Pain killers that don’t cause confusion or dopeyness/loss of balance?

ElizabethAnn

Registered User
Jan 4, 2014
189
0
Northumberland
Mum (84, with AZ) is in quite a bit of pain with her extremely hunched back and coccyx (all pre dementia problems). We’ve got a coccyx wedge cushion which did seem to help a little originally and have tried a ring cushion (like a donut) that Mum didn't seem to be able to get on with. The only pain killers she was taking were 2 paracetamol, 4 times per day. Unfortunately these were no longer giving Mum any relief.

She seems unable to get comfortable either sitting or lying in bed, so she’s not been sleeping and wanders around for most of the day and night. When she does sit (for 5-10 minutes), she completely bends over with her chest on her knees (often on the loo), presumably because this is the position that gives her a little relief from the pain.

The District Nurse has checked her out thoroughly and can find no reason for the many loo visits (although we will be checking out “Vaginal Atrophy” (many thanks for that tip LadyA)).

The OTs can’t suggest anything else equipment wise to help Mum.

The GP has now prescribed 10mg Amitriptyline (which Mum has had previously, but it was stopped as it was thought it was adding to Mum’s confusion).

After about 11 days (perhaps we need to be more patient?) on Amitriptyline, the pain does seem to be less intense, but it seems to be making Mum quite dopey and a quite unsteady on her feet. She’s still wandering, especially at night, looking for things that she's lost. So now we’re worrying about her falling.

We’re expecting the GP to visit again this week.

Ideally, we’re looking for a pain killer that blocks her physical pain without making her confused, dopey or unsteady on her feet and one that will hopefully allow her to sleep a little better…

All our research so far suggests that we may as well be searching for the Holy Grail :eek:

Has anyone had any success with pain killers that don’t cause confusion or dopeyness/loss of balance?

Any advice or pointers would be gratefully received…

Many thanks Elizabeth.
 

marionq

Registered User
Apr 24, 2013
6,449
0
Scotland
To be honest there's a downside with them all. Cocodamol is strong but can cause constipation. Paracetamol is the least harmful but doesn't last long. I used to take codifen continuous which was prescribed for arthritis at the back of my neck and was very effective and slow released over a period. Eventually though the doc wanted me to stop taking it and so I did. Isn't there a pain clinic which specialises in these things?
 

ElizabethAnn

Registered User
Jan 4, 2014
189
0
Northumberland
To be honest there's a downside with them all. Cocodamol is strong but can cause constipation. Paracetamol is the least harmful but doesn't last long. I used to take codifen continuous which was prescribed for arthritis at the back of my neck and was very effective and slow released over a period. Eventually though the doc wanted me to stop taking it and so I did. Isn't there a pain clinic which specialises in these things?

hmmm.... pain clinic - sounds just what we need... I'll be mentioning that to the GP...

http://www.nhs.uk/Livewell/Pain/Pages/Longtermpain.aspx

Thanks for that idea Marionq :)

rgds, Elizabeth.
 

Sue J

Registered User
Dec 9, 2009
8,032
0
Hi ElizabethAnn

The only thing that helps my symptoms and doesn't make them worse is paracetamol and aspirin. Amytriptyline is contraindicated in dementia I believe. I hope you find something that helps.

Best wishes
Sue:)
 

ElizabethAnn

Registered User
Jan 4, 2014
189
0
Northumberland
Hi ElizabethAnn

The only thing that helps my symptoms and doesn't make them worse is paracetamol and aspirin. Amytriptyline is contraindicated in dementia I believe. I hope you find something that helps.

Best wishes
Sue:)

Thanks Sue - we're coming to that conclusion... I'll post back if we find something that works for Mum.... fingers crossed...

rgds, Elizabeth.
 

nitram

Registered User
Apr 6, 2011
30,318
0
Bury
"Amytriptyline is contraindicated in dementia I believe."

The SPC does not mention dementia, it does mention 'the elderly'.

