Pain Control

[Henrietta]

I would say over the last couple of months I have had paramedics, hospital, out of Hrs Drs or GPs tweak Dad's pain meds on average twice a week.
Now he is on a cocktail of Dyhdrocodeine 60mg twice a day, 8 paracetamol a day and Oramorph. He is now wobbling about so much at home and when he goes to the loo, he walks with a zimmer frame plus a trolley or stool at the same time!. Me thinks he is due for a fall anytime soon. The hospital discharged him and don't want him back because it's "just backpain" (from fractured vertebrae and osteoperosis) .
It' s just taken him 5 minutes to walk the legnth of the kitchen with his bits. I think he will be in hospital again very soon the way he is going.

[susieq]

Henrietta has your Dad ever been referred to the local Pain Management Clinic ? Most hospitals have one, I think usually connected to the physio department. Your GP would be the one to refer him - they teach you how to manage and control long term chronic pain (they are especially good with back pain).

This link might be useful http://www.nhs.uk/Livewell/Pain/Pages/Longtermpain.aspx

Some hospitals also have a 'falls prevention' clinic, so it might be worthwhile finding out if there is one in your area.

[bowlingbun]

Is dad taking anything to stop his osteoporosis getting worse?

[Henrietta]

Hi Susie and Bowlingbun

Dad has been seen by the trips and falls team at Scial Services. He has had visits by OT, been into hospital for pain and seen several GPs regarding pain but no one has mentioned a pain clinic, although I think perhaps I have heard of one in this area.
Dad takes Colecalciferole D3 which I think is also calcium. He had a medication review last week. Were you thinking of anything else BB?
I've had a look at the link and think perhaps Dad is too "clapped out" for general clinic. He has kidney complications severely reducing the options for pain management and perhaps with so much in the equation, everyone prefers to leave decisions to Drs. If (or should that be next time ) I see another Dr I will ask about pain clinics.

[bowlingbun]

Yes, I've only got one kidney, advised not to take any Ibuprofen type medication as it is supposed to affect kidney function. Shame really, as it's so effective for arthritic pain. I had Oramorph after several major operations, it's great for dulling pain and helping you relax, but I think had I been able to walk at the time, I'd have wobbled too!

[Henrietta]

Yes me too - I had Oramorph after hysterectoy an dit made me sick after a while- very nauseous so I hope I only have to use it for Dad on the odd occasion. He seems to be shuffling around this morning - a bit dippier than usual but still functioning.

[susieq]

Is dad taking anything to stop his osteoporosis getting worse?

To my knowledge there is only one drug that can actually help - Fosamax (Alendronate). It's not a pain killer but works by building up bone density over a period of time; however if not taken exactly as prescribed (on an empty stomach, with a full glass of water and stay upright for 30 minutes after) it can have unpleasant side effects.

Mum was prescribed it soon after being diagnosed with osteoporosis in her upper spine and it certainly worked for her as subsequent bone scans showed her bone density had improved considerably; but the onset of dementia some years later meant that she didn't then remember to take it (it's a 'once a week' or 'once a month' drug). Because, by that time, her bone density had improved so much her GP stopped the Fosamax and replaced it with a calcium supplement (which she hated and refused to take anyway !).

[Henrietta]

Hi Susie

Thanks- no not heard of that one, Dad doesn't really do upright as he is severely stooped.

[susieq]

Hi Susie

Thanks- no not heard of that one, Dad doesn't really do upright as he is severely stooped.

Unfortunately when they get that stooped it's probably too late for Fosamax - Mum was lucky in that she was referred by her GP for an MRI scan straight away and from the results was then then referred to an orthopaedic consultant who specialised in osteoporosis. They concluded that Mum's osteoporosis was the result of an early hysterectomy (when she was 50) that was not followed by HRT. Her osteoporosis was diagnosed in her late 60's and her dementia was diagnosed in her early 80's - so she was taking the Fosamax for 10-12 years.

It is worth noting that if any female has an 'early' hysterectomy or an early menopause it is worth talking to your GP about having a bone scan and HRT as the HRT does provide protection against developing osteoporosis later in life. (Both my sister and I have regular bone scans - every 3-5 years - because Mum and at least one of her sisters had osteoporosis; so far we're both clear ).

[bowlingbun]

Bone density problems seem to be very unpredictable. The general perception is that people with light skeletons are more likely to get problems, but mum was big boned. I'm also big boned, had a scan recently, also had a hysterectomy at 33. Nevertheless, my bone density is almost off the scale at the top!! Until my knee ops I've always been active and hard working, digging the garden, DIY etc, and I like to think that helped, but then so did mum, and she ended up bent double. Recently, there is a lot of talk about people being Vitamin D deficient, apparently vital for good bones, and now I wonder if this was a major factor as far as mum was concerned. She had the most beautiful auburn hair (inherited by my eldest son) but she also had very pale skin which burned after only 10 minutes in the sun, so on hot sunny days she would stay indoors all day. This is slightly off topic, but anyone reading this should make sure their carees get some sunshine, and perhaps a Vit D supplement.