Pain management for seniors

[Calm]

I know this belongs in Social, but I really need as much advice as I can get on this and am starting here to get this widely viewed. Apologies up front, mods please let it stay for a day at least, maybe two, then switch.

I figure there are enough older posters as well as those who have parents in much the same place as mine, that I could get some feedback   I like to cover personal experiences as well as the med websites when looking at new stuff 

My 89 year old mother is in excruciating pain all day and night as far as I can tell (she sometimes is crying as she walks to the bathroom), would just sit and veg if she could which is making it worse.  She also has poor memory so can’t be trusted with meds on her own or to ask for them in a timely manner. 

She is on narcotics right now at night but I have to stay with her until we get the paperwork done for her care facility to handle that and so I have had a chance to observe her and it is clear her bad memory goes nonexistent and she is pretty much incapable of interacting on more than a basic level if narcotics are used and at a low level just seems to have her complaining more not less (thinking ability to distract herself from the pain gets lost).

She has been getting nosebleeds so Advil and Excedrine got taken away as well, at least for awhile  

Does anyone have any suggestions of more effective or longer lasting I could put before the doctor tomorrow when she gets a balloon taken out of her nose (nosebleed that wouldn’t stop). I plan to get an appointment with a geriatric specialist, but so much other stuff going on right now it may be a month or more before we can get there.  No allergies to meds, but her legs are really swollen these days and lots of weight gain as she moves less and has lost the ability for self control. The now is what matters for her. 

Edited August 23, 2019 by Calm

[RevTestament]

5 hours ago, Calm said:

I know this belongs in Social, but I really need as much advice as I can get on this and am starting here to get this widely viewed. Apologies up front, mods please let it stay for a day at least, maybe two, then switch.

I figure there are enough older posters as well as those who have parents in much the same place as mine, that I could get some feedback   I like to cover personal experiences as well as the med websites when looking at new stuff 

My 89 year old mother is in excruciating pain all day and night as far as I can tell (she sometimes is crying as she walks to the bathroom), would just sit and veg if she could which is making it worse.  She also has poor memory so can’t be trusted with meds on her own or to ask for them in a timely manner. 

She is on narcotics right now at night but I have to stay with her until we get the paperwork done for her care facility to handle that and so I have had a chance to observe her and it is clear her bad memory goes nonexistent and she is pretty much incapable of interacting on more than a basic level if narcotics are used and at a low level just seems to have her complaining more not less (thinking ability to distract herself from the pain gets lost).

She has been getting nosebleeds so Advil and Excedrine got taken away as well, at least for awhile  

Does anyone have any suggestions of more effective or longer lasting I could put before the doctor tomorrow when she gets a balloon taken out of her nose (nosebleed that wouldn’t stop). I plan to get an appointment with a geriatric specificalist, but so much other stuff going on right now it may be a month or more before we can get there.  No allergies to meds, but her legs are really swollen these days and lots of weight gain as she moves less and has lost the ability for self control. The now is what matters for her. 

My dad is one of the few polio patients left in the U.S. He had polio in his legs - primarily the right, but electrical testing showed his left was also affected. The last 2-3 years he has also struggled with lymphedema in his right leg. Advice for your mom will depend on the cause of her pain. To keep down the swelling in the leg, my dad was using a lymphedema machine from Israel which basically blew up material put around his leg like a balloon. However, one of his helpers was using an "H wave" machine (something like a more powerful tens unit) because of severe back issues. He brought it over for my dad to try, and since he has been using it for the last 2 weeks, his leg has stopped swelling up. 

He had a severe flareup of pain since trying to exercise his legs some months ago. This makes it difficult for him to even sit, because his gluteus maximii muscles will hurt. However, he has slowly managed to bring the pain down using a combination of massage, hydro therapy and now the H Wave machine. He also uses a combination of a narcotic, aspirin and acetamenophine to help control his pain. He says he doesn't notice any difference with sublingual CBD.

I will put your mother in our prayers.

