Hi, Everyone. I am still here, still trying to deal with my 76 (almost 77) year old mother. I have other posts on here about her coming back after mutual estrangement, house hoarded, needing major neck surgery, teeth extractions, and now long term pain management for her osteoporosis and degenerative spine disease in her thoracic spine. She'd had several injections, then a nerve ablation, none of which worked. Pain management dr wanted her to get an implanted pump.
She refused. I was not really keen either, as I know it will be many appts a long and stressful drive from where we live. Her pain doc does not do them and he tried to send us to a colleague. I already tallied up 38 out of town medical appts for her thus far. Again, this is someone I reluctantly take care of. I have my own health issues, which are really flared currently. I feel trapped in hell with her. The info they gave her on the procedure said they hope for 50% pain reduction, and she wasn't impressed. Her friend had a bad time with one, furthering her disinterest.
Anyway, her PCP has been the one giving her hydrocodone, gabapentin, muscle relaxers. Her psych NP gives sleep med (Halcion) and antidepressant. The pain dr has been very hands off as far as giving any pills. In December, her PCP office, which has been chaotic and unprofessional, had their nurse quit. We now have problems getting her pain med called in. The last time this happened, she gave several days' notice, they failed to call it in, and she went 5 days without. I was out of town at the time and had no idea about it. I got back home, was taking her to a psych appt and she told me she'd been vomiting and having diarrhea all night badly. And had been sorta sick for a few days. When she mentioned the lapse in meds I realized it was withdrawal. We went onto the psych office, where the NP said the same thing. NP was adamant I speak to the PCP and get it resolved. The next refill with the PCP went better, after I managed to catch he dr at the office. And now here we are again, Thursday night, and no refill sent in even though she requested it twice. I'd asked pain dr office if they would just give her the pills and they said no, they only want her to have the procedure.
This is so complicated, because she does tend to take the maximum pills she's allowed, has showed addictive behaviors in the past. But now, at 76, she legit has a bad spine. She's got the MRI to prove it. Her activity level is altered. She can no longer be upright much due to pain. She says she can't tell the pills help much, but she can tell when she skips them. My question: if she goes into withdrawal over the weekend, what do I do? The last time, the psych NP said it was dangerous at her age, dehydration from being sick, etc. I know an ER wouldn't give pain meds. Could we show up and at least get nausea meds and rehydration? I've been telling her the PCP office is a poorly run sinking ship and we need to find someone else. Still does not solve the pain management issue. PCPs now just about never give opioids. If she goes the pill-only route, it seems she'll need a new pain Dr too. We only have two in our area. I just have no clue what to do if she goes into withdrawal over the weekend. I can't stand her house, won't stay there with her. I won't bring her to mine. Oh, and my husband's beloved 100 year old grandmother just passed and we have funeral events that I'd really like to attend.
About 4 years ago, I had unexpected surgery that resulted in a lot of pain. Very limited scripts for opiates (hydrocodone, + oxycodone) as this was in early 2021, in midst of huge opioid "crisis" in US. Patient forums often strongly advised people to avoid having any kind of "elective" surgery, as they could have difficulties handling severe pain + refusal to get opioid scripts from doctors.
I was told at the time to just take a combination of Tylenol* + nausea prevention medication. (There is such a thing, which I didn't know, both as a script and an OTC (Over the Counter medication). It helped a little bit as I recall. Nausea can result from severe post-surgery pain, which I also didn't know (prior to surgery).
Oedgar: In your Original post you write: "her PCP has been the one giving her hydrocodone, gabapentin...", I have just been prescribed gabapentin for a neuropathy issue. Have you noticed any "bad" things using this drug? I've been told to proceed with caution both by a pharmacist and an MD regarding this drug. Good luck! This sounds like a very complicated -- and exhausting -- situation.
*Tylenol: You don't mention heart disease (or sorry if I overlooked this) but if anyone is on the blood thinner warfarin the amount of Tylenol you can take on a daily basis has to be carefully monitored by your anti-coagulation specialists (usually pharmacologists).
I’m also 77 and I have had back/spine pain from serious scoliosis for over 60 years. The xray proves it - 54 degrees thoracic curve, 52 degrees lumbar curve. You don't just rock up asking for opiates, you have the history to prove it. I have unlimited tablets equivalent to Tylenol 3. I am not addicted and only take it when I need it (usually 2 or 3 tablets and very very rarely 6 tablets in a day). My script has to be authorised by the central medical authority here, but it's just a phone call from the GP to them to authorise repeats. I find that lying on top of a hot water bottle is useful for my own pain, although that may be irrelevant for your mother.
I’m in Australia, where drugs are required to be labelled by their contents rather than by a brand name (like Tylenol), which means you get a lot better ‘educated’ about what you are taking and what works. I have endone tablets, which are a much nastier opiate, but I’ve only been reduced to them 4 times in the last year. Good luck, to you and your M. Pain management is important, and it needs self control for long-term help.
When I went to the ER with pancreatitis, I got intravenous fluids in order to rehydrate, other meds for pain, and was sent home with a pain med prescription and a referral to a gastroenterologist They weren't about to leave me in severe pain for days.
I only took a couple. I found yoga to be beneficial for pain control for my condition (extended child's pose).