[n8isgr8]

Hi all, I am a new lpn. My mother was a hemotologist, before all her pain issues began. She has had numerous surgeries on her back, she has crushed veterbrae, fused disks, and a pseudomyelomenigeocyle and other probs. Surgery is not an option at this point as she has no health insurance due to other circumstances. She is seeing a pain management doc who is giving her morphine and methadose. She has tried every other kind of pain meds but this is the only regimine that is working for her pain....Here is the problem, When she takes the med which take away some of her pain she is not functioning cognitively, as she did before the meds, cant hold a conversation without saying something off the wall and not related to the issue for example..The cabinets are growing fuzzies??!!!! She falls asleep with lit cigarettes, puts coffee on without the pot, and toasted a piece of toast,,,WITH THE PAPER PLATE, and started a small fire. PLEASE help with suggestions. She says this is her perscribed dose, and is the only dose that touches her pain. she is on disability but here in NJ she has to wait 2 years for medical coverage... Imagine that ! her social workes are trying to help and she has a DR. Friend who said he may be able to do surgery at no cost....But what do we do in the mean time. I am so worried and she lives about a half hour away. THanks for any info
- Jami

[hollyster]

[quote=n8isgr8]Hi all, I am a new lpn. My mother was a hemotologist, before all her pain issues began. She has had numerous surgeries on her back, she has crushed veterbrae, fused disks, and a pseudomyelomenigeocyle and other probs. Surgery is not an option at this point as she has no health insurance due to other circumstances. She is seeing a pain management doc who is giving her morphine and methadose. She has tried every other kind of pain meds but this is the only regimine that is working for her pain....Here is the problem, When she takes the med which take away some of her pain she is not functioning cognitively, as she did before the meds, cant hold a conversation without saying something off the wall and not related to the issue for example..The cabinets are growing fuzzies??!!!! She falls asleep with lit cigarettes, puts coffee on without the pot, and toasted a piece of toast,,,WITH THE PAPER PLATE, and started a small fire. PLEASE help with suggestions. She says this is her perscribed dose, and is the only dose that touches her pain. she is on disability but here in NJ she has to wait 2 years for medical coverage... Imagine that ! her social workes are trying to help and she has a DR. Friend who said he may be able to do surgery at no cost....But what do we do in the mean time. I am so worried and she lives about a half hour away. THanks for any info
- Jami[/QUOTE

Hi
I am sorry for what you and your mother are going through. Her medication regime must be changed. There are ways to safely manage pain. True pain management lessens the pain enough to prevent cognitive impairment. Her medications must be reviewed before something tragic happens. Is your mother taking antidepressants? Has she had cognitive pain managment therapy?
It is very hard to find the right mix of medications and other therapies. If you can contact her social workers and tell them the things she is doing and her inability to think clearly. She is a danger to herself and others. The social workers would be negligent if they do not get her help.
I empathize with you and your mother. I am going in today for the fourth procedure on my back this year. I understand how horrible the constant pain is and the hopelessness that comes with it. (I would love nothing more then to be able to sit up and eat a meal.) I have been very involved in my hospitals pain management comittee and for or CCU and PCU. So I see both sides.
Take care. If I can help in anyway please PM me.
Holly

[z's playa]

The only thing I can think of is to get her home care, someone to look in on her throughout the day. Perhaps put her on the nicotine patch. The fire thing worries me.

These may sound like extreme measures and money may be a problem.. I understand.

Has she ever tried an analgesic patch?

I'm not a nurse yet and I by all means don't want to let on that I am or am an expert with these things but situations like yours was covered in class and these were some of the things we discussed. Your concern is understandable. My heart goes out to you and your mom. One of our own here at allnurses is going through hell trying to deal with her pain as well. It affects everyone who cares about her.

Z

[doodlemom]

Has she been able to be on the same steady dose for a while? How many prn doses of MS does she need a day? If it's several then maybe they need to go up on her methadose which would give her more steady pain relief. Once she's on a good steady dose for a while, her congition (theoretically) should get better.

[hospiceLPN]

I would really check into a duragesic patch these are quite effective titrated easily and usally controll mod to acute pain. Best of luck to you and her!
Hospice LPN

[elthia]

What kind of adjunctive meds is she on? If it is neurological pain vs nociceptive (sp) pain, narcotics might not be enough. does she c/o or radiating pain, burning sensations, or tingling/numbness in the extremities??
Just an idea, but sometimes adjunctive meds can help with neurological pain.

[rnmom3153]

Hi, I have a possible solution. I've worked in a pain management MD office lately and here they're using "Provigil" to counteract the sedation that accompanies these meds. It's a nonamphetamine stimulant used in Narcolepsy, shift work disorder, to name a few. PM me if you would like more info I have Lots and lots of info. I've been researching it for personal reasons. Good Luck. That is so frustrating and scary...
***Carol***
rnmom