Elderly mum in severe pain, told to lose weight

[TSSM]

She is in her 80s and is very overweight which we all realise isn't helping. She has severe osteoarthritis in her knees and possibly elsewhere, she can barely walk. She lives with pain every day and is on a range of pain meds including a morphine patch. For some reason though she has had a major escalation of daily pain levels recently and so we spoke to her GP about the amount of pain she is currently living with (despite the meds.) His best suggestion is that she lose weight. That's fine as a longer term way of dealing with it, but when I spoke to her on the phone earlier she was almost gasping at the severity of today's pain (and she is REALLY stoic and not one to complain.) She hasn't slept for more than a couple of hours for days now, she's in too much pain. Does anyone have any similar experiences and would be happy to share how it was dealt with? I can't beleive there isn't anything available that might help. (She also takes co-dydramol and paracetamol.)

When was the last time she was actually seen and examined by her GP?

She was seen last Friday. GP did a brief check over and listened to her heart but wasn't so helpful about the pain issue.

Amitryptilline can be good for pain and sleep

At a certain point they just can't give you any more pain relief. If she's on co-dydramol and paracetamol and morphine she's probably out of options. Upping the dosages or adding more prescriptions could seriously damage her, especially if she's already got a dodgy heart. What weight loss strategies is she currently employing?

If she's been examined and the pain isn't new in origin but an exaccerbation of existing pain, maybe a pain team can help? it could be neuropathic pain due to pressure on nerves in her back, so she needs something additional, as those drugs she is on don't deal with neuropathic pain. Waste of time telling her she needs to lose weight as she would have done so long before now if she could.

Ah sorry!! He did give her amitryptyline as a new addition to her mix...but no joy with that as yet. Does it take time to kick in?

@cottagegardenflower yep; she's 86...been a disordered eater all her life

It’s horrible but true that losing weight WILL make a huge difference. Would you make her carry a rucksack full or a large toddler? No because it would be agony for her. She needs to put the weight she’s carrying down and every tiny bit will help. A hot bath helps too. Not fixes but it all helps.

@MolliciousIntent She is basically now starving herself, totally unsustainable. She was told at the GP appt that shes put on 20kg in the last 18 months 😨She will starve for a bit then give up and then pile it on again

Who does her shopping? Would she accept meals planned in advance no other food in the house except healthy snacks?

Where is the pain OP? Has she had physio input recently? If it’s knee pain and surgery is not appropriate then she could explore knee bracing (again she may not fit criteria but worth asking) and/or a referral to the Pain Management team. They are a great group of professionals (Physio, OT, psychology, nurses) who help people cope and live well with pain if there is no active ‘treatment’. She needs support, guidance and understanding. Hope things get better for you all soon.

Poor woman. My mum had a lot of pain and was told it was a UTI. Turned out it was diverticulitis she was in agony. Older people's complaints about pain arent always investigated. Perhaps another Dr appointment and you can go along and help advocate for her (or did you already try that)?

A TENs machine might help, has she seen a community physio and occupational therapist to see if rhey can suggest any equipment that might help her feel more comfortable . Also speak to the arthritis society, they have great information..

@Isaidnoalready She orders online, lives alone, so eats what she wants 🙁We had some minor success with buying in a food plan/delivered meals but she is sooo fussy about what she'll it it just didnt work
@MercurysMeteor Her knees are the worst (no knee cap left, basically) but she has phases like now when everything hurts - back, shoulders, neck, sciatica type pain down her leg. Never seen a physio, tho we have tried leg braces

@WhatsInAMolatovMocktail She gets diverticulitis from time to time as well, her quality of life is grim
@BlanketsBanned She has a tens machine...we have tried evverything to keep her comfortable but we seem to have basically run out of options of things that actually help. But no, never had an occp therapist etc. Might well be worth an ask.

If it is mainly her knees has she tried a joint injection ? Not helpful if widespread pain though .

20 kg in 18 months seems a lot. Has her eating habits really changed that much in that time? Where is the excess weight?

20kg in 18 months? Fucking hell, that's a lot of weight to gain in such a short space of time. That's the weight of the average 5-year-old child! I can see why the GP thinks weight loss is really important.

Just two thoughts on the morphine:

1. Has the dose been increased to take into account her higher weight?
2. The body adjusts to morphine over time and people tend to need higher doses to achieve the same level of pain relief.

Have you discussed either/both of those things with the doctor? Also, what support is she receiving to help her manage her weight?

If she is in pain, not moving around much, comfort eating then no wonder she has put on weight, diverticulitis is pretty miserable too. She might find a riser recliner chair, a knee rest and walking trolley helpful. I agree she needs her morphine patch eeciewed, is it butrans. Is she safe taking codydramol and paracetomol, is she aware of the paracetamol risks.

Amitriptyline takes a while to kick in but it is very good when it does, or I found it so. It can also be increased if it isn’t helping. They normally start on a low dose.

With that level of disability and at the age of 80, her GP should really be actively supporting any weight loss. Its absolutely no good telling her to go away and lose weight when she's so debilitated with pain. GPs do help with programmes for those with osteoarthritis to lose weight.

I'm actually cross on your behalf about this.

Go back to her gp and demand a supported weight loss programme. This can include personal training, dietician advice, membership to Slimming World, strength training etc etc And that's at the standard end of the scale, for a geriatric lady with immense pain I'd expect 121 help from her GP.

Once you've done that, I'd also look at getting her seen by a physio (could be done on nhs) for exercises to strengthen and support her joints which will help with arthritic pain. If not a physio, then a good qualified pilates instructor - probably have to be paid for cos I don't think they work on nhs, but worth their weight in gold.

Agree that's about 4lbs a month continously! How does she do her shopping/cooking?

Thanks for the replies, i'll answer a few questions:
@FelicityBennett Yes she has been having the steriod injection for a few years, but it's not helping any more (not convinced it ever did.)
@Musicalmaestro It is a lot. It goes on everywhere but a bit more on tummy
@zafferana I know, its scary. Really good point about her higher weight and the efficacy of the patch. But yes, GP is concerned about her having more opiods.
@Basilbrushgotfat I did ask him about weightloss support but he dismissed it as unneccessary because shes ' clearly an intelligent woman who knows what she should and shoudn't eat.' Um, really? If it was as ismpel as that she wouldnt have been obese for the last 40 years. Thank you for your reply basil, it validates my feeling that she's being brushed off.
Thanks for other replies too, everyone had something useful to say, which doesnt happen on every MN post lets face it!!😂

Yw, I really hope you get somewhere - maybe see a different gp if you can?

I also wonder about the toll the pain is taking on her mental health. Must be a serious one. She might be consuming more food in quantity and also calorie dense food because its the only way she has of coping, in which case active close support from her gp is even more necessary.

Plus, with such weight gain I'd have though they'd run blood tests to check it's not thyroid related or anything else?

It maybe worth speaking the a pharmacist to ensure she's getting the most from the pain relief ie timings. She may also benefit from additional vitamins to her diet including b12, vit d, iron and omega 3... Steroid injections would only thin the bones further. There are also studies that show increase in exercise and meditation can help manage pain.