Should my dad be in this much pain?

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My dad (84) had to have his leg amputated 7 weeks ago, he's recovering well in a community hospital.

He has very little pain in his stump, but he's in agony with his lower back. He's on some form of slow release opiate medication in the morning, paracetamol and oromorph. He's miserable with the pain but the doctor and consultant who visits weekly, say he can't have anymore pain relief.

He's had an x-ray and it showed spondylitis nothing else. They booked a CT scan then another doctor decided he didn't need it, so cancelled it.

He won't take Gabapentin as it gave him hallucinations, so I'm at a loss of what else he could have. I thought ibuprofen but they said he can't have it as it's not good for his tummy.

Can anyone suggest something else to try or something I can ask the doctors for please. He's refusing physio as he's in so much pain, but needs it to build strength to get home.

I’m afraid I don’t know but as my own dad is a similar age and terminally ill I didn’t want to scroll past. Is there a second opinion you can get on the pain meds, someone else in the team or another doctor? Given his age there is perhaps less concern about morphine / opiate addiction than in a younger person (?). Also what about naproxen/Aleve? It is in the same category as ibuprofen for stomach irritation though.

Can you ask to see a pain specialist or even a specialist pharmacist? There might be a way for him to try Gabapentin again to see if he can tolerate it. They might have other suggestions too. How is he managing psychologically and emotionally re: the amputation? The mind body connection is strong and in my.experience can sort of override otherwise effective painkillers.

The nurses are brilliant, they ask the doctors/consultant to review him but nothing changes. Dad thinks they just give him stuff to shut him up!

I'm seriously thinking of getting him flsome CBD gummies, but not sure if that's a good thing!

Agree, ask for referral to pain specialist. It's not ok to be left in pain

They say he clock watches for the oromorph, he hates being in hospital so is not happy.

As for the amputation, it took his foot going black and sepsis to persuade him to have it done. He was very poorly, and I know he really didn't want it done.

He doesn't let on his feelings, but I know he's worried how he will cope at home as he lives on his own.

He should be able to take ibuprofen or stronger like naproxen if he’s taking something to protect his stomach, I’ve been on naproxen for years and take lansoprazole to protect my stomach. Unless there is another reason he can’t take it.

id be pushing for the other scan again. Also maybe something like Pregabalin for nerve pain.

He needs to see a pain specialist. Unfortunately it’s a bit of a myth that there are just stronger and stronger pain killers. Even morphine doesn’t work for some people (as he might be finding with the oromorph). Different painkillers work best in different combinations for different types of pain (nerve, muscle, bone) and people react to them in different ways at different times.

You could ask if he could try amitriptyline. It works well on nerve pain and many people find it helps them sleep better too. I’ve taken it now for several years and it’s made a huge difference to my pain levels. I also tried gabapentin and really hated it - it made me nauseous and dizzy.

There are other options. He should not be left in pain. I wonder if it’s partly due to positioning?
is he in bed a lot ? Try and encourage him to work with the physios.

He can have ibuprofen with a stomach protector , also things like TENS machine.

If he can't have ibuprofen he could maybe have celecoxib. It is another anti inflammatory but much gentler on the stomach.

If he can't have gabapentin, he could try another neuropathic medication such as pregabalin for amitriptyline.

Is he on a high dose of slow release morphine?

for the multiple people advising anti-inflammatories - that is really poor advice for an 87yr old who's had to have a leg amputated and about whom you know very little (including medical history and other medications). There's a lot more to think about than the GI side effects - the renal/cardiovascular risk is more likely to be a (serious) problem.

Back pain in this context could have lots of different causes (and therefore lots of different treatment options) and it's really not that easy to comment useful ideas on here without a lot more info.

So they think he IS taking all his pain meds or are they prescribing and he's just not taking it?

I am no GP but have had chronic back pain a few times and it can be insufferable. They should be trialing different pain medications if one isn't working for him, or HE needs to trial them to see if the hallucinations are still a side effect for him.

Would anything like a TENS machine work? I am not a medical person or have any experience just wondered .