Mom complains of constant pain. She has been on Norco for about 6 months. It’s not working and they suggested Morphine-should I consent?

I would consent to 'yes' on the morphine, and no I don't think it matters at her time of life if she develops an addiction. At 78 years it should be all about quality of life. If morphine helps her pain then that's what she should be having.

I don't know all of her medical conditions but it is a fact of life that there is NO pain relief for certain conditions - I speak from experience. I am in agony 24/7 due to spinal problems and everything possible has been tried to no avail and it is causing me to lose the use of my legs - I can't walk. If there is something that might relieve the pain, give it to her. She is not in good shape and she is elderly. At this point it does not matter and might ease the situation all around.

I agree with Becky that your Mom needs to be evaluated by a Pain Management Specialist--someone who is part of a "Team" of doctors, nurses, physical therapists, social workers, psychologists, etc. who specialize in pain management. (Please note the key word is "MANAGEMENT", not "get rid of".) 

Ask the assisted living doctor for recommendations and whether outside specialists are permitted to see people at the assisted living facility. Ask your Mom's previous doctor or the local medical university if they have doctors who specialize in "Pain Management" or can recommend someone.

You state that your "personal approach is less medication, fewer tests, minimal doc visits...is it really fair to use this approach for my mom?" My response is "No, the 'less is better' approach for your Mom is not fair to her." Compression fractures can be very, very painful and hard to treat and/or control the pain related to the fractures.

Each person experiences health issues/problems differently. Some people will be in lots of pain and not say a word to anyone--just take a Tylenol and go about their day. Others with the same health problem and pain will moan and groan with every little ache and demand pain medications frequently.

ALL pain is REAL.  And unfortunately, sometimes the treatment (drugs) can make the person’s pain worse. Please contact a Pain Management Team--they can determine whether morphine will relieve or increase your Mom's pain.  Sometimes it takes a village (of health care professionals) to help relieve someone’s pain.

Having had several spinal issues myself, upper and lower, the suggestions made by some to consult with a pain specialist might be a good starting point.

Quite honestly, no Rx they gave me for pain ever worked on spinal pain. Initially tried ibuprofen (hard on the liver too!), and PT (electrotherapy included), but mainly because no one had identified the REAL problem - that took a year and additional Xrays. Then it was a 5 yr journey to find a doctor who could take care of it! He needed more tests and another year to be convinced that surgery would help (C5 disc.) The clincher was getting me to agree to one "pain therapy", as a diagnostic only. This is the injection others mentioned. Done by the right person, this DID help. Generally it lasts about 3 months. By 2 months it was wearing off and started to feel worse than before - so my question was did I do more damage while pain-free or does it just FEEL worse because I have been pain-free? Bottom line, it DID relieve, almost instantly, the pain.

Interesting was post surgery (disc removed, vertabrae fused, metal support attached and I stayed overnight.) I asked for something to help me sleep. If they'd told me I could take the leg things off, I would've just gone for a walk! Never had a sleeping pill before, but was willing to try. Without telling me, nurse shot me up with morphine! I was NOT in pain, and was NOT happy she did that! So, what did this do for me? I fell asleep for about 15 min and it felt like 1/2 hour. Wow, sign me up...NOT. Even the pain meds they gave me on discharge did nothing really (percocet I think?) I cut the dose, but didn't even really need it - the PAIN was gone post-surgery!

Same result but worse years later with Dilaudid - NOT killing pain, just leaving me feeling in a fog AND because I wasn't warned, ended up impacted!

Gabapentin doesn't do anything for me either. Nothing.

I personally have no use for these drugs. Anytime I can avoid drugs, I do. If there's a non-drug safe alternative, I use that. When they are really needed AND work, fine. But, not everyone gets the same benefit. I would consult with a pain specialist and inquire about the possibility of injections or any kind of out-patient treatment. Given her age and other medical issues, surgery is probably not a good idea. With imaging they can likely source the pain and perhaps take most of it away for several months with an injection! I've had one additional injection treatment on my lower back (vertabrae slip out of place sometimes!) Sometimes people only get one and by the time it wears off, all is good. For my mother, who has dementia, I requested the injection in the knee, as a preventative (she should've had knee replacements done YEARS ago!) after a bout with intense pain (by the time we could be seen, the pain had subsided, but Xrays showed bone on bone!) Doc said if she were 20 years younger, we'd be talking surgery. Age and dementia ruled that out!

