[spoiled28]

Please help! I've been a hospice nurse for 6 yrs and this is my first ALS pt with uncontrolled pain. We have tried morphine (Roxanol 15-20mg Q 1 hour) at times and finally was able to get ahead of his pain. Refuses to go in for inpatient IV therapy pain management or to have IV pain meds at home. We have tried ativan along with pain meds and also have him on duragesic patches 100 mcg.

Any ideas to go along with current therapy, would be appreciated.

[medicalma'am]

Dear Spoiled28

What is the source of this patient's pain? ALS does not usually have pain associated with it. Is this patient at home or in a hospice facility?

[earle58]

if roxanol helped him, why not stay on it?
more ideal, would be a long acting morphine q 12 hrs, w/ roxanol for breakthrough.

why are you so focused on iv?
is his swallowing still intact?

leslie

[ray2512]

Have you tried gabapentin. 300mg first day, second day bid, third day tid.

[Allow Mystery]

I agree with leslie's advice. If unable to swallow, you
may want to consider pain pump if he has IV access
(port) or subq pump.
Best wishes!

[BlueRidgeHomeRN]

Ditto..agree with Leslie.

Also might want to look at gabapentin, Cymbalta, xanax..in combo with Ms04 or dilaudid.

Don't forget the non-pharmocological interventions--heat, ice, massage, TENS unit, aromatherapy, music, and the like. They can do wonders as an adjunct to narcotics.

Let us know how he is!

[earle58]

if he's in the terminal phase, i would concentrate on meds for pain, anxiety, secretions, constipation.

don't want to overwhelm him w/a zillion meds.
just keep the priorities in mind.
if morphine's helping him, not sure of need for neurontin too.
i like to keep it simple.
usually pain is muscoskeletal rather neuro.
gaba works for some, morphine for all.
and hope he's been on something for depression?

leslie