[Calm]

Thank you for the info and the prayers. 

I love my Tens machine, interesting something similar could help with swelling. Will talk about that with both my PT and her doctor.  

[california boy]

I think we need to know what kind of pain and what is causing the pain before we could offer anything helpful,  Can you elaborate a bit more?  What narcotics is she on?

 

[Calm]

Arthritis all over. Bad, nasty looking (xrays) scoliosis of the lower back, but hurts all over. Her joints all crack when I lift her up at all. Legs are rather bowed and she slumps a lot. Drapes herself over her walker rather than stands up straight.  She dies a little every time she goes up or down a step, even small ones  

I have learned I will never be a geriatric nurse.  I don’t have patience for life in slow motion  

Small dose of hydro-codone  (5 mg) just to make her nose more comfortable from the balloon for a few days, seems to screw up sleep more than pain kill.  She just got those for the last few days.  She was so excited about them, thinking they are somehow going to give her great relief (I can get her to get ready for bed by the time I drive over in 30 minutes compared to the usual 2 hours while she wanders around winding down).  But all I see is disturbed sleep until it wears off at 4 hours or so  

She has been using ad-vil and that seems to help the most, but given the nosebleeds she has had that won’t stop, it may be out as an option. She likes excedr-ine but I think that is more energy than pain as she dismisses Ty-lenol. 

Edited August 19, 2019 by Calm

[The Nehor]

Have you tried heat and cold treatments? It helped a bit with my grandmother. The science behind it is inconclusive but I suspect the sensations distract from the pain even if they do not mitigate it directly.

Joint movement actually can help with the pain too but it causes more pain while you do some stretches, Not sure if she is up for that.

Sounds like it is near the end though. Do not be afraid to pray for a speedy transit to the other side. It is not selfish. It is seeking relief for everyone but of course with “thy will be done” stuck in there.

[Tacenda]

4 hours ago, Calm said:

Arthritis all over. Bad, nasty looking (xrays) scoliosis of the lower back, but hurts all over. Her joints all crack when I lift her up at all. Legs are rather bowed and she slumps a lot. Drapes herself over her walker rather than stands up straight.  She dies a little every time she goes up or down a step, even small ones  

I have learned I will never be a geriatric nurse.  I don’t have patience for life in slow motion  

Small dose of hydro-codone  (5 mg) just to make her nose more comfortable from the balloon for a few days, seems to screw up sleep more than pain kill.  She just got those for the last few days.  She was so excited about them, thinking they are somehow going to give her great relief (I can get her to get ready for bed by the time I drive over in 30 minutes compared to the usual 2 hours while she wanders around winding down).  But all I see is disturbed sleep until it wears off at 4 hours or so  

She has been using ad-vil and that seems to help the most, but given the nosebleeds she has had that won’t stop, it may be out as an option. She likes excedr-ine but I think that is more energy than pain as she dismisses Ty-lenol. 

It's the most difficult thing in the world to see your mother in this shape, you know my situation with my mom in a care center, but she didn't have that kind of pain. She did have pain, but not to that degree. I keep wondering if someone is dropping the ball, not you Calm, just the medical personnel. One care center that took care of my mom, made her slump over etc. like you describe because of a medication they were giving her, we got her out of there stat. But this probably isn't the reason your poor mother is. 

My go to is always CBD for things, you know me. But apparently Rev's father hasn't been helped, except maybe he didn't use it long enough to see the results, or needs more time. I wish she could be helped with that because it's works wonders for inflammation.

I've read magnesium and tumeric helps. Has she tried those? Or possibly a good chiropractor/massage therapist?

 

Edited August 19, 2019 by Tacenda

[california boy]

I know we have had discussions about this before, so I don't want to start anything, but I just read this in my news feed a couple of days ago.  I though I would throw this out.  I have no experience with it, or know anyone who is on it, but I though I would pass it on since it is a completely different alternative.

