Does morphine accelerate Alz decline?
My Mom has Alzheimer’s dementia, diagnosed about 3 years ago. I put her under hospice care a few months ago; it felt like she was starting to decline, and I wanted her to get palliative care.
Recently, she has been experiencing severe nerve pain in her hip, radiating down her leg. To help manage her pain, I asked them to give her morphine when she needed it. Things seemed ok at first, but now she seems to be in free-fall in terms of her dementia symptoms. Major confusion, complete lack of focus, thousand-yard stare, inability to really engage. I’m not even sure she really knew it was me when I saw her today.
Has anyone else experienced similar with their loved ones? Any other forms of pain management that have worked better for you?
Thanks in advance for sharing your experiences.
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Morphine does a number of things it's intended to do. One of them is to stop sciatic pain, which, if you've ever felt that pain, is excruciating. Yet it's given a very bad rap, for some reason unbeknownst to me.
If your mother is at the end of her life, with AD at play, and sciatic nerve pain to boot, and the morphine is making her a bit loopy BUT relieving her pain, why are you so worried that she has 'a complete lack of focus and inability to really engage?' How much was she able TO engage before her pain was relieved, with AD going on ANYWAY?
If hospice chooses to give mom another narcotic pain reliever to help with her sciatic nerve pain, she'll likely be loopy from that medicine too. Such is the nature of pain meds.
Your goal is to keep mom pain free now. Calm and relaxed and comfortable. Not totally engaged and talking circles around everyone in the room.
It honestly confuses ME when people expect their loved ones to be out of pain totally AND totally engaged and not at all loopy from the meds at the SAME TIME.
Wishing you the best of luck keeping your mother's comfort in mind while under hospice care.
It’s so hard when she has a hard time being an accurate reporter about her pain. I saw her today about 15 hours after her last dose, and she was a bit more “there,” but still worse than she has been. It could just be that her trajectory with the disease has changed, which happens. At this point, we’ll just take it day to day and work with the hospice nurse and doctor.
Weighing how much pain relief you can get with the minimum dosage you can take--that's a slippery slope and can prove fairly taxing.
Keeping mom comfortable is your #1 priority, If it comes with a certain measure of decline with the ALZ, then you need to evaluate your priorities.
My dad, on Hospice with Parkinson's, was taking Morphine as needed, round the clock. He definitely was less verbal, less agitated and in almost no pain. We decided to opt for pain relief over 'alert time'.
Morphine is narcotic and it can make you "loopy" but it does what it is meant to do.
By the time I had to start Morphine for my Husband there was no noticeable decline...he had declined about as far as he would, he was bedbound, non verbal, and pretty much was sleeping 23 hours a day. BUT it did allow him to relax muscles that had been constricted for a VERY long time. And he was able to breath easier and I think he had better sleep. (although how could I tell if he was already sleeping 23 hours!?)
And I suppose the other question is does she REALLY need Morphine for the pain she is experiencing? Is there another medication that would work as well without the effects of the Morphine? (Tylenol? Advil?)
Have you tried cutting back on how often she gets it or the dosage to see if there is any difference? I would perhaps try that and see.
My late husband(who had vascular dementia)was under hospice care in our home for the last 22 months of his life and started on morphine pretty early while under their care because he was in constant pain. He eventually was put on fentanyl until he died.
I honestly don't recall thinking that his pain medication was making his dementia worse, but I was more concerned with trying to get him out of pain, which sadly he never was, but that's a whole other story.
Talk to moms hospice nurse and see what they think and if they can cut back on it if you think it's a concern.
Best wishes.