How much opioid pain reliever is too much?

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My mother fell a week ago and is in a great deal of pain from compression fractures of the spine that were made worse by the fall. She sleeps 22 hours a day while taking the lortabs the doctors prescribed. Any reduction in dosages creates unbearable pain.

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There is so much in the news about opioid addiction I think it makes many paranoid. Mom is in pain, it needs to be relieved. So, whatever she needs. Maybe consider an evaluation by hospice.

A story about my FIL that I never met. He passed of prostate cancer about 40 years ago. He was a very intelligent man, was a director for a federal government agency. He was given prescription for opiods to ease his pain. He did not want to take it for fear of becoming addicted. Strange, he knew he was dying.
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Talk to your mother's doctor about this.

Since your mother is experiencing unbearable pain, she definitely needs to be medicated. Opiates really do help people who have severe pain be more comfortable. To deny someone who is experiencing severe pain effective treatment is inhumane. Period. For her sake, and those who might be caring for her's sake, please store her medications in a medication safe.

Don't worry about her becoming addicted. This is the least of her problems at the moment. Talk to her doctor, first. She might benefit from a pain management consult. Pain management clinics / consultants come in all flavors. You want someone who works with seriously ill elders who are experiencing severe pain. You don't want someone who works primarily with younger people trying to wean them off of opiates. Doctors who specialize in pain management come from many disciplines: physical medicine and rehabilitation, neurology, psychiatry, anesthesiology and surgery. Choose a pain management consultant who comes from an appropriate discipline and for you that would be physical medicine and rehabilitation or anesthesiology. You definitely don't want a psychiatrist. Good pain management requires a multidisciplinary approach. It's a combination of methods, not just one method, that work.

I would also consider a palliative care consultation. Palliative care is not hospice. Your mother can still receive curative treatment and still receive palliative care. Palliative care teams generally do have people who are very knowledgable about symptom management and pain control.
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Pain must be managed or her poor body will not heal. The worry of addiction is nil, really, and even if she became "addicted" at this point in life, would it matter?

We worry SO MUCH about opioid abuse...and too little about QOL. If mom is getting up some, as much as she can bear, and eating some, I'd not worry too much. You don't say how old she is--but this could be the beginning of the "end" Perhaps look into hospice care? She might get better pain relief with less sleepiness--and she could "graduate out" of hospice if she heals and is in less pain. Or palliatve care---either one.
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Get real people this poor lady is in severe pain and Lortabs are not the stongest of narcotics. She is likely to need some pain relievers for the rest of her life with the compression fractures.
Never allow a patient taking narcotic to control them themselves it is too easy to forget when you took the last one or even if you took it.

The aim of good pain management is to keep the patient comfortable all the time. Never allow the pain to get out of control because it is much more difficult to regain control. The main problem with the less strong narcotics is that they contain a lot of Tylenol and overdosing on that can damage the kidneys. Aspirin and similar are also not a good idea as they can cause bleeding and upset stomachs. 

It is also not necessary to give these medications at the hours prescribed. Certainly don't wake some one up if they are sleeping peacefully. If something is prescribed every four hours and they don't show signs of discomfort till six hours then give it then. It is also a good idea to time doses so something is available about half an hour prior to doing something like a bath which will cause pain.

When someone is painful well before the next dose is due contact the Dr and you will be told to increase the dose, decrease the interval or have something stronger prescribed. If someone is wearing a fentynal patch or long acting morphine they are usually prescribed a less strong med as what is called for breakthrough pain. This is prescribed at certain intervals to take before the long acting narcotic is due. If the patient is taking a lot of breakthrough meds then the Dr will increase the dose of the long acting.

I used to use the analogy of Diabetics being dependent on Insulin, they could be said to be adicted because they can't live without it. In the same way people with severe pain become dependent on pain killers which is very different from addiction where the pills are taken for the effects other than pain relief.

The mother in this case has suffered a severe injury and shock to her system so it is natural to sleep for long periods while the healing is taking place. This applies to people of all ages but is especially marked in the elderly. This applies to any shock to the system so peace and quiet are essential and visits limited.