Even Heparin, which has been around a long time, causes problems for me (platelet counts went sky high, when it should reduce the counts AND also caused a hematoma!) No more of that for me! My dad was to take several blood thinning meds for life after heart surgery. They cut the dose over and over and finally told him to take 2 baby aspirin/day. Apparently blood thinners don't work so well in our family!

So, before resorting to drugs, since she seems to want to be more active, see if you can get a consult with a pain specialist. Although there may be no harm in giving her these medications, why not try something like the injections first? One every 3 months vs taking meds every day, maybe multiple times/day. Just be sure to find a good one, hopefully someone others can refer you to. One of these docs I ended up with caused me MORE pain while trying to inject me (the surrounding discs to C5 degraded, and eventually were removed and fused.) If not, then the pain doc can Rx the right meds.

I have been on narcotic pain medication since continuously 1997 due to 2 failed back surgeries.
I started with Lortab for about the first 4 or 5 years, then Methadone for about 3 years( Although it works good for pain the withdrawals are the worse I have ever experienced in my entire life.) I have been on Morphine ER RTC and Morphine IR as needed for break through pain.
Although my body is physically dependent (addicted), I do not see any of the symptoms of emotional addiction. I the 23+ years, I have never ran out of meds, never "lost" them, had them "stolen". My kids have never played with them on the beach and mixed them up with beach sand,(All excuses I have heard people use at the pain clinic).
Without these meds, I do not think I could function in my day to day life.I am taking above the recommended dose for acute pain according to the CDC recommendations. Every several months, my Dr asks if I am ready to cut me meds back. ( I had to change clinics about 3 years ago and the new clinic cut my dose by 25%)
If she is really in pain, she needs relief.

I am not a medical professinal, but she needs a medication for the pain. Prayers sent.

simple tumeric powder is a highly effective pain killer. There are many studies you can find online. Google "medical studies on the efficacy of tumeric to relieve chronic joint pain".
It 'matters' at whatever age, that the body is, to be as healthy as humanly possible.
Health comes from an old Greek word that means "Whole".
The more medications the lady receives, the further she will move away from health.
Get simple organic tumeric powder .
If you must gets capsules, get plain organic tumeric powder...no added black pepper, standardized dosage, or 'extra cucuramin. Just the wholesome food tumeric.
When herbs (foods) are wholesome there are NO side effects. And many side Benefits.
1teaspoon of the powder, 1 tsp raw honey, 2Tblspns full fat plain yoghurt and 1/3 to 1/2 cup warm water. Stir well. Have her take this 10 mins before a healthy meal.
If she must have capsules, 3 caps x 3 times daily 10 mins before meals Will greatly relieve pain, swelling & irritation. And eliminate the need for the NSAID she is currently taking. NSAIDs are very harsh on the stomach, liver & heart.
MORINGA
Moringa is the plant that has the highest nutritional profile of any I have come across in many years of clinical experience.
Google: Comparing the nutritional profile of moringa compared to other high nutrient foods.
I regularly see wonderful improvements in the health and well being of all who take it regularly. Particularly the elderly and infirm.
And do take it myself often.
Again, there are no side effects, as Moringa is a whole & highly nutritious food.
Even 2 or 3 of the simple Moringa capsules with each meal
will greatly improve her nutrition, her strength & her well being.
Despite assertions by some websites owned by pharmaceutical companies that foods (tumeric & moringa) have side effect, and may interact with medications this is inaccurate
It is my experience, that these simple foods have no side effects, and work in a simple & highly effective manner to improve organ function, decrease inflammation and pain, increase mental acuity, regulate the immune system, and improve the patients well being in all cases.
This is Always dependent on the tumeric & moringa being 100% wholesome..no added anything, enhanced anything, nor standardized.
Nature knows best!
Additionally, buy a bottle of massage oil with added Arnica & St johns wort (if possible) If not, buy almond oil, add 10 to 20 drops of Stjohns wort, peppermint, and rosemary essential oils. Shake well. Rub into your hands well until they are warm
Gently massage her back, not only painful area, as much of the back as possible. And the bottoms of her feet. Look at a reflexology chart, and you will see the reflexes in the feet to her back . Work gently but firmly on her feet also
Hippocrates refers often to massage as "one of the finest of medicines"
Morphine has a half life of just 2 hours...meaning the amount of time it provides pain relief is relatively short. It will cause addiction if used for more than 3 days consistently And has serious & in some cases, life threatening side effects.
Please read about the side effects.
Narcotic psychosis is common in morphine patients. This will lead in all likelihood to an incorrect diagnosis of dementia..and even more medications.
It must surely be distressing to be hospitalized for a lady that has never been so ever before. If you add morphine to her regimen it will greatly increase both her suffering, and the rate of her demise.
You know from your own experience that health & medications are never seen together. And the line between "effective therapeutic dose" & "respiratory depression " with morphine becomes quickly blurred as the patient develops tolerance to the morphine, and dose must be increased to provide adequate pain relief
Please weigh the consequences of making your decision carefully.
We are responsible for the relief ,or the pain ,that our decision bring to others
Bless you