4.4 Special warnings and precautions for use
The elderly are particularly liable to experience adverse reactions, especially agitation, confusion and postural hypotension
...
...


https://www.medicines.org.uk/emc/medicine/25740
 

ElizabethAnn

Registered User
Jan 4, 2014
189
0
Northumberland
"Amytriptyline is contraindicated in dementia I believe."

The SPC does not mention dementia, it does mention 'the elderly'.

4.4 Special warnings and precautions for use
The elderly are particularly liable to experience adverse reactions, especially agitation, confusion and postural hypotension
...
...


https://www.medicines.org.uk/emc/medicine/25740

Thanks Nitram. I guess the 'postural hypotension' could be why Mum's unsteady on her feet :(

Looks like we need to find something else...

rgds, Elizabeth.
 

nitram

Registered User
Apr 6, 2011
30,318
0
Bury
Postural hypotension is when somebody's blood pressure drops when they sit up or stand up quickly, they can feel dizzy, light headed or even faint.

Also known as orthostatic hypotension.
 

Cherryade

Registered User
Jul 27, 2015
53
0
Perhaps giving her the amitriptyline at night might help. A friend takes that at night along with 2 co-codamol to help pain. But the co-codamol might be too strong alongside. But it would certainly help her sleep.
 

ElizabethAnn

Registered User
Jan 4, 2014
189
0
Northumberland
Perhaps giving her the amitriptyline at night might help. A friend takes that at night along with 2 co-codamol to help pain. But the co-codamol might be too strong alongside. But it would certainly help her sleep.

Thanks for your thoughts Cherryade.

The current prescription is for 10mg of Amitriptyline, which Mum takes at night. But, although it seems to be helping with the pain, the side effects are giving us concern for Mum's saftey (from falls) :(

regards, Elizabeth.
 

cragmaid

Registered User
Oct 18, 2010
7,936
0
North East England
I've taken Amytriptyline for many years, I take it for pain relief at night along with Dihyrocodeine and Paracetamol, but I actually take only a half dose,( being half of a 10mg tablet), because I find that I have trouble with the full dose, often struggling with waking in the morning and can remain dopey for a while.
I take mine at bedtime and the effect seems twofold, the combination gets me off to sleep quickly as a rule however I do tend to wake a couple or so times during the night and then the Amytripyline seems to kick in properly before I get up and can doze on long past the alarm.
It may be more beneficial to take the dose earlier than bedtime , but only if Mum can be supervised until she settles to sleep.

It is also possible that Mum is feeling Dementia Pain rather than actual pain... it hurts in her mind and her memory just as badly as real pain. I am also wondering, could Mum be suffering from constipation?

I would ask to have her meds reviewed, ask about pain relief patches too and I would ask if they could put a crash mat by her bed. ( I am assuming, perhaps incorrectly that Mum is in a CH. )
 
Last edited:

ElizabethAnn

Registered User
Jan 4, 2014
189
0
Northumberland
I've taken Amytriptyline for many years, I take it for pain relief at night along with Dihyrocodeine and Paracetamol, but I actually take only a half dose,( being half of a 10mg tablet), because I find that I have trouble with the full dose, often struggling with waking in the morning and can remain dopey for a while.
I take mine at bedtime and the effect seems twofold, the combination gets me off to sleep quickly as a rule however I do tend to wake a couple or so times during the night and then the Amytripyline seems to kick in properly before I get up and can doze on long past the alarm.
It may be more beneficial to take the dose earlier than bedtime , but only if Mum can be supervised until she settles to sleep.

It is also possible that Mum is feeling Dementia Pain rather than actual pain... it hurts in her mind and her memory just as badly as real pain. I am also wondering, could Mum be suffering from constipation?

I would ask to have her meds reviewed, ask about pain relief patches too and I would ask if they could put a crash mat by her bed. ( I am assuming, perhaps incorrectly that Mum is in a CH. )

Many thanks for you thoughts Cragmaid.

