Is there really nothing for long term severe pain?

[HGF37]

My dad has severe advanced osteoarthritis in multiple joints (he had a massively physical job until his 50s.) He has become more and more sedentary as a result, has put on weight too, and is now 83, obese and getting really close to not being able to walk at all, its just too painful and difficult. He has pain patches but they dont seem to touch the pain...well, presumably it would be even worse without. He can't sleep, is scared to move to be honest, would rather not drink during the day so he doesnt need to get up to go to the toilet...its just too painful. The GP says there is nothing more they can offer in terms of pain relief (he is on butec 20 morphine patches) Is there really nothing else/more? I really couldnt care about addiction to morphine at this stage, he just needs help. Can anyone advise??

Well, those patches go up to a 75mg version so there's a much higher dose available, but it may be for palliative care.

There are other types of patch as well - fentanyl and so on but GPs may be worried about prescribing that.

Ask his GP for a referral to the pain clinic at the hospital.

@NCForQuestions Really? I googled butec and it said 20 was the highest...and GP has said its the highest. But I do suspect there must be a higher dose of it, or of something else!

My mother is 72 and has the same condition. She cries at night because she is in such severe pain and they say there is nothing else they can do.

Butec is a brand name, so it's possible it's made under another name
https://www.nhs.uk/medicines/buprenorphine-for-pain/how-and-when-to-use-buprenorphine/

I'm so sorry, both your parents are being let down. If there isn't anything that can actually be done for pain like this, should they at least be offered something for sleep at night?! Diazepam? Anything!

Definitely ask to speak to a specialist if the GP are not able to help.

I'm on dihydrocodeine for osteoarthritis, your DDad has my sympathies, he really does. It's the worst pain as it's just constant. Can't escape it.

Ask for pain clinic referral if possible to talk about pain management options.

For osteoathritis the options are miserable.

There is strong evidence that morphine (and other strong opioids which would include Butec) don't help chronic non cancer pain and over the long term have side effects such as supressing the immune system. GPs have been pushed hard to reduce the amounts of these they are prescribing.

He might benefit from steroid injections into the worst joints.

Or going to pain clinic to see if he could have any nerve block procedures. However waits for pain clinic are huge - when my DM got desperate we paid privately. She had a procedure which worked brilliantly for one pain, but it was very expensive and unfortunately just made her feel all her other pains even more.

It's a miserable situation.

20 is the highest dose of Butec (buprenorphine) but fentanyl which is another opioid comes in higher dose patches. There are also disadvantages to using strong opioids long term…
Has he tried creams that you can rub on? Either anti-inflammatories or capsaicin? Definitely worth asking for a pain clinic referral too. Joint injections can sometimes help as well.

My 88 year old mother has similar. Osteoporosis and arthritis plus other spinal vertebrae issues. She takes pregabalin every day and paracetamol the rest of the time. She has oramorph for occasional use when really needed but hasn't had to use it for quite a long time now. I think it is the pregabalin that really keeps everything under control and she panics if it runs low before the pharmacy automatically sends out her next medication package.

My understanding is that different pain relief regimes work for different people. I do hope he finds something that works for him soon. Maybe keep on at his GP. My mother's had her admitted to hospital for assessment and to work out a proper regime.

Which joints is it impacting? The only relief I got is replacements

Have you considered looking into any of the natural remedies such as Krill oil, curcumin, turmeric? May be worth doing. Of course always check if they are contra-indicated with other medicines.

My DH has secondary cancer in his bones, predominantly his spine which has caused a significant number of fractures and incredible pain. I know this is a different illness, but there are other pain relief meds. Whether they'd be appropriate and if they'd prescribe them is another matter.

DH takes Oxycodone Hydrochloride tablets (slow release) and the same medication as a liquid (fast release). He also takes Pregabalin. All these meds have side effects of causing drowsiness, but they ease his pain considerably.

I'm 60 and have osteoarthritis in both knees and can feel it developing in my hips. Walking and sleeping are already difficult and I dread what I'll be like in another 10 years 🙁

If opiate based pain relief isn't working brilliantly, it's unlikely tumeric will do much. I know people want to try their best to help but honestly if it was that simple we wouldn't need to go to see a GP for something stronger than paracetamol.

He can be prescribed fentanyl patches and oramorph.

I was diagnosed with osteoarthritis before the age of 40. Both my parents have it too. I have it in the hips. It's exhausting just getting through each day.

I dread what I will be like when 50😫

Had the GP referred him to the pain management clinic?

Ive had pain injections and also nerve block injections through them

Has he also tried taking a range of medications together?

I tried pregablin / gabbapentin / tramadol / amitriptyline - it was a mix of things together to get some form of relief before the injections happened

https://www.england.nhs.uk/south/info-professional/safe-use-of-controlled-drugs/opioids/

https://painkillersdontexist.com/

Let’s start at the beginning.

Butec is NOT morphine.

It’s buprenorphine. Which is for “moderate, long-lasting pain.” NOT for severe, long-lasting pain.

It is NOT the same as morphine and does not work in the same way. Morphine is organic, whereas buprenorphine is a chemical analog and as such, obviously may not work as well, especially for things like arthritis and osteoarthritis (it might be an ok medication for some forms of nerve pain). In my opinion, personally, it is much, much weaker, and it’s often what they use in America, at least, to help people quit morphine. Why the UK uses it for widespread pain control in severe situations (with, of course, accompanying reports it doesn’t work), I just have no bloody idea.

So yes, his doctors are full of it. If this is his GP or something. There are actual medications for SEVERE, long-lasting pain, such as morphine, fentanyl patches (which if your father cannot get up to use the toilet, he should OBVIOUSLY qualify for), and a few other options.

For all those suggesting stronger opioids - oxycodone, fentanyl, oramorph etc it is very unlikely that the GP, or even a pain clinic, will do this for a non cancer pain, especially one that hasn't responded to the Butec at all.

Please please push to see a consultant. I had my first hip replacement at 27, second at 32, knee at 31 and a knee, elbow and wrist in the coming months. Don't live suffering. I have RA and OA

Has he been advised whether losing weight would help with his pain? I am not at all dismissing the pain your poor dad is in but sometimes we need lifestyle changes as well as medication. It may be that losing weight wouldn’t help but as you mentioned that he is obese I just wondered.

Good grief, you have really been through the mill😔. Really pleased you have had replacement surgery to make life bearable though, a huge positive. I fear that might be the next step in a few years looking at possible surgery. Taking dihydrocodeine is working if I have four doses each day. 60mgs usually per dose.

Well… that’s horrific, then. Cancer is not a magical illness that causes the kind of pain that no other illness causes (though I am not underestimating the pain cancer can cause - like all pain, it’s not a race to the bottom). And especially when people who are getting older are in so much pain that they can’t function, it’s absolutely inhumane. For doctors to just assume that cancer is the only illness that causes pain that requires strong opioids is mad. I understand the need to avoid an opioid crisis, but that’s very possible while also treating those who are immobile from pain or dying from other reasons besides cancer. It just seems incredibly cruel to me - butec IS only for “moderate, long-lasting pain.” It says so right on the package. So if the medical system will deny people the medications designed for “severe, long-lasting pain,” AND you have no doctor-assisted suicide, then I can’t think of much that’s more cruel, regarding pain and health care.

I am not overly overweight but it's a valid point for some arthritis sufferers that weight loss can improve symptoms. I have been trying my best to lose weight but slow progress. Much harder to lose weight now that I am older!

Had years of cthonic pain. Gabapentin and oramorph didn't touch it. High doses of amitryptiline didn't stop it but but made it so I didn't care so much. Worth asking for help.