What is her life expectancy? Risk of addiction is not terribly serious for those who are dying anyway. If she is reasonably expected to live beyond this current illness, I would give it more thought.

On the whole, for someone who does not need to go to work, is not operating heavy machinery, etc, I would say that her comfort is the most important consideration. If you live in a state where medical use of cannabis is legal, that is a great way to wean off opioids if she gets to the point where it they are no longer needed.

You are right to put aside your personal preference and try to see what is best for your mom. My sisters and I have been encouraging my mother to take the opioids that her doctors have prescribed for pain. If she does not take them she does not sleep, then other conditions worsen. Mom fears addiction but we tell her that it really doesn't matter. She is almost 96 and might live another 5 years or die next week. Whatever her life expectancy I would prefer that she be comfortable and able to enjoy what little that she can in what remains in her life.

Talk frankly with the AL doctor. Tell him/her your personal concerns but also ask what is best for your mother. Make your decision according to what is best for her, not for you. Best of luck with a tough decision.

(By the way, my sisters and I share your preference for as few meds as possible, and minimizing medical intervention for ourselves. We still have active lives that we are trying to maintain. Those ideas have little relevance for a woman whose activities are limited to what can be done from a chair and do not require either good hearing or good vision. Mom has few things which give her comfort and pleasure these days and a mild opioid addiction would not hamper these things if she did get addicted.)

There is a difference between addiction and dependence. A person with diabetes is dependent on insulin; you would never say they are addicted. Proper medically prescribed opioids give some relief to a person with chronic irreversible pain - that's it. Even if you want to call it addiction - so what? The important question is not what you feel comfortable with but what your mother needs. She obviously has pain which is medically justified. For the most part only those who experience serious, chronic, debilitating pain should make the decision to take opioids. They are the only ones that truly understand the devastating physical, mental, and emotional toll pain takes.

The government has done a good job of convincing everyone that all opioids are bad; they are not. You mentioned she is taking gabapentin and Tylenol. You need to be aware that the FDA has issued a 'black box' warning on gabapentin because of the extremely negative side effects many people have experienced and often it has no effect on the pain. Further Tylenol causes over 500 deaths (probably a lot more) a year. And it shouldn't be taken by anyone with liver problems and it also isn't very effective for pain for most people. Opioids are far safer.

It definitely sounds like she has not received ENOUGH opioids to deal with her pain. Once she reaches that level, it's unlikely she will require more - that's also another 'addiction' myth. Those who take opioids to relieve pain do not feel euphoric, they only feel some relief from the constant nagging pain. Addicts on the other hand, keep seeking more and higher doses of anything because they are addicted to the euphoric high. There are many studies that show what the true addiction and overdose rates are - less than 1.6% of those with valid opioid prescriptions die of an overdose. And the majority of people who do overdose are younger, taking multiple opioids, and the majority of the time it includes heroin and illegal fentanyl from China. If you wish, I can email you that research so you feel more comfortable.

My mother had received opioid pain medications for years because of her spinal injuries. When she went into hospice care at 93, the doctor stopped all of her opioids 'cold turkey'. She suffered a cruel and unnecessary death 18 months later. I appealed but the doctor convinced her health plan that patients with dementia feel no pain. She called me everyday and cried her heart out but there was nothing I could do. You should be thankful that the facility cares enough to provide your mother with the proper medications to comfort her in her last days. Give her whatever she needs to feel comfortable.

