At 86 why wouldn’t you take painkillers?

[genandtonic]

My mother-in-law is in a care home six hours away. She refuses to move to a care home up here, for various weird and illogical reasons.she’s deemed to have capacity.

She’s in terrible pain every day with rheumatoid arthritis , can’t hold a phone for long, won’t wear hearing aids, won’t take any medicine with a consequence that she is bedbound, in pain all day every day and has awful spasms from lack of movement.She occasionally takes paracetamol but won’t take painkillers because tge side-effects might affect her 😳 and because one of the carers is on painkillers and they didn’t work for her.

She’s calling us all several times a day crying and sobbing in pain and can’t hold the phone obviously it’s really distressing for us all. She can also be really nasty.

Any tips on how to make her see sense or how to stop this nonsense much appreciated!

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

@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

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?

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.

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?

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 !

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 .

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 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.

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.

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!

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.

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.

Ask for the care home to arrange a visit from her GP to discuss pain relief. They may suggest alternatives that she hasn't tried. If this was happening with my dM, I would have a chat with the nurses in charge and explain how distressing you are finding these phone calls, I know they would be trying to find a solution.

Tough love. What does she expect from you if she won’t help herself? Sympathy fatigue is real.

That's all fine, but if you make that choice not to have pain medication, you shouldn't then phone people up several times a day to tell them how much pain you are in.....

Agree @P00hsticks

When I or rather my husband got utterly fed up of my mother not taking on board any suggestions I made to improve her life, one of my siblings told me I was the problem as I was constantly looking for solutions. Well sorry but if you are ringing me with problems and moans then yes of course I will put forward ideas to improve things. He also went on to tell me just to put my phone down somewhere and let her ramble on whilst getting on with other jobs….so essentially ignore her.

Everyone saying about side effects, tbh when you're in that much pain you need to remember the benefits outweigh the potential side effects.
Also issues like constipation are easily remedied and it's hardly worth worrying about addiction when you're in your 80s.

OP I think I'd be giving her some tough love. Tell her to stop being a martyr, either take medication to help or stop complaining about it, there are no other options really.

With my mum, her 'logic' was if you are ill, you take a tablet. So if you don't take the tablet, then you can't be ill!!

We got round it by finding a mantra to repeat gently (for her it was "the doctor says . . . " cause she trusted doctors) We also found using the word 'lovely' helped - let the lovely nurse give you some medicine. It will help. Just repeat and infinitum and hope that it sinks in.

Yes this is my Stepdad and my mum to a degree but he is worse, his dc make Drs appointments for him

My dad broke his back in 1975. He wouldn't touch anything other than 2 paracetamol maximum of once a day. He just adapted himself and took himself to bed whenever the pain got too bad. But, that essentially meant he opted out of large chunks of life. He died at the end of September, still refusing to accept anything at all, by which point he had fibrotic lung disease, prostate cancer, heart failure, an indwelling catheter that blocked constantly and had fractured his hip which resulted in post operative delirium. His world was VERY small (he was 88) yet that's how he decided he wanted to live. He wasn't a social person, wanted to keep all of his money to himself and was married to my mum for 64 years (we still haven't worked out how!) It's their decision to make. Turn your phone off. The home will call you if there's any cause for concern.

I can see why she doesn’t want to move closer to you.

As someone who has RA, it’s not as straightforward as taking some painkillers and everything is ok. They have lots of side effects that are just as unpleasant and they often just dull the pain a bit but the pay off isn’t always worth it.

Your MIL has capacity and hopefully she keeps it throughout so she can control the medication that works best for her.

She can also be really nasty

Many narcissists or covert narcissists refuse to take painkillers because they enjoy using their own suffering for attention or to manipulate those who care about them. Sometimes it goes on for so many decades that they're not even consciously aware of it. But it boils down to getting a narcissistic supply from making other people feel they are responsible for your pain/illness and being able to have full control over the "mood" of the family. As long as you have some sort of physical affliction, you can use that to control the attention from those around you.

Covert narc mum did that for decades. Every illness was a huge drama and it seems the only thing that made her feel better was guilt-tripping other people around her about why they didn't do more to prevent her discomfort, instead of just taking medicine and getting on with it. She would deliberately go outside without a coat in winter, come down with something and then moan and moan about how cold it was when she went outside. Nobody forced her to go outside but she bizarrely made it feel like they were at fault.

It's so hard to get the balance, isn't it? She might be looking for sympathy, but she might genuinely be struggling with the side effects of the medication. For us constipation may be a mild inconvenience. For someone in pain already it can be genuinely frightening.

Looking at your op again, I would not assume that this is 'nonsense'. But equally, there is nothing that you can do for her. End of life is inelegant, unpleasant and difficult. You can't be there to hold her hand because of where she's chosen to be. Just try not to get annoyed. Keep reassuring her and repeating that the lovely nurse will help. She might not be lovely, and she might not help, but you are giving her hope and the possibility of trusting others, who might help.