At 86 why wouldn’t you take painkillers?

My mother is an ex pharmacist - she very rarely will take painkillers- the side effects can be nasty as described above. But it does sound as though your MIL needs something to help this intense pain.

I agree with @johnyromt that often it is about control, and I mean that kindly. Their worlds become so small and over time they have been medicated to ‘try this’ etc etc they possibly just want to be able to control some part of their life.

My father is in a nursing facility where he is incredibly well cared for but his natural response to the HCPs suggesting say having a biscuit from the tin, watching the TV when the sport is on he likes is almost a knee jerk grumpy NO every time. Reluctantly followed by a ‘oh I will have that biscuit’ minutes later.

I think many of us on the EP threads are so exhausted we perhaps don’t understand that having lost control over their lives is frightening. My parents made terrible life choices totally burying their heads in the sand but living it up travelling etc and partying a lot whilst mocking their peers, and me for being boring and sensible in getting things in place such as suitable home alterations or organising life admin. I can see from both of mine that often the nastiness and bad temper stems from regrets at some of the decisions they made and also didn’t make-they have both told me this many times but still expect us to pick up the pieces.

She should be on biological injections if she’s that bad! Anti inflammatories are also what she needs not painkillers!!
Don’t let her read the potential side effects though and tell the carers to stop telling her shit about their medication as that’s not helpful!!! Point out to her she’s 86 she’s survived this long what could potentially happen isn’t worse than the pain she’s in. If she calls you crying etc just say to her if she’s not going to take the medication she’s prescribed what does she expect you to do about it?!?! And no sympathy just put the phone down imo as she’s just wanting attention. If she doesn’t get it she may just take her pill!

DM wouldn't take painkillers (at first) with several broken bones as she was worried about addiction and side effects.
You can't make her do anything, but you can decide to take fewer calls or change the subject when you do speak. I know that might seem harsh, but it's not achieving anything.

If she's had liver or kidney problems (even a uti) then she's going to be worried about paracetamol.
If she has stomach issues then she's going to be worried about ibuprofen.
Tramodol can cause serious vomiting and migraines.
Codeine can cause awful constipation where being impacted is a serious concern.
What's left?

Also honestly nine really touch the sides with an auto immune condition. She might need to trial biologics which is something the Rheumatologist will be involved with. Perhaps offer to go to her next appointment. If she doesn't have one then push the GP for a referral. She must be in agony

Edit - She can also be really nasty.
Being in such pain, for years, can make you this way especially with people who flippantly think taking a paracetamol will take away autoimmune pain.

Well cocodamol causes horrible constipation, tramadol can space you out, NSAIDs can cause upper GI bleeding and stomach issues and chronic paracetamol is bad for your liver. So nobody is being silly by not taking these painkillers if these side effects would bother them or affect their life more than the pain.

People are allowed to be in pain. Thinking people shouldn’t ever feel pain is how the opioid crisis set in in the US. Doctors started out overprescribing painkillers for small issues and people got addicted. Elderly people have choices, you shouldn’t nanny people and push them into your way of thinking, or if you do, beware when you are that age and people are insisting they know better than you about your own life.

If swallowing is an issue I recommend dissolvable paracetamol - first bought some in Sweden when I had chronic tooth issues . and dissolve into water - I realise it’s still ‘swallowing’ but with some people drinking is ok but they struggle to swallow tablets. I also find they seem to get into your system quicker .

My step dad is mid 70s has a pain condition associated with his medical condition, he takes a paracetamol once in a blue moon ! I don't know why they want to suffer it is really strange, my sd excuse is he is on enough tablets !

There's a feeling sometimes with the elderly that just 'toughing it out' is the best way to go and taking tablets shows a weakness. I must admit that I myself (60's) think that if I can get through something without painkillers, then that's better for me in the long run. I had 3 babies without pain relief.

Alternatively, she may have difficulty swallowing. My sister recently died from cancer and had terrible problems swallowing at the end. They gave her an IV and gave painkillers that way, but even inserting the IV (into hands/arms/feet) became extremely painful. It was awful to watch.

Can you find someone (ideally with RA) for whom taking painkillers has caused a significant improvement - she might pay attention then?

It isn’t a generational thing. Many people don’t like to take painkillers.

Unfortunately your MIL can choose as she has capacity. Try not answering the phone. We did that with my MIL when it became increasingly difficult. Mostly we answered but sometimes we didn’t. It gave us a break.

Have you explained to her that new meds aren't set in stone? Like she could trial one, then if she has intolerable side effects, she can stop it if she really wants to.
Also has she even asked the doctor about pain relief? If she explains she doesn't want side effects, there could be some that are generally better tolerated than others.
There's also other meds for RA that aren't "pain relief". Not sure if that would make a difference to her mindset?

@genandtonic sadly being deemed to have capacity she can make her own decisions. Even bad ones. Join us over on Cockroach cafe for a good vent.
www.mumsnet.com/talk/elderly_parents/5474948-cockroach-cafe-spring-in-autumn

It’s a generational thing. My parents are just the same…