If your mom is starting to walk again and regain some of her previous functional ability, I'd hold off on the morphine. I'm wondering if anxiety and/or depression aren't contributing to her perceived level of pain. I'd suggest that she be referred to a pain clinic for consultation. Most have a 3-pronged approach: evaluation by an anesthesiologist for pain control, physical therapy to regain strength and prevent muscle contractures, and lastly, mandatory sessions with a psychotherapist who will determine if there are other psychiatric/emotional issues which may be underlying her pain or at least contributing to it. The issues with morphine are that they depress the respiratory system and can cause confusion in the brain. I'm concerned that it might result in confusion at night and this might result in a fall, fractured hip, surgery,... and often a downward spiral from there. You might also consider acupuncture or Reiki therapy. Reiki is an Eastern technique of hands-on healing which results in deep relaxation and many times it relieves or significantly decreases pain. Is she bored such that she has little to do or think about other than her pain? The psychological effects resulting from the Corona virus, particularly those related to isolation and the inability to get out as much, have a much greater impact on the elderly. Can your mom get outside for 10-15 minutes of sunlight on a daily basis? If not, you might want to consider a vitamin D supplement. Has she had a recent physical exam with lab work? I wouldn't want to be inadvertently looking over other possible issues which might be contributing to her pain. Has she tried any of the medications which are applied topically to the area where the pain is? Being able to put something directly on the area of pain has both physical and psychological benefits when it comes to pain control. I'm thinking about either a Lidocaine patch which dulls the pain or Voltaren gel which is worked deep into the the muscles (essentially it's Motrin/Advil/Ibuprofen in a tube!) and provides deep penetrating warmth and relaxation of the muscles. Although she'd have to be careful with it, what about a small amount of a muscle relaxant such as Flexeril or Robaxin (stay away from Soma, it has addictive properties)? Can she take anti-inflammatories? These are medications that are similar to but stronger than aspirin which perform two functions. They decrease inflammation which in turn decreases pain. Additionally, for those who aren't too sensitive to the cold, ice is a very effective method of pain relief for muscle related injuries and spasms. For others, they may prefer heat via a heating pad or hot packs. If using a heating pad or hot packs, DO NOT place them directly onto the skin. Keep a towel or facecloth between the skin and the hot surface to prevent serious burns. The other thing that can be done is to use several types of medication and alternate them. For example, 2 extra-strength Tylenol upon rising, followed by two to four 200 mg Advil/Ibuprofen/Motrin 2 hours later, followed by the Lidocaine patch 2 hours later,... A busy pain med schedule will also give her something to do. Best of luck! You are wise to be concerned about starting Morphine if it's not essential for pain relief.
P.S. A word of caution about using anti-inflammatories. If mom has ever had a clot or bleeding in her brain or if she has a history of bleeding, like a GI bleed, or bleeding from her rectum, minimize or avoid all Advil/Ibuprofen/Motrin and use the Voltaren gel sparingly.

I was on Norco for awhile and finally got off them. Yes it matters if she is an addict. Its bad for her and everyone around her. What I would do is try to get her off the pain meds or atlas slow the intake for a couple of weeks and see if her pain has subsided.
Its hard trying to give advice for something like this -
I would try Kratom, go online, do research on this. Its really a miracle and the Answer to America's Opiod Epidemic.
I can't say what is fair or not for your mother but what I can say is you care enough to ask or question.

Dear "Rebeccaal,"

I can see your mother has been through a lot over the course of many months. There are many drugs/medications that people can develop a tolerance to.

My mom is 95 and was completely mobile and able to dress herself. I did buy her a walker at the end of last year but, that was more to just be prepared and start getting her used to using it. She has Alzheimer's but still lived in an ALF. Once the lockdown happened things quickly changed. She nearly died of severe dehydration and had COVID. Once hospitalized further tests showed she had a severe UTI along with bi-lateral pneumonia. Upon leaving the hospital, she went to a rehab facility for three weeks. She can no longer walk or dress herself without assistance and I brought hospice on when I moved her into a new facility in their memory care unit. They took her off medications but, wanted to give her morphine for the pain she had in her lower back (she was scheduled for an injection on the very day of the lockdown so I decided to cancel it). I declined only because I knew she wasn't in the type of pain that would deem it necessary.
When my dad was under hospice care in 2004, he had Pancreatic Cancer and was in a great deal of pain so I said "yes" to the morphine as he was nearing death.

