Date: Sep 2005
    Posts: 201
    wolfmarket HB User
    Re: Help with Mothers chronic pain-PLEASE

    The med derived from the snail is Prialt and I know that Shoreline knows quite a bit about it!

    Alan

     
    Old 09-19-2005, 04:23 AM   #7
    feelbad
    Senior Veteran
    (female)
     
    Join Date: Dec 2003
    Posts: 10,122
    feelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB User
    Re: Help with Mothers chronic pain-PLEASE

    THATS it! dang I know i should have remembered that as i was kinda watching this thru trials and stuff.geez,brain dead.thanks alan.Marcia

     
    Old 09-19-2005, 02:32 PM   #8
    Shoreline
    Senior Veteran
    (male)
     
    Join Date: Jun 2003
    Posts: 3,519
    Shoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB User
    Re: Help with Mothers chronic pain-PLEASE

    Howdy, Prialt is only available as an intrathecal medication. It works by blocking NMDA receptor activity and stops the cascade of neurotransmitters and bio chemicals unique to chronic pain. You mentioned she had a pump but did you mean IV PCA or an implanted Intrathecal pump. If control of meds is an issue an implanted pump is pretty much tamper proof and has several advantages over oral opiates. They are programable to deliver extra meds if she has more pain upon rising or more pain in the evening. Last year I switched from a comparable dose of oral opiates to an implanted IT pump an the biggest difference is how clear my head is.

    If she hasn't had an Intrathecal pump, it's worth a trial. You have exponentially more opiate receptors in the spine and they can use 1/100th the amount of an oral dose and get better results. IT meds don't run systemically through her body and brain and you don't have the same level of impairment from IT meds.

    When you say she has been rehabbed 3 times it does make folks wonder if she was truly presenting addictive behavior or simply under medicated and mis diagnosed by well meaning but opite phobic docs. As long as you have worked with or around docs, you know they are not always right. Prior to 96 there were basically no LA meds other than MScontin, developed in 84. So the usual and strongest med used would have been low dose opiates mixed with apap. #2 5mg percodan or percocet every 4 hours would have been about as strong as she would have had access too unless some doc prescribed morphine. That was generations ago when the use of morphine was restricted for post op and cancer.

    The mere fact that 2 percs every 4 hours didn't manage her pain and she took more doesn't mean addiction, It may simply mean under medicated. Pseudo addictive behavior can occur where she takes more than prescribed or perhaps has multiple sources when pain is poorly managed. Poorly managed pain is also part of the reason she is in so much pain now. The gateway theory of pain says let someone suffer and they may suffer even more later. Pain is imprinted, biochemical changes occur and NMDA receptors fire randomly causing a sort of pain overload. Other NMDA blockers like Ketamine are used to break the cycle of pain and to block pain for procedures like shoulder relocation or settng of bones or longer surgeries at higher doses. Unfortunately ketamine has some potent disassociative properties. Methadone is another drug that blocks this receptor believed to regulate pain reponse, opiate tolerance and blocking this receptor seems to be particularly more effective on neruopathic pain.

    Having not been there to see what brought her to rehab it's hard to take a side. My view on addiction is pretty simple. Addiction is destructive, opiates can be used by people in pain and improve the quality of their life. I've yet to meet an addict whose drug of choice improved the quality of their life.

    I've been involved in pain management since the early 90's prior to long acting opiates and the new philosophy about using them. Having been a nurse for 30 years you have to consider the generation you came from and what you learned about opiates then. Iím sure you have met and dealt with plenty of patients that had true abuse problems but mere use or higher doses than seem reasonable to one doc or several docs doesn't equate to addiction. Not everyone has the same POV about opiates now as they did 30 years ago, but many docs made up their mind about opiates 30 years ago when they went to school and did their internship. Most are not going to change what they have always believed and seen examples of addiction and dependence going to change their POV.

    It would be sad to think a CP patient that was under medicated was thrown in rehab each time some doc said you can't hurt that bad so you must be an addict and need rehab. Anyone that uses opiates simply to function without help could consult with an opiate phob surgeon tomorrow who tells the family ďMom is an addictĒ because she use opiates to manage pain. Families believe the doc, want mom to get better and see that as getting better and do force legit CP patients into rehab. That issue alone can destroy marriages and families and it may be based on a one time visit with some surgeon that lets his patients suffer. I had a surgeon suggest I was an addict simply for asking for meds, I hadnít taken anything for pain in over 2 years at the time. He pulled my wife aside and tried to make arrangements to have me admitted ASAP for my addiction?

    You have to live with the decisions and choices you have made regarding your mom but it seems now that opiates would be OK if she was getting the relief you might expect. That amount does sounds outrageous to someone that is comparing it to what they received for post op for pain 10 years ago. However, so much more is known about the difference between chronic pain and acute pain now, views have begun to change. Tolerance is an inevitable consequence and yes she can still be in pain on what you might consider a high dose of pain meds. I wouldn't call it low but you have to look at the benefit versus the negative effects they may cause.

    The patient also has to have realistic goals and expectations. Thatís where a good pain clinic will come in. They will not only push meds but work on other aspects such as acceptance that sometimes no matter what is prescribed the patient is going to have some pain. Sometimes the best you can do is take the edge off. I imagine after 50 years that edge has gotten extremely rough to except.. There are other modalities and other meds but you don't want to get so concerned about the number of mgs of an opiate she takes that using everything in the kitchen sink is acceptable.
    My first doc that prescribed an LA opiate and freed me from my bed was still very cautious. Instead of increasing the dose of opiate, she would add med after med, some were potent psych meds. Some simply for side effects, and then sleep and depression and anything you can think of except enough opiate. Fortunately I had to change docs, the first thing he did was increase the pain meds and discontinue 5 other meds. The other meds were far more impairing than opiates.