What Marijuana really does to your body

Quote

 

In addition to THC, weed has cannabidiol, better known by the handle CBD. Generally, it’s mentioned along with THC, as these two are the primary reasons to smoke marijuana. Anyway, CBD has nothing to do with triggering the high; instead, it provides the pain relief and potentially other forms of relief for conditions like epilepsy. This is no small deal, as pain is generally the reason people seek out medical marijuana in the first place.

Rheumatoid arthritis is one such painful condition. One of the things it causes is inflammation, and it’s the sort of chronic pain that drastically lowers quality of life. An early study took a look at nearly 60 patients who suffered from rheumatoid arthritis, giving half a placebo and half a medicine based on cannabis. In the end, results confirmed that those who had been exposed to the medicine had significant improvements regarding the pain they experienced and the quality of the sleep they received. This evidence has been backed up by other studies, which reveal a number of other cannabinoid products having a similar effect.

Likewise, inflammatory bowel diseases are often painful conditions; as with the above study on rheumatoid arthritis, studies were conducted on people with chronic Crohn’s disease as well. Half received the placebo, while half received a drug. The majority of the patients who were given the cannabis saw an improvement in their symptoms. Still, there is definitely room for more research, as a follow-up study failed to deliver similar results. This may be a matter of dosage, as the second study was conducted with a low-dose CBD. It might be that a higher level of CBD is necessary, or that some other factor of marijuana is more significantly responsible for pain relief.

 

Sounds like it is in the early stages of understanding  how effective it is.  

As a side note:  My partner's son has severe Crohn's disease.  After reading this article, I asked my partner about this.  His sons doctor did recommended he try marijana and it seemed to help.  He also added that his son finds regular tobacco to help with his condition even more effective than the marijuana.  I was quite surprised and asked if the doctor actually prescribed smoking.  He said he didn't prescribe it, just suggested it.  This kid has one of the most sever cases of Crohn's disease in the country and has had quite a few experimental drugs and procedures done.  Not much left of his large or small intestines. They don't give him a long term life expectancy, so cancer is something they seem less concerned about.  

[mfbukowski]

5 minutes ago, Tacenda said:

I've read magnesium and tumeric helps

Turmeric is fabulous and is a natural herb and it seems compatible with other medications. For me that is the big issue because as far as I know you can take it with low-level opioids to enhance their effects, or alone just as a pain and inflammation  reliever.  However it is also a blood thinner, so if bleeding is a problem it might not be appropriate- unless the problem is vascular. (Not an issue of "thin blood" but an issue of a broken vessel etc)   If her prothombin time is good it should be fine (INR test)  Check with the doc.

I have no medical training, just my own experience with this body I have.

A good and effective dose level for me is 1500 mg per day, 6 feet 210 pounds.  

Get turmeric that says "Standardized to 95% Curcuminoids" on the label because otherwise you might be getting ripped off because the way the manufacturers cut costs is putting in just a few percent curcuminoids (active ingredient) and lots of fillers.

You can buy it in health food stores or pretty much anywhere they sell vitamins- but make sure you get the standardized versions.

I don't know if they have Trader Joe's where you are but by far they have the best deal on the best turmeric I have found.  It tends to be expensive in health food stores but TJ's has it priced comparably with other herbs.

 

[The Nehor]

Be careful about supplements in general. There is virtually no regulation on them containing what it says on the packaging. I would try to use supplements that have gone through independent testing in labs if at all possible. There are several sites you can check with test results.

[Tacenda]

35 minutes ago, mfbukowski said:

Turmeric is fabulous and is a natural herb and it seems compatible with other medications. For me that is the big issue because as far as I know you can take it with low-level opioids to enhance their effects, or alone just as a pain and inflammation  reliever.  However it is also a blood thinner, so if bleeding is a problem it might not be appropriate- unless the problem is vascular. (Not an issue of "thin blood" but an issue of a broken vessel etc)   If her prothombin time is good it should be fine (INR test)  Check with the doc.

