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 Pain Medication 
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Joined: Sun Oct 04, 2009 10:18 am
Posts: 276
Location: Washington State
Post Pain Medication
I have only a few hours from now before my LO will be discharged from the emergency room at our local hospital. She fell yesterday in her room and while hip/abdomen xrays and cat scans show no fractures and there is no obvious source of pain, she was in excruciating pain last night prior to being given morphine.

Can anyone point me to a thread on pain medication or list the pain meds LBD patients can or can't have? I'm afraid that when the morphine wears off her pain will return and she will go back into a totally delusional state. If she shrieks, accuses people, and complains of so much pain when she is back in the ALF I am afraid they will call an ambulance again or will want us to go to a psych ward.

Before you ask me to search the forums myself, I tried a search on pain medication and came up with 727 hits. I don't have the time to refine a search or spend hours looking through. Currently my LO takes sertraline (25 mg), two tylenol at 325 mg, thryoid medicine, a baby aspirin, desmospressin for urinary urgency, calcium and vitamin D, vitamin B, and ducosate for stool softener. No AICHEs, coumadin, or antipsychotic. She can't take seroquel. Thanks in advance.


Sun Feb 21, 2010 10:28 am
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Joined: Sat Jan 03, 2009 2:59 pm
Posts: 1978
Post 
Here is something I have found! I hope it helps:




Pain relief is one of the most difficult problems to manage with LBD
patients. In 1990 the World Health Organization approved an "analgesic
ladder" which recommends the stepwise introduction of stronger
painkillers if the more basic ones are ineffective. The word analgesic
simply means painkiller which is any member of a group of drugs used
to relieve pain and to achieve analgsia, which means the absence of
pain. These guidelines were originally introduced for the management
of pain in cancer, but have found application in all fields of
medicine. The first step is paracetamol or acetaminophen (like Tylenol
or Exedrin). The second step involves the addition of an NSAID (e.g.
ibuprofen, Advil) or a weak opioid (such as codeine). The third step
comprises the addition of a strong opioid (such as morphine, oxycodone
or a fentanyl preparation); if codeine is being taken the opioid
replaces codeine.

This final step is where the problems for LBD patients are the worst.
I am not aware of any opioid or similar narcotic that does not have
the potential to cause problems with LBD patients. Trying to manage
pain and still maintain quality of life is difficult, and in some
cases impossible with an LBD patient in severe pain from a source that
may not curable.

Talk to the doctor about your current and future options with pain
management so that you understand the choices available to the doctor,
and also so the doctor understands your wishes and those of the patient.

_________________
Irene Selak


Sun Feb 21, 2010 10:56 am
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
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Annie N,

If your mother can tolerate morphine, why not continue her on morphine? There's a liquid version called Roxanol.

Another pain med that EricSEA -- a Forum member ages ago until he got exasperated with the LBDA's policies towards the Forum -- recommended we consider is Ultram (tramadol).

Robin


Last edited by robin on Sun Feb 21, 2010 1:31 pm, edited 1 time in total.



Sun Feb 21, 2010 1:29 pm
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
Post 
PS. Sorry to hear about the fall. Glad nothing was broken.


Sun Feb 21, 2010 1:30 pm
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
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I think for "AICHEs" you might mean "AChEIs," or Exelon, Aricept, or Razadyne. That's a glaring omission. Can she not tolerate any of those?


Sun Feb 21, 2010 1:33 pm
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
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Annie, I'm so sorry this has happened to your mother! Good grief! What next? I do hope the source of her pain can be discovered. There could be a soft tissue injury that may not have shown up on the CT scan but could be detected on a more sensitive MRI. If it persists more than a few days, I would suspect some kind of injury. Does she have any bruises?

Yes, morphine, when tolerated, is a great pain reliever. She can take it in tablet form at her facility. Any narcotic analgesic will make her fuzzy, though, and increase her risk for falls. Of course, they will know that and watch her more closely. As you indicate, comfort is the highest priority right now.


Sun Feb 21, 2010 2:57 pm
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Joined: Sun Oct 04, 2009 10:18 am
Posts: 276
Location: Washington State
Post Thanks for the quick replies
As it turned out, my LO did not need any more pain medication after being given the morphine last night. Now she is back to her standard tylenol. It is nice to know that she can tolerate morphine. Also, Irene, that was a wonderful article that you provided.

Mom was so happy and relaxed on morphine. I love morphine. I wish she could be on it all the time. But I know that she can't so we will hold it in our back pocket for the next time she is in such pain (thanks for the suggestion, Robin). I don't know why the pain was so intense. There were no fractures. There may be some soft tissue damage but she can't have an MRI (pacemaker) which is one of the tools that I constantly regret not having available.

She was discharged about noon. Lots of confusion now. She just told me that I looked just like her daughter. We are providing 24/7 care for the next couple of days until she gets back into the routine. The Dr. sent an order for 24/7 care to the ALF but it is impossible. Judicious hiring of caregivers and lots of family time is the best we can do. It takes about 2 minutes for someone to look away and she can fall in that time.

I think "AICHe" for AChEIs. I used to belong to the American Institute for Chemical Engineers. It sticks in my mind better. Anyway, Mom was prescribed Exelon on Friday and I was hoping to start it Monday. Friday she was refusing to ever take it because I was so enthusiastic about it. We'll see. Have to let things calm down a bit. Thanks again for your help.


Sun Feb 21, 2010 5:45 pm
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
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Exelon comes in patch form. That may be easier to administer. Many LBD caregivers place this on the back in a place where it's not easy for their family member to remove.


Sun Feb 21, 2010 6:07 pm
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Joined: Fri Jan 15, 2010 9:33 pm
Posts: 3396
Location: Vermont
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Hi Annie - so sorry for your stressful weekend with your mom's latest health problems. I hope you have things under control now and she is feeling better. Lynn


Sun Feb 21, 2010 6:28 pm
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
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My husband has been on the Exelon patch for over two years now and it has controlled his agitation and anger somewhat. The early effects on his cognitive status were profound but it's impossible to tell if it's still doing anything in that regard. The small patch adheres well to his back and doesn't come off in the shower. I place it in a different spot every night.

Some can't use the patch because their skin is too sensitive. Some people become nauseated on the oral formulation. They start with a 4.6mg dose and then go up to 9.5mg. Hope it works well for your Mom and I'm SO GLAD she's no longer in severe pain.


Sun Feb 21, 2010 6:35 pm
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