No amount of narcotics is too much as long as the dose is increased gradually based on symptoms.
Sorry for long post but when I get going on something I care for it is difficult to stop.
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Your poor Mother and those awful falls...I'm so,so sorry.
I think she should have whatever amount brings her relief and if the Lortabs are making her too sleepy,maybe another pain medicine would work better,like morphine and a fentanyl patch.That's what my Mother was on after she broke her neck and it really helped and she could still function.Hopefully,your Mother's doctor will find the right recipe soon.Take good care,Lu
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My father took a large dose of Vicodin for a long time for very severe arthritis pain. His hip was distintegrating. He finally had a hip replacement and suddenly no more pain! He never took another Vicodin and I saw no signs at all of withdrawal symptoms.
This opioid hysteria is harmful to the people who really need them. Just the term "opioid crisis" doesn't really describe anything. There are many opioids. I think the crisis is with Heroin and Fentanyl. And maybe with overprescribing some others. But many people really do need pain medicine. If Drs are so paranoid that they won't prescribe them, we have a problem.
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I can only tell you from personal experience of when I broke my ankle and was temporarily on Percocets. I had a starter script from the hospital that I took every four hours. I was in bed most of the time and used a wheelchair to and from the bathroom as well as my crutches for navigating between the chair and the toilet. When I went to get the boot from the ortho, I was only allowed up to one or two refills. I was given aspirin to help me not use so much of the Percocets. I don't know how long your patient has been on opioids but they're only meant for very temporary short-term use. What you need to do if you haven't already done so is have her doctor referred her to an orthopedic and maybe even a spine specialist. They need to wean her off if she's been on this or any other medication for longer than she needs to be. Perhaps the specialist can help wean her off by giving her alternatives. Since she has broken bones, you should try to help her tackle the pain through her diet by strongly encouraging a proper healthy diet such as mostly plant-based and lots of whole milk. When I had my broken ankle and was in bed most of the time, I had a friend who voluntarily took me in and took care of me for a short while. He made sure I had a healthy diet and definitely plenty of whole milk. He also had to remind me to pop my Percocet every four hours because I would've never otherwise remembered since I'm not used to taking pills that often. I was always careful to first put something on my stomach before taking that pain pill, which is why he got me some light bedside snacks like chips, cookies and donuts to eat before taking my pill. Hopefully your mom is actually eating something before taking any of these pills, not eating can actually damage your stomach lining at some point or another. I don't even know if she's taking these things as prescribed or more often, I don't know since I'm not there to see what's going on. All I know is generally you're supposed to be off of opioids within about a week or two. This was my experience, which is how I know I was to be weaned off of the Percocets and put onto aspirin. Since she's sleeping so much, you may actually want to talk to your mom's doctor to see how much she supposed to be sleeping during this time. My friend actually encouraged me to sleep during my own healing process because Percocets actually do make you drowsy. I was trying to fight sleep but before I knew it, I was out. I don't recall how long each pill made me sleep, but anytime you have a break you definitely need to sleep more as part of your healing process. If sleeping  interferes with your life and prevents basic survival care such as eating, drinking and other basic care, then it's a problem. I don't know if your mom is managing her own pills, but perhaps it may be time to set up a nanny cam and see what she's doing and whether or not she's overdosing on her meds. What I would do if I were you is keep track of what time she takes each pill and also check the label to see just how often it's supposed to be taken and how many she's supposed to be taking with each dose. If you find she's overdosing on her meds, then you need to take over and dispense those pills for her. If not you, someone trustworthy needs to step in and take over her pair during this time until she's well enough to care for herself
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More than time to differentiate "recreational use" of drugs from pain relievers needed for severe pain that does not respond to other treatments. Obviously, if there are treatments that can control pain short of opioids, then try them - by the way that is why we need universal insurance coverage. I believe that part of this "epidemic" is the result of so many people not having access to modern medicine. Obviously they have to treat themselves anyway they can - thus drugs that don't cure but allow them to continue living. However, it is just evil, torture really, to deny people in excruciating pain the means to relieve that. People like Jeff Sessions say they hate drugs, but for sure they are the first to agonize over a hangnail. Just let the little people suffer. Seen too much of that, up close and personal.
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You should definitely speak with her physician. Since she's sleeping just 2 hours  shy of one day, I don't know what more can be done for her since the Lortabs is making her so lethargic, yet she is still in pain.
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Dear Binteled,

This is a serious concern and I can understand your worry. Please follow up with the doctor or call an ambulance if you suspect an overdose. Oversleeping is serious. If you don't trust the doctor, I would seek out a second and third opinion. Pain management is not an exact science but I hope you can find the right balance for your mother.
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