    If mom is taking a med that you question the value of, try decreasing some of the more potent psych meds used. If her pain doesnít increase and her head clears then ditch some of the other stuff that doesnít work. Sometimes pain is so great, the patient is afraid to give up anything that may be giving any amount of relief. Thatís where the support and knowledge of a clinic that uses a multi disciplinary approach will help. No Offense, but having a nurse for a daughter doesnít guarantee the best pain management available. It just guarantees that she gets YOUR medical opinion.

    Some patients require several different opiates. Different opiates bind to different opiate receptors and each class of opiate receptor has several sub classes, aside from the common receptors all opiates bind too, a different class opiate will bind to receptors the other class doesnít. Instead of increasing the oxy, adding methadone, morphine or the Duragesic patch may be much more effective than more and more of the same.

    A clinic will also help her take advantage of the relief she does get. I doubt she will ever jog again but the right meds and modalities could get her moving enough to get into an aquatic program where she can start helping herself by strengthening muscles she hasnít used in years. She has to maximize the relief she does get and not focus on the relief she isnít getting. If her goal is Zero pain, she may have to except that may never happen or she has to be totally zonked to reach that, which isnít expectable. Most folks can find a level of relief they can function at and retain a decent level of clarity. When it comes to meds itís truly trial and error and weighing the benefit versus the side effects. If the meds are more impairing than her condition, there should be a better way to manage her pain.

    Iím sure you have seen and dealt with this more than most people but these articles are probably some of the best on explaining how chronic pain is so different from acute pain. It requires very different treatment than say postoperative pain, which can also be severe, but short lasting as not to create the biochemical changes in the brain associated with chronic pain and you donít see the development of tolerance with acute pain.

    Part 1
    http://www.hosppract.com/issues/2000/07/brook.htm

    Part 2
    http://www.hosppract.com/issues/2000/09/brook.htm

     
    Old 09-20-2005, 06:03 PM   #9
    Tammy Garber
    Newbie
    (female)
     
    Tammy Garber's Avatar
     
    Join Date: Sep 2005
    Posts: 2
    Tammy Garber HB User
    Re: Help with Mothers chronic pain-PLEASE

    When my mother was an addict she was not a pain patient. It was years ago and she will tell you she used drugs to escape a failed marriage. I only mentioned that fact so that yall could understand the amount of drugs that she is able to take and still function, She never appears high or fuzzy on the 240 mg of oxy3xs a day and who knows 70-100 mg of lortab every 24 hours, 20 mg ambien a night and probably 30 mg valium a day, not to mention prozac, and risperidol,I dont care whether she is an addict or not, I only want her pain relieved, I do not care about the number of mg's,,, I just want something that will help her. Our problem is complicated in that my dad is also a pain clinic patient, He has inoperable c3456, he is 80 and very frail, he gets 5 10 mg lortab a day, but because my mothers pain is so bad, he gives her at least 3 of his pills per day leaving himself without adequate coverage, So until her pain is controlled his will not be. It is terrible to watch your parents get to this point in life and suffer like this. I am not trying to micro manage their meds, I am only looking for alternatives to suggest to them to take to their pain management Dr.

     
    Old 09-20-2005, 09:10 PM   #10
    mike j
    Junior Member
    (male)
     
    mike j's Avatar
     
    Join Date: Jul 2004
    Location: Seattle
    Posts: 49
    mike j HB User
    Smile Re: Help with Mothers chronic pain-PLEASE

    Thank you for the information shoreline.

    This made me realize what I had to through before I got help. Tomorrow first thing I am going to send a thank you note to Dr. Steelmen for helping me the first time as well is giving me some relief and peace of mind.

    Tammy people on this board are not here to judge you. Most of us our everyday people. As I've said in my first post be proud of what you've done for your mother. I think sometimes we sound like preachers.I apologize if I sound like that.

    Please let us know what happens. I have learned so much from people like Shoreline and yourself as well. At times we all forget there are a lot of good people.
    __________________
    Mike j

     
    Closed Thread

    Related Topics
    Thread Thread Starter Board Replies Last Post
    Help I am at the end of my rope... tinabean34 Pain Management 4 07-01-2010 11:55 AM
    Help/Advice neededASAP -Fentanyl detox, pain pat. abused meds will need meds in futre Confused089 Abuse Support 34 07-06-2008 05:33 PM
    Help for Chronic Constipation - Amitiza clasact1956 Irritable Bowel Syndrome (IBS) 35 09-14-2007 09:09 AM
    HELP! Turned down by new insurance company b/c of meds! IZZY'SMOM Pain Management 24 05-04-2007 04:10 PM
    HELP My mom is in Pain and i dont know what to do? jennyVee Pain Management 3 06-11-2006 08:28 PM




    Thread Tools Search this Thread
    Search this Thread:

    Advanced Search

    Posting Rules
    You may not post new threads
    You may not post replies
    You may not post attachments
    You may not edit your posts

    BB code is On
    Smilies are On
    [IMG] code is Off
    HTML code is Off
    Trackbacks are Off
    Pingbacks are Off
    Refbacks are Off




    Sign Up Today!

    Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation!

    I want my free account

    All times are GMT -7. The time now is 01:50 AM.





    © 2022 MH Sub I, LLC dba Internet Brands. All rights reserved.
    Do not copy or redistribute in any form!