I have no medical training, just my own experience with this body I have.

A good and effective dose level for me is 1500 mg per day, 6 feet 210 pounds.  

Get turmeric that says "Standardized to 95% Curcuminoids" on the label because otherwise you might be getting ripped off because the way the manufacturers cut costs is putting in just a few percent curcuminoids (active ingredient) and lots of fillers.

You can buy it in health food stores or pretty much anywhere they sell vitamins- but make sure you get the standardized versions.

I don't know if they have Trader Joe's where you are but by far they have the best deal on the best turmeric I have found.  It tends to be expensive in health food stores but TJ's has it priced comparably with other herbs.

 

I buy mine from Puritan Pride, they have a great product that is really inexpensive. I make Kefir, and break open my tumeric capsule and pour it in, and then add pepper and stir. They say pepper is needed for some reason. 

Had many bouts of UTI for some reason and had to have antibiotics over and over again, then read how Kefir will put back the good bacteria. Luckily no more UTI infections as well, knock on wood. 

Edited August 19, 2019 by Tacenda

[clarkgoble]

Be careful about interactions as well. My wife's mom just was dealing with tons of interactions which were causing problems. There's lots of doctors out there who aren't terribly good and who's go to is just prescribing medicine without looking at what other medicines are there. Supplements can be good, but again you have to really worry about interactions. And while interactions with major drugs often has at least some information, lesser used drugs frequently are a crap shoot. So you have to be very, very careful. 

As to supplement quality, all I can say without getting specific is be careful. Health companies - whether oils, pills, or so forth - tend to have a lot of companies that aren't the most honest. Track carefully how what you are taking works. 

Edited August 19, 2019 by clarkgoble

[mfbukowski]

17 minutes ago, The Nehor said:

Be careful about supplements in general. There is virtually no regulation on them containing what it says on the packaging. I would try to use supplements that have gone through independent testing in labs if at all possible. There are several sites you can check with test results.

Totally agree.

My testing has been in vivo  right in my kitchen, trying lots of expensive brands til I found a couple that work. With pain is pretty obvious. It either makes you feel better or it doesn't.

And at $8. a month I'd still take it if it was placebo effect

We call that "faith healing"

 

[mfbukowski]

5 minutes ago, clarkgoble said:

Be careful about interactions as well. My wife's mom just was dealing with tons of interactions which were causing problems. There's lots of doctors out there who aren't terribly good and who's go to is just prescribing medicine without looking at what other medicines are there. Supplements can be good, but again you have to really worry about interactions. And while interactions with major drugs often has at least some information, lesser used drugs frequently are a crap shoot. So you have to be very, very careful. 

As to supplement quality, all I can say without getting specific is be careful. Health companies - whether oils, pills, or so forth - tend to have a lot of companies that aren't the most honest. Track carefully how what you are taking works. 

Yep totally agree.

Pragmatism in action.

 

[RevTestament]

7 hours ago, Calm said:

Arthritis all over. Bad, nasty looking (xrays) scoliosis of the lower back, but hurts all over. Her joints all crack when I lift her up at all. Legs are rather bowed and she slumps a lot. Drapes herself over her walker rather than stands up straight.  She dies a little every time she goes up or down a step, even small ones  

I have learned I will never be a geriatric nurse.  I don’t have patience for life in slow motion  

Small dose of hydro-codone  (5 mg) just to make her nose more comfortable from the balloon for a few days, seems to screw up sleep more than pain kill.  She just got those for the last few days.  She was so excited about them, thinking they are somehow going to give her great relief (I can get her to get ready for bed by the time I drive over in 30 minutes compared to the usual 2 hours while she wanders around winding down).  But all I see is disturbed sleep until it wears off at 4 hours or so  

She has been using ad-vil and that seems to help the most, but given the nosebleeds she has had that won’t stop, it may be out as an option. She likes excedr-ine but I think that is more energy than pain as she dismisses Ty-lenol. 

