My mom truly makes me shake my head. She is in pain ALL THE TIME. She has taken Vicodin forever and it really isn't doing much other than now it's just a habit. She was given morphine she will take it then the pain will subside and go away, then she gets really drowsy and high feeling and decides never to take it again. Then she complains about the pain again after a few days or more. Says “I have to talk to the nurse bout this pain” and the same thing happens again. They've tried other types of pain meds and she refuses anything that makes her "high" or really drowsy. She is 87, terminal on hospice, a miracle to be alive, in home almost completely on bed rest. She is such a control freak that she doesn't want to feel out of control yet she's in excruciating pain and knows shes dying soon. I don't get it.
That said - towards the middle of this time on pain meds I had a doctor who himself, was a chronic pain sufferer. He explained what worked for him and asked if I'd like to try it. Hands down it has been the most successful at controlling my pain.
The theory is to "stay ahead of the pain". That taking pain meds once you're already experiencing fairly severe pain, it is less effective to try to treat it with pain meds. So - you take pain pills on a set schedule. This isn't a high dose - it can even be Advil or Tylenol - this is a "baseline" pain treatment. Then if you begin to feel "break-through" pain, you take something different - something stronger- but don't wait until the break-through pain is really bad. It will be too late.
It is also a great suggestion to explore anti-anxiety meds, often the need to control things comes from anxiety. And really, when facing death, anxiety is an understandable reaction. She is in control of so little else in her life, that the medication choices may be the last thing.
Having said that, have they tried slow release medication patches? Fentanyl comes in many different strengths and the patches are worn for several days (removing the burden of having to take pills) and slowly release the medication into the system, absorbed through her skin.
Is the hospice team using a "multi-modal" approach to her pain? That is when different combinations of medications are used. For instance a narcotic and tylenol or ibuprofen given on a schedule. If tylenol or ibuprofen is given on a set schedule it can help keep the blood levels constant and take away some of that see-saw effect. Additionally, depending on the cause of her pain there are medications such as neurontin that can be used for "nerve" pain, massage and warm compresses can be good also.
I wish you the best in this journey with your mother. It is a challenging one, I know!
Margaret
There's meds in between Vicodin and morphine. I'd talk to her dr and see what options remain open to her. Sounds like she is in hospice? They are very good at matching pain med needs and the pain. Lower doses of morphine are usually fairly well tolerated and given on as-needed basis.
Added to that, an anti anxiety med usually gives the patient the relief and controls the anxiety they also often feel.
Vicodin, at this point, would be like taking an aspirin.
Talk to her doc or the hospice care manager. Keeping her OUT of pain will help to control it all day, not having the awful ups and downs.