Amitritptyline does seem to be very popular... several other family members take it for a variety of reasons (foot pain; migraine; other aches and pains)

Taking the medication earlier is something we could consider - Mum has a 24 hour live-in carer, so there is constant supervision.

I'd have said Mum has felt "dementia pain" in the past, which she could eventually be distracted from. But recently, we feel that we can see real pain in her eyes - and no amount of distraction seems to work :( and of course there is probably "dementia pain" on top of it :(

Only today I checked on constipation and was assured that this is not the case. I didn't press for much more detail :eek:

I thing asking for a medication review, and enquiring about pain relief patches are definitely questions we'll ask the Dr.

Hadn't thought about a crash mat by her bed - we'll look into that too.

Many thanks for the very useful tips :)

rgds, Elizabeth.
 

tryingmybest

Registered User
May 22, 2015
638
0
My Mum also has terrible coccyc pain but for the last few months has been on Meptid. She is no longer in pain, walks a lot more upright and sleeps better (although now we have other problems with not eating or drinking properly but unrelated to pain meds). It took me nearly 2 years to get the gp to prescribe something different during which time Mum was in agony and bent over double. I purchased every cushion and device under the sun to try and help! In the end it was a check up at the older people's clinic that prompted them to suggest this to the gp and the difference has been amazing so please do enquire about this. Good luck xx
 

ElizabethAnn

Registered User
Jan 4, 2014
189
0
Northumberland
My Mum also has terrible coccyc pain but for the last few months has been on Meptid. She is no longer in pain, walks a lot more upright and sleeps better (although now we have other problems with not eating or drinking properly but unrelated to pain meds). It took me nearly 2 years to get the gp to prescribe something different during which time Mum was in agony and bent over double. I purchased every cushion and device under the sun to try and help! In the end it was a check up at the older people's clinic that prompted them to suggest this to the gp and the difference has been amazing so please do enquire about this. Good luck xx

Many, many thanks tryingmybest - your Mum's pain situation sounds so very similar to Mum's.

So sorry to hear that your Mum is having eating and drinking problems now - hope this improves a little soon - so worrying :(

We'll definitely mention MEPTID to the GP - fingers crossed...

regards, Elizabeth.
 
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LadyA

Registered User
Oct 19, 2009
13,730
0
Ireland
Sounds like it's osteoporsis pain? My mum has severe osteoporosis and arthiritis in her spine. She's on so much medication (for her heart) that she just uses paracetomol and ibuprofen gel for her back - she finds the gel quite good. I was on amytriptyline as a migraine preventative many years ago, but I had to come off it - I found also it made me very sluggish and (although it's an anti-depressant), it made me quite depressed.
 

ElizabethAnn

Registered User
Jan 4, 2014
189
0
Northumberland
Sounds like it's osteoporsis pain? My mum has severe osteoporosis and arthiritis in her spine. She's on so much medication (for her heart) that she just uses paracetomol and ibuprofen gel for her back - she finds the gel quite good. I was on amytriptyline as a migraine preventative many years ago, but I had to come off it - I found also it made me very sluggish and (although it's an anti-depressant), it made me quite depressed.

Many thanks for this LadyA - I think you're right about osteoporosis & arthritis - Mum definitely has quite a severe case of kyphosis (extremely hunched/bent back).

Mum too is on lots of medication (including for her heart) :(

Hadn't thought of ibuprofen gel :eek: definitely worth trying...

Many thanks for the tip.

Regards, Elizabeth.
 

la lucia

Registered User
Jul 3, 2011
592
0
My mum is 96 and when she had pain problems last year she was given a weekly morphine patch.

She already had mobility and balance problems but although morphine sounds 'heavy duty' it actually had no impact on her balance. I think the dosage of the patches was quite low but they helped her a lot with the same lower back / osteoporosis / coccyx pain.
 

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