I am sorry Calm. Chronic pain management is a weak point in our modern medicine. Because of the advanced stages for your mom, she might get a physician to prescribe an opioid on a long term basis with of course the attendant risks of addiction and the other usual complications. 

I have a brother in law with a severe type of arthritis. At times he has been in extreme pain. He tried a new type of medicine which actually made him much better, but after awhile a life threatening complication(side effect) forced him to stop. It may no longer be available, and was essentially in testing. I will inquire about his pain management routine. IIRC he experienced less pain while on a vegan diet, but essentially lives with fairly severe chronic pain.

[Calm]

3 hours ago, mfbukowski said:

prothombin time

Yeah, another big word that makes doctors look at me with respect!   m

hopefully i will pronounce halfway decent

they just called and want us to be there 20 minutes earlier while mom wants to argue I told her an hour later. Sigh, focus Mom focus!  And what the—- am I doing on the board, lol. 

[RevTestament]

16 hours ago, Calm said:

Arthritis all over. Bad, nasty looking (xrays) scoliosis of the lower back, but hurts all over. Her joints all crack when I lift her up at all. Legs are rather bowed and she slumps a lot. Drapes herself over her walker rather than stands up straight.  She dies a little every time she goes up or down a step, even small ones  

I have learned I will never be a geriatric nurse.  I don’t have patience for life in slow motion  

Small dose of hydro-codone  (5 mg) just to make her nose more comfortable from the balloon for a few days, seems to screw up sleep more than pain kill.  She just got those for the last few days.  She was so excited about them, thinking they are somehow going to give her great relief (I can get her to get ready for bed by the time I drive over in 30 minutes compared to the usual 2 hours while she wanders around winding down).  But all I see is disturbed sleep until it wears off at 4 hours or so  

She has been using ad-vil and that seems to help the most, but given the nosebleeds she has had that won’t stop, it may be out as an option. She likes excedr-ine but I think that is more energy than pain as she dismisses Ty-lenol. 

 

8 hours ago, RevTestament said:

I have a brother in law with a severe type of arthritis. At times he has been in extreme pain. He tried a new type of medicine which actually made him much better, but after awhile a life threatening complication(side effect) forced him to stop. It may no longer be available, and was essentially in testing. I will inquire about his pain management routine. IIRC he experienced less pain while on a vegan diet, but essentially lives with fairly severe chronic pain.

Cele-brex really helped relieve his symptoms for a number of years until he began losing feeling in an arm due to the development of a lesion. I don't know the name of the experimental drug but it was probably chemically related to Cele-brex. It was apparently around $10,000 per month (which he did not pay), but according to him began causing neurological issues. 

[sunstoned]

19 hours ago, Calm said:

Thank you for the info and the prayers. 

I love my Tens machine, interesting something similar could help with swelling. Will talk about that with both my PT and her doctor.  

I experienced a back and hip injury in my teens.   Sometimes when it flares up, to the point I can't get out of bed,  I will use my Tens machine.   It always helps to take the edge off of things.   My father, who has now past experienced swelling in his lower legs for years.  I forget what the diagnosis was, but it was serious enough that he was basically house ridden.  He also used a Tens machine at night.  It helped with the swelling and allowed him to sleep through the night.

[Calm]

Did he use the Tens machine all night or for the twenty minutes most units I have seen generally recommend (I think mine has the warning not to go over an hour)?  I could so see just having it going all night.  Bet I could dispense with some of my restless legs meds if I could do that.

When in painkilling mode, I will do a total of two hours with a half an hour break.  Hopefully I am not messing anything up, not like I really crank it up.  I need to get mine out again.

[RevTestament]

5 minutes ago, Calm said:

Did he use the Tens machine all night or for the twenty minutes most units I have seen generally recommend (I think mine has the warning not to go over an hour)?  I could so see just having it going all night.  Bet I could dispense with some of my restless legs meds if I could do that.

When in painkilling mode, I will do a total of two hours with a half an hour break.  Hopefully I am not messing anything up, not like I really crank it up.  I need to get mine out again.