At this point, hospice has given her a high dose of Tylenol instead of the morphine. She is also on a medication for anxiety and to help her sleep through the entire night as she was falling during the night. I'm wondering how well your mom sleeps because it is important for healing to take place within our bodies.

The fact that your mom has been uncomfortable for months probably plays a role in her depression along with the pandemic. My mom has fallen at least ten times since the end of May which is a lot for her. She too is frail and has arthritis.
The memory care director suggested she be given an antidepressant. I was hesitant but, I allowed them to start her on a very low dose. I don't want my mom to be in a sedated state. I will be watching her during my "window visits" to see if I notice anything "off." They said it would take a month for it to start working. I won't hesitate to have her taken off of it if it's presenting a problem for her.

Sometimes I think we get in our heads that once a medication is being given especially when someone in the medical field suggests it, we think they have to stay on it. Your mom has asked to be put on morphine for a reason. If I had decided to let hospice put my mom on morphine and I didn't think it was right for her, I would have told them as her medical P.O.A. that I would like it to be stopped and let's go another route. In other words just because we decide to try something doesn't mean it's carved in stone. Everyone reacts and responds differently to various medications. Some will say "x,y,z" works for them and someone else will say it doesn't work for them. I guess I just feel like there's no harm trying it with the knowledge you can change your mind if it isn't helping in the way you thought it would or should.

I hope you will find an answer that you will be comfortable with and that will ultimately help your mom during this difficult time in her life!

Pain from compression fractures is reported to be intense. I was a homecare nurse and I took care of a woman around 78 - 80 yrs with a compression fracture. I had taken care of her husband twice before. I knew her to be stoic, mobile, active and a great CG to her husband. When I cared for her she was in so much pain she couldn’t function. She was given Percocet for pain and was reluctant to take it or any other med except Tylenol due to hoopla over opiates. This woman was miserable and was in so much pain she broke down and took the Percocet which provided considerable relief from her pain.
Pain affects well being. If your mother is that uncomfortable please consider giving her morphine. A body in pain will not work optimally. Pain can adversely affect appetite, sleep and overall quality of life.
Norco is usually the first pain med prescribed. There are others between. You may discuss other opiates available. For chronic long term pain usually extended relief morphine is prescribed for all day pain control.
I wouldn’t worry about addiction if she needs pain relief. If taking morphine improves your mother’s quality of life & she’s not driving and is home bound I would offer it. Doctors don’t prescribe pain meds easily these days so I’m thinking your mother has a true need documented by diagnostic testing.

My mother is in constant pain from neuropathy in her legs, yet her doctor won't prescribe more than Tramadol to help her. It doesn't help, she's up 1/2 the night in pain, but still not 'ready' for hospice at 93.5 with more issues than Newsweek. I'd cut off my right arm to have the ability to get morphine prescribed for my mother. Addiction is the least of my concerns at this stage of life. What's left of it should be as comfortable and easy as possible, rather than consumed with non-stop pain for NO GOOD REASON.

Put yourself in your mother's shoes and then ask the same question. What would YOU want done if you were in her position? If it were me and my kids were talking about addiction, I'd have a fit! I'm going to write explicit instructions in my will that state how I want to kept comfortable in my old age no matter WHAT it takes, but that I want no heroic measures taken to keep me alive ie: Feeding tubes *God forbid* or ventilators, etc.

Good luck!

Sunshinelife,
While I appreciate your passion for all things herbal, I will tell you that I have tried all things herbal to no avail!
There is a time and place for modern medicine!!
If herbal medicine could cure all things, then pain and cancer would be a thing of the past!
I believe that we should give natural resources a try. Having said that, it didn't make my cancer go away! It didn't cure my SEVERE spine pain!!!
Please be careful not to discourage people from seeking conventional medicine!
Sometimes it is a viable option!!

Norco works for a while and must be increased as it is adictive. Pain must not be ignored as it will do other things in the body and always causes anxiety and we must "get rid of it" always in her mind. Talk to Dr. about us of morphene and especially a "drip".