Mom has bone on bone arthritis in her shoulders and won't take all her pain meds. What do I do?

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She has accepted that she has to live with the pain and that she will for the rest of her life. Mom lives alone and has two caregivers, me and one from an agency. She has been treated with narcotics for the past year and recently was put on a 12 mcg fentanyl patch to accompany her vicoden. The 25 was too powerful. So she is having 9 on a scale of 10 pain and was told by an ER doc this week to up the vicoden to 4 a day. Today she told me she won't take the 4th pill because it makes her too groggy.

It's wearing on me being her caregiver because I hate to know she's in pain every day and has such poor quality of life. Most of the time, we can't leave the house to go out to eat because she's in too much pain.

I dont' have a clue now.

She also was told by her primary doc that she can have a glass of wine a day. Seriously???

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Your not going to like this but I would recommend Marijuana. My 85 year old mother in chronic pain is oh sooo much happier! There I said it....finally!
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Can the Vicodin be cut in half? Maybe 3 1/2 pills a day would work...
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I would rather be in some pain that feel groggy all the time too. Maybe half doses would work better, or even a calculated regular dose of acetaminophen (no more than 1-2 grams a day depending on medical conditions would take the edge off it. Are joint replacements a possibility? My mom had her knee done and it did not help her get up walking as we had hoped, but at least it didn't hurt her all the time...
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If you haven't already, take Mom to a pain specialist.

It is Mom's body, Mom's pain, Mom's decision of how much medication to take. Discuss it; give her your opinions, but respect her choices.

How does Mom do on a glass of wine a day? Does she have trouble stopping at one? Does she have any impairments from it? (Unsteady on her feet, for example?) If it doesn't seem to cause problems and her doctor says one glass is OK, I wouldn't be the bad guy and try to stop her. See what a new evaluation at a pain clinic suