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Old 12-29-2018, 05:41 PM
 
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Just watched a documentary about a woman with a medical condition caused by medical care. I any event, she carried on in her condition with terrible pain. My question is - why can't the pain be controlled? I worked in hospice care for a while and EVERYONE was pain free, as that was the goal of hospice. No cure, just comfort care.


With all the opiates, fentanyl etc. out there - how can anybody be in uncontrolled pain?


It's one of my biggest fears about getting sick and dying.
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Old 12-30-2018, 10:48 AM
 
Location: The Driftless Area, WI
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The trick is to reduce the pain to a tolerable level AND keep the patient functional. That's not always possible. Sometimes you have to choose between the two.


For hospice pts (by definition life expectancy <6 months) the choice may be to knock them out to alleviate suffering. With such a short time course, tolerance to meds isn't usually a concern. ...For pts with longer life expectancy, continued use of narcotics often requires increasing doses as tolerance develops. The point may come where the meds are no longer working.


Some pain can be treated with nerve blocks or surgical ablation, but the resulting anesthesia has its own set of problems to be dealt with.
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Old 12-30-2018, 10:53 AM
 
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Quote:
Originally Posted by guidoLaMoto View Post
The trick is to reduce the pain to a tolerable level AND keep the patient functional. That's not always possible. Sometimes you have to choose between the two.


For hospice pts (by definition life expectancy <6 months) the choice may be to knock them out to alleviate suffering. With such a short time course, tolerance to meds isn't usually a concern. ...For pts with longer life expectancy, continued use of narcotics often requires increasing doses as tolerance develops. The point may come where the meds are no longer working.


Some pain can be treated with nerve blocks or surgical ablation, but the resulting anesthesia has its own set of problems to be dealt with.
Thanks. That makes sense. Not very comforting but you sound like you know what you're talking about. I can only hope that when the time comes, I can qualify for hospice.
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Old 12-30-2018, 11:00 AM
 
Location: The Driftless Area, WI
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Originally Posted by sayulita View Post
Thanks. That makes sense. Not very comforting but you sound like you know what you're talking about. I can only hope that when the time comes, I can qualify for hospice.

I know a lot about intractable pain: I've been married to the same woman for 37 yrs.

Personally, I want to die nice and quietly in my sleep, like my uncle--- not screaming in terror like all his passengers.
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Old 12-30-2018, 11:05 AM
 
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Originally Posted by guidoLaMoto View Post
I know a lot about intractable pain: I've been married to the same woman for 37 yrs.

Personally, I want to die nice and quietly in my sleep, like my uncle--- not screaming in terror like all his passengers.
Ha! I love that one! But be kinder to your wife. She may be the one making all your medical decisions as you lay helpless one day!
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Old 12-30-2018, 04:53 PM
 
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Originally Posted by sayulita View Post
Thanks. That makes sense. Not very comforting but you sound like you know what you're talking about. I can only hope that when the time comes, I can qualify for hospice.
Usually you "qualify" for hospice if you're diagnosed with an illness where you're expected to live 6 months or less... so yes, you should. Any circumstance in which you don't qualify is probably a pretty sudden death so you won't care.

What you have to worry about is if you were to be in some sort of chronic pain situation that isn't caused by a terminal illness, in which case you will live with it for a long time, will still need to try to live as normal a life as possible which means high doses of narcotics aren't a possibility (both because of possible addiction and possible side effects), and death is not on the horizon.
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Old 12-30-2018, 05:01 PM
 
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Originally Posted by K12144 View Post
Usually you "qualify" for hospice if you're diagnosed with an illness where you're expected to live 6 months or less... so yes, you should. Any circumstance in which you don't qualify is probably a pretty sudden death so you won't care.

What you have to worry about is if you were to be in some sort of chronic pain situation that isn't caused by a terminal illness, in which case you will live with it for a long time, will still need to try to live as normal a life as possible which means high doses of narcotics aren't a possibility (both because of possible addiction and possible side effects), and death is not on the horizon.
That's exactly what I'm afraid of and what the documentary was about. She lived and is still living (as far as I know) with intractable pain. She cannot live a normal life and wishes for death. Parked in a substandard nursing home for the foreseeable future. Hell on earth to me and just about everyone.
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Old 12-30-2018, 05:12 PM
 
Location: Fredericksburg, Va
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Not all pain can be controlled by medication. Sometimes, you have to have a surgical intervention or physical therapy. There are options besides pills.
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Old 12-30-2018, 09:29 PM
 
Location: Swiftwater, PA
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Originally Posted by cb at sea View Post
Not all pain can be controlled by medication. Sometimes, you have to have a surgical intervention or physical therapy. There are options besides pills.
Sometimes doctors make the wrong call and prescribe physical therapy of surgical intervention when there is really no cure. Thus they can increase the amount of suffering.

As far as hospice care and pain free with opioids; they also bring their own problems (like constipation). Of course one can argue that one should take medication to relieve the constipation; but in hospice the patients ability to take pills and liquids and food can be diminished. It's a vicious cycle and many are simply dying with no way to save them or truly reduce their suffering. Being trapped in an immobile body and not being able to think clearly is plenty of suffering even without the pain. Toss in some lingering pain and life turns into a living hell with patients that might not even be able to communicate their problems.
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Old 12-30-2018, 09:34 PM
 
Location: San Antonio, TX
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My sister has lupus and rheumatoid arthritis and only one of her doctors is willing to prescribe a pain medication. Then when she goes to pick up her tramadol (she can't drive and can barely get down the stairs of her apartment, but can't afford to move to a ground floor apartment) the pharmacy tells her it's their policy to only fill pain prescriptions for a 5 day supply. It's no wonder she ends up stuck in her bed for days, crying because it hurts too much to get up and missing important doctor's appointments.
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