canklecat

Thanks for the feedback, that helps me see your perspective too. I think if you'd said "advocate" rather than defensive I'd have reacted differently. But the intent would be the same, despite the words. I have strong opinions on the topic because before my own recent bout with with pain I was the primary caregiver for three consecutive older family members since the early 1990s. Before then in the 1970s-early '80s I worked in health care (mostly dialysis, some operating room and other patient care experiences). I have a lot of experience with patients who are experiencing legitimate pain.

And, over the past decade being around a lot of older and disabled folks I've seen some situations that could be considered misuse of prescription pain meds and recreational drugs and drinking. Even at this relatively later stage in life (I'm 60 now) I was surprised to see how little some people change with age. If folks were scamps, rascals, ruffians, ne'er-do-wells, druggies and drunks when they were younger, they probably won't improve with age. They only get a little slower, need less to get wasted, and their drunken/drugged threats can usually be safely ignored. And I realize our local public hospital, where I'm also a patient, is chock full of these folks.

But I've also learned to not jump to assumptions and conclusions about the pain levels other folks claim to be suffering.

For 11 years I was my mom's caregiver. I took over that role unexpectedly and somewhat reluctantly. I had just finished a 15 year stint as caregiver for my grandparents, who died 10 years apart. They weren't terribly difficult patients, and were fortunate to have a modest but reliable retirement income and very good insurance, so all their basic needs were met. Grandmother used small amounts of hydrocodone for years and it helped. She remained remarkably independent and was active around her home and garden until age 89. My granddad used hydrocodone less often and mostly preferred old school remedies from his youth -- stuff like BC powders, Doan's pills, anything that was familiar from years ago. I know he was in pain but he preferred to be grumpy than to be drugged.

So I could continue working full time, while aides and housekeepers visited for a couple of hours a day. But after helping settle their estate sale I was ready to move on to something completely different. Anything other than health care.

But my mom's case was completely different and far more demanding. Besides disabling physical issues she was also in the early stages of dementia, which gradually worsened over the decade. She had a lot of chronic pain, but wasn't a good candidate for much physical therapy or exercise. The best she could do was putter around home, use her walker to get the mail and visit neighbors, that sort of thing.

And she was a recovering alcoholic, who quit around 1988 and never had a relapse. Because of her sobriety she was reluctant to use any opiates, so for awhile she declined refills of Tramadol back when doctors had the discretion to refill those routinely without government nannies interfering with medical professionals. But after two knee replacement and one shoulder replacement surgery, and worsening problems with lifelong scoliosis and lordosis, she was in chronic pain. But she rarely used the full prescribed dose of 3 Tramadol a day and often went 45-60 days between refill requests for a 30 day supply. In particular her best neurologist encouraged her to make good use of the pain relievers to ease the pain so she could get up and move around during the day. That particular neurologist was very good about reminding her that the purpose of prescription pain meds was to enable patients to function more normally, not to just sit around in a drugged stupor all day. Mom was pretty good about heeding that advice.

So her doctor knew she was a safe bet and low risk patient, despite her history of alcoholism. And while mom reacted strongly to anesthesia and morphine in the hospital (hallucinations and disorientation lasting for weeks), she never experienced any side effects from the small amounts of Tramadol she used. It seemed to meet all of the claims from the European studies I'd read years ago.

For awhile she had visiting home health aides and nurses, but lost the Medicaid funding for those a few years ago. Frankly I wasn't sorry to see them go. Some of them were grossly incompetent or lazy -- there are no licensing standards or experience requirements for unskilled aides in Texas. The nurses filled mom's daily prescription reminder box, but some of them got it very wrong and I had to check and redo it anyway. Some of the aides tried to get into mom's meds, so I had to hide or lock the meds away.

In December her femur broke spontaneously while she was walking in the kitchen. Fortunately she wasn't further injured in the fall. I palpated the area and thought the titanium knee joint had come apart. Mom thought the femur itself had broken above the knee. Turns out she was right. She was surprisingly calm after the initial shock and was pretty calm and quiet after a couple of minutes while we waited for the ambulance. They gave her fentanyl for pain, which is a wonder drug for severe pain when administered correctly by professionals. It worked very quickly, lasted only 20-30 minutes and mom wasn't confused, disoriented or hallucinating as she had done under morphine and other anesthetics.

That experienced relieved my doubts about whether my mom occasionally exaggerated her pain level descriptions. During doctor's visits she'd describe her pain level as 7-8 and I thought "Nah, it can't be that bad," but I didn't say anything. Turns out she had a pretty high tolerance for pain so when she complained it meant she was in serious discomfort. When I saw how bad the femur break was, yet she had cried for only a minute or two, I realized she was much tougher than I'd given her credit for. The paramedics said the same thing -- they see patients in severe pain who don't admit it.

But after the femur repair surgery mom's dementia worsened badly and she never really recovered. She's been in a nursing home all year and probably won't be able to live at home again.

I didn't expect to have my own first-hand experience with being a "geriatric" patient with chronic pain, but life doesn't care about our plans. I was hit by a car in May and that changed everything. I have a little different perspective on the issue now.

At the ER the staff said the shoulder break and dislocation were pretty bad and offered morphine. I laughed and said, nah, just a Tramadol or hydrocodone will be enough. I might be in more pain in a day or so when the swelling and inflammation kicked in. But for that moment the pain wasn't too bad. They gave me one pill but said the morphine was available that night if I needed it.

The only other times I've had any prescription pain meds, I used them very little. After a couple of dental surgeries I used hydrocodone for only two or three days, and returned to work the next day. I finally threw out the unused pills a year or two later. When my back and neck were broken in 2001 I had a month's supply of oxycontin. That lasted me for 10 years. I took it very rarely and didn't like the sensation -- it was an effective pain reliever but made my skin crawl and itch.

Anyway, there should be ways for medical professionals to evaluate patients individually for pain management, and up until around 2015 they were still able to -- although they rarely actually did a full patient profile to do risk assessment, usage patterns (days, times, circumstances when pain meds were needed, to help identify effective treatment, etc.).

Now my disabled neighbors who have histories of substance abuse get no meds for legitimate pain. I understand the reluctance of medical professionals to risk their licenses and certifications over high risk patients. But the current approach doesn't solve any problems. It only shifts the burden. I've seen some neighbors who had been sober return to drinking heavily again to cope with pain. This creates a burden for other neighbors who don't cause problems. Some of them hang out in the parking lots of nearby convenience stores and gas stations hoping to score something to ease the pain. It's a sad sight, seeing people in their 70s and older begging for dope. I don't know what the solution is for that.

I've tried anything I could find that's legal. Luckily the kratom I mentioned in another lengthy post helps. I can function, do housework and laundry, do my physical therapy, etc. I use it only a couple of times a week when the pain is pretty bad. I don't ride my bike outside on those days, but do use my indoor trainer. Exercise boosts my natural body chemistry's pain relievers and often the best I feel is the 2-4 hours after exercising and riding my bike. Unfortunately it's short-lived. The body doesn't know or care where the pain relief comes from, whether exercise induced or externally administered.

Frankly it's an inferior solution. But it's the best we have for now.