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??

It been a tough few years. Really struggling at the moment with my knee. Because of how bad my legs were I've never really fully recovered to full potential of my new joints and have really weakened leg muscles. I've been lucky to have such an amazing RA team, I was diagnosed when I was 16 and without their support I don't think I'd have managed to come as far as I have.

Surgery is the best thing I have done. Especially for my hips. The lists at the moment are years long, so don't leave yourself to get to an unmanageable point before asking for help

@5YearsLeft

It’s not a case of doctors assuming anything. It’s that there are clinical guidelines and best practice based on evidence, and that the evidence shows opiates are not helpful for chronic pain for the majority of patients AND puts them at significant risk of harm.
If they worked and were safe, these medicines would be prescribed freely, but they’re not.
Chronic pain IS awful but I have seen so many patients who have been harmed physically and psychologically by opiates that were prescribed for legitimate conditions, and there is no doubt they would be living a much fuller life if they had never gone near them.
No matter how much the opiate is increased in strength, a tolerance builds rapidly and then you’re just taking it so as to not get withdrawal effects. Then there is a spiral of increased doses, more and more adverse effects and often at the end of it, the person is still in about as much pain as they ever were.
It’s not a case of the solution to the problem being there in the doctors’ hands and them refusing to pass it over to the patient. There is no cure for chronic pain, painkillers can be prescribed up to a certain point but then the bad stuff starts to outweigh the good so there is a ceiling on what is acceptable to prescribe.
I’m saying this as both a healthcare professional and someone who has taken opiates for pain.
OP I’m so sorry that your father is suffering like this. A pain clinic referral would be my recommendation.

@5YearsLeft doctors are not doing this to be purposefully cruel, it's because of the relative absence of medications that are actually any good in this situation.

The higher doses of morphine etc simply don't work for chronic pain in the way they do for cancer pain.

Even at end of life, when doctors are more likely to try higher doses, these pains are very difficult to control.

Definitely glad you have a supportive RA team to call upon if you have a bad day. They must be a fantastic resource and hope you have an easier time of it going forward 💪

Sometimes not. Or not all of them anyway.

My mum doesn't have cancer. She has oramorph. She rarely uses it now, but it is there just in case.

@VanillaFrosted@AnnaMagnani I understand the points from both of you and I’ve seen the research. I get it, and you’re obviously not wrong. I suppose the problem is just that I’m coming from a different life experience and part of healthcare, having only worked with the elderly and in hospice, and since I’m dying, but not of cancer. So I’ve seen a lot of people who didn’t have much time to worry about the side effects of too much pain medication (OP has indicated that her father is elderly, and it sounds like he’s past the point that joint replacements are an option, but maybe not). Unfortunately, I’ve seen people in horrific pain for no reason who didn’t have that long to go. The effects on their immune system, their sex hormones, the issue of building a tolerance - none of those would be issues, and yet doctors still refused stronger painkillers, and years later, I’m still not sure why. Would I ever recommend opioids for the poster who said she was diagnosed at 16? Absolutely not. And if I saw a doctor doing so, I would be really concerned about it. But 16 and facing joint replacements versus 80+ and not drinking because it hurts too badly to get out of a chair… so different. I just feel like there have to be so many more options for these shitty conditions that very unfortunately can’t be reached by nerve blocks or creams or fish oil. I know I’m projecting, and I’m projecting a lot, but it breaks what is left of my heart. Let people who are crying all night in pain take stronger medication, or have cannabis (smoke or edibles or whatever), or have weightless floating therapy, or anything we’ve discovered on earth that might help. I just… I hate this suffering. And I’m so terrified it will be me in a year. I’ve had pain in the past so bad that I’ve been retching. It just makes life hell.

I don't have cancer I have been taking fentanyl and oramorph for my health condition that causes chronic pain for 13 years.

My mum was on Fentanyl patches for neck pain for many years until the patches killed her ( accidental overdose). She was in no way terminally ill and was still young. I have huge reservations about them being used unless for palliative care, although I appreciate they do help people with difficult to manage pain. I guess I am very anti these patches because of what happened, if she had not been prescribed them she would likely be alive today.
I hope your dad gets some help, has he had steroid injections into the worst joints ? People find this can give relief for some time.

I have advanced arthritis and it is horrific. I am on buprenorphine patches 35mcg, tried 50mcg and made no difference. Thinking of stopping them as I don’t think they help at all tbh.
Naproxen helped for a while but not anymore and has damaged my stomach despite taking it with omeprazole.
I take amitryptilline 80mg for nerve pain and this doesn’t work much either.
Paracetamol does nothing.
Can’t take pregabalin or gabapentin which some find good for nerve pain as I need to lose weight and both these cause weight gain.
Oromorph did nothing.
Basically I think surgery is my only option but although a hip replacement will help with mechanical pain because I was misdiagnosed and also have this in my spine ( which am told may be inoperable) too the nerve damage is likely permanent as they have been compressed for years.
Get your poor dad an urgent referral for a proper assessment not just the gp.
My past gp was the useless git who left me in this position in the first place and their advice even just on pain meds turned out to be totally incorrect.

Often wonder whether cannabis would help my mother but I know nothing about it or its interactions.

I would consider CBD alongside the prescription medications, very good results for long term pain relief and no side effects

So there is another category of drugs which technically are not pain relief which he could try

The SSRI's work to reduce nerve activity and so you get less pain through. You can think of it as turning the dial down on the pain.

It's common to prescribe them especially when people are having trouble sleeping.

Amytriptyline is usually what is prescribed first. It has side effects of making people drowsy (good for sleep) and weight gain which people are usually less happy about.

Gabapentin and pregabalin which have been prescribed for this issue in the past are no longer prescribed.

So I'd suggest going to his doctor and asking for amytriptyline.