Your tips for more pain meds from doc

[Groomofthestool]

Hi all

DM 75 has MS. Newly in a care home. DF recently passed. They used to get by as he would give her over the counter pain meds on demand.

Now she is in a care home they wont give her ibuprofen. Repeated doc visits and they only insist she takes codeine, paracetamol. She refuses codeine. She forgets about pain when talking to doc and doesn't push it. We've been going round and round in circles for months.

I am finally here from Canada, seeing the doc in morn. What can I say to get them to ramp it up?! I have done video calls with doc but keep getting fobbed off. Anyone articulate out there? She is in too much pain to get out of bed so she sleeps all day and can't sleep at night. She's miserable. I want a morphine patch or something.

[Tornado70]

I would request a trial with bunov patch. They can work so effectively, with less side effects than a lot of oral medication.
Just be politely insistent! If the doctor won’t agree then say you want a different GP to review.
I do hope it goes well.

[PermanentTemporary]

List the problems and ask how they can be addressed. Keep saying 'and are there any other options?' And remember you have the right to ask for a second opinion.

[LivStanshall]

They may not want to prescribe ibuprofen because it can cause stomach ulcers and kidney problems in the elderly but it is worth asking them specifically why they won’t.

Why is she refusing codeine do you know? Patches are a good idea but they need to prescribe something for constipation if they are giving her opiates.

[NepheliLoux]

I wouldn’t advise opiates. https://painkillersdontexist.com/

If she has MS her pain may be neuropathic in nature and she might find something like Pregabalin beneficial

[QueenOfHiraeth]

Anti-inflammatories are not recommended for use in the elderly as the side effects can be more serious with age and co-morbidities so they are, usually, only used in short courses if at all.
Prescribing opiates is usually done in a stepwise fashion so start with codeine then review dose and drug upwards as needed Do you know why she refuses codeine? If it is side effects there may be the same, or even more, issues with others including patches and other drugs may be more appropriate.
The GP may have valid reasons for their approach and more knowledge of her clinical conditions so you may be better to approach this as information provision and shared decision making rather than requesting controlled drugs straight off.

[saraclara]

My mum is refusing Codeine as well. With good reason as last time she was given it, she got so constipated that she had an anal fissure so bad that it needed treatment. Given that she's bedbound, the risk is even greater, as she's not moving. Hopefully the doctor will move on to tramadol, and if that doesn't work, morphine. Again, intense nerve pain, due to stroke.

[Thewolvesarerunningagain]

I would suggest asking for a referral to the pain unit (specialist unit usually attached to a local hospital). But their waiting lists tend to run long

[Greybeardy]

Pain can be incredibly difficult to manage in older folk generally, and especially when they’re very disabled. NSAIDs do often do more harm than good and they’re quite right to be reluctant. Unfortunately the same can be true with opioid pain killers - they will need to be very careful titrating up if they do prescribe them. The next best step depends on what’s causing the pain (neuropathy/arthritis/something completely different) and no one here can assess that and there may not be a ‘quick’ fix for the problem. Reading between the lines a bit it may be that non-pharmacological pain management (physio etc) may also help. Good luck.

[Rainraingoawaycomebackanotherday]

There are other pain killers available. My DM takes gabapentin for her MS related pain.