I have used Arniflora to great effect for general aches and bruises. According to the literature, it may help arthritis some too - every little bit helps. Of course even if it does help, applying that all over the extremities every day would probably get a bit expensive, but if she has a particularly bad spot, it is something she could apply any time.

[Calm]

She used something that did get costly, did find it for around $7 on Amazon rather than 12$ or more in health stores. But it is homeopathic (I know Arniflora is too, I just can’t feel confident in the explanations for how such works, but since they often help someone I don’t have issues with people are using them if the can afford it and it doesn’t substitute for something safe and more reliable...our minds are powerful tools, sometimes believing in something we can see and touch give us access to its healing abilities).  I rather Mom use her Arnicare than overdo it on Ad-vil. I am guessing it is probably the massaging and insulation warmth of the oils in it that is the best benefit. She doesn’t use as much now since more work.

Thankfully she is comfortable as she and Dad were prudent over the years, so no sacrificing something better at this point. 

Edited August 20, 2019 by Calm

[RevTestament]

13 minutes ago, Calm said:

She used something that did get costly, did find it for around $7 on Amazon rather than 12$ or more in health stores. But it is homeopathic (I know Arniflora is too, I just can’t feel confident in the explanations for how such works, but since they often help someone I don’t have issues with people are using them if the can afford it and it doesn’t substitute for something safe and more reliable...our minds are powerful tools, sometimes believing in something we can see and touch give us access to its healing abilities).  I rather Mom use her Arnicare than overdo it on Ad-vil. I am guessing it is probably the massaging and insulation warmth of the oils in it that is the best benefit. She doesn’t use as much now since more work.

Thankfully she is comfortable as she and Dad were prudent over the years, so no sacrificing something better at this point. 

I am not a believer in homeopathic remedies, and I have used plenty of things that don't work. I don't know why, but Arniflora Arnica gel just works for me - usually within minutes. Just don't eat it.... I am not saying it will help her, but even if it is placebo, if she thinks it is helping why not? esp if she is feeling pain upon touch...

Fortunately, despite my horribly flat feet, the Lord has blessed me so that I rarely experience sore feet or legs anymore... I used to constantly with walking. I developed horrible shin splints trying to play basketball. I moved here and took my arch supports out of my shoes... forever it seems. I have enjoyed being essentially pain-free that way...maybe I will chalk it up to the thinner atmosphere  Anyway, I still use Arnica gel for the occasional bump or ache. I have to say I love the stuff. For these things I think it is much better than lidocaine, etc.

[Calm]

Whatever works.  

[sunstoned]

5 hours ago, Calm said:

Did he use the Tens machine all night or for the twenty minutes most units I have seen generally recommend (I think mine has the warning not to go over an hour)?  I could so see just having it going all night.  Bet I could dispense with some of my restless legs meds if I could do that.

When in painkilling mode, I will do a total of two hours with a half an hour break.  Hopefully I am not messing anything up, not like I really crank it up.  I need to get mine out again.

My father's machine was much nicer than mine.  I believe it was something his doctor/insurance got for him. It did have a timer set up that was separate from the Tens. It would run for a duration, then stop for a time, then start back up again. I don't know what the durations were, but I do know that at first he would use it once a week, but then later, he was on it every night.  He had to sleep in a recliner to use it.   

The local chiropractor where I live had a machine that was a commercial version of what my father had.  He put me one it once when I was having some real problems with my back.  The electoral charge was more powerful and could be controlled much better than the over the counter version that I personally have. It really worked well.  I went from hardly being able to walk, to walking without crutches within an hour.  The Doctor said that he had a clientele of Rodeo riders that would use it because of their injuries.

 

[Ahab]

My wife says Lyrica (now available as a generic drug pregabalin) provides the most pain relief of all of the pills she takes, even better than hyrdocodone, which she also takes.  And drinking some dill pickle juice helps when her legs cramp up on her, too.