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.)

How much co-dydramol and paracetamol is she taking a day? Co-dydramol has paracetamol in it and she shouldn’t take both together.

There are other options than morphine for pain relief. Opiates can also cause increased sensitivity to pain so even if it stays the same, the person feels like it's gotten worse.

My mum is a bit younger but sounds similar - she has fentyl patches and is on an injection to help manage her weight (Victoza). She also had an ice machine for her joints that really helped. Swimming/time in a pool may also offer her some relief.

Imo a sudden, severe increase in pain without a known cause (like a fall) needs to be checked out.

@Basilbrushgotfat She is already diagnosed with an underactive thyroid, and to be fair gp has just booked her blood tests. Interesting point. I wonder if it has worsened and not got picked up over lockdown (when everything went to pot at her gp surgery.)

@Changingmynameyetagain I am fairly sure she doesnt take painkillers safely when she is desperate. However, yes, she is aware she shouldn't mix codrydamol and paracetamol.

Make another appointment and be very clear with the that the nature of the pain has changed and that you would like them to reassure you that they have ruled out any other underlying causes of widespread pain. Its unlikely but there may be something new going on causing this widespread pain and that's the first thing to think about.

Then ask for a referral to the pain management team. If your mum has been on morphine patches for a while at a decent dose they can start to have a paradoxical effect and increase pain. The pain management team will be able to advise whether or not its worth slowly reducing the morphine to see if it actually improves the pain. You would need medical supervision to do this safely.

Long-term pain is tricky to manage and it's rare that it can be completely controlled with medication. Other things like physio, changes around the house and pacing activities can be really helpful, again the pain management team can advise here. Or if your local physio service offers something like the hip and knee ESCAPE pain course that can be a really good introduction to coping with arthritis.

Potentially controversial opinion here but I think the weightloss has been overemphasised. Its really hard for GPs to make suggestions re:managing long term pain and losing weight is something that is likely to have health benefits (and if I'm being cynical- keep you away from the GP for a few months or longer!). However, there is not strong evidence to support weighloss as making a huge difference to knee pain. The best evidence is for strengthening exercise.

Amitriptyline can be an excellent painkiller for neuropathic pain, but it does take a while to work. You have to take it consistently, not just when the pain is bad, and for maybe a couple of weeks before it has much effect. Also, they start you on a tiny dose but that can be increased if it's not working.

It should certainly help with sleep once the dose is right.

However, a lot of people find they put on weight with amitriptyline. I've been on it for 10 years and it's great for pain, but I've put on several stone in weight and it's slow-going and hard work to lose it again.

i have joint pain in my knees. I use cold packs on my knees when I go to bed. It’s mainly so that I get to sleep without more painkillers.

Just wondered if it might give a little relief and it’s something she can do in the short term while something is being sorted out.

@sleepymum50 Thanks for the suggestion, sadly she does already use icepacks. And heat pads. And CBD oil. And supplements. And everything really.Thats the problem, I cannot think of anything left to try.

Hi @TSSM I'm sorry your mum is suffering. Her GP is letting her down. My own mum has severe chronic pain from arthritis too and IBS and an irritable bladder to boot. She is on a morphine patch, has paracetamol, buscopan, amitriptyline, ibuprofen gel (she can't take it orally) and has oramorph for breakthrough pain. She's a few years younger then your mum. She is seeing a private physio who has been fantastic and has done home visits. Mum struggles to walk due to the pain but is doing great with her exercises. At home she has a two tiered trolley on wheels for transporting meals and drinks from the kitchen to dining room:/living room/bedroom. A perching stool for the kitchen, a bath shelf for sitting on to have a shower, and her newest addition is a four wheeled walker so we can get her out and about safely. The GP has been great with her although some of them at the practice didn't want to increase the patch dose. The one who has chronic pain himself did. Finding a GP that understands is so vital and I highly recommend seeing a private physio. The initial visit was £70 I think but follow ups are £50. Hot water bottles are a great help too. Supportive cushions/pillows to improve posture when sitting or in bed. I hope your mum finds some relief soon. Chronic pain is so debilitating. I don't think at 86 that significant weight loss is realistic when the pain prevents exercise. for you both.

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Are brilliant and much more effective than ice packs.

Why dont you try her on a whole foods plant based diet? She can eat as much as she wants - but only WHOLE foods....fruits, veggies, beans, brown rice and potatoes. This diet I found hard to keep weight on, so I could not stay on it long term. But it also helps reduce inflamation and pain. it reverses heart disease, diabetes etc as well. However, if she goes on the diet, she needs to be monitored by doctor as well if she is on pills for heart, diabetes or BP bc the diet makes your body (at least for many) not need the pills anymore. So doctor needs to reduce and adjust medication accordingly.

I don't know if she's too old but has knee replacement surgery been considered? I know someone who had both knees replaced age about 70 and she basically got her life back and is still going strong 20 years later. She was also very overweight long term and in a lot of pain prior to this.

@SamPoodle123 Thanks, but she just won't eat wholemeal. She is a fussy disordered eater. She will literally retch at some of the foods you suggest. Plus, she's an emotional eater so it's more to do with the fact she stuffs her face with shite when shes low (ie when shes in pain!)

@3beesinmybonnet She says no one ever suggested it in the past. Now I go to the GP with her and so asked the GP about knee replacement and he said it's a possibility but not at her current weight. She is 86 though.

Thanks so much for all comments, theres lots to consider and try!

I think any lifestyle change will be extremely difficult for an 86 year old, did the gp have any suggestions.

? I can't beleive there isn't anything available that might help.
But there's lots that people have suggested here to do, not wanting to do something isn't the same as nothing being available.

@MichelleScarn Helpful comment 🙄 If you actually read the thread you will see that I have thanked people a couple of times, and acknowledged that there are lots of ideas here to try with regard to pain relief and pain management. With regard to weightloss tho, I think that after 80 years of disordered eating she is very set in her ways and unlikely to change signigficantly now; at least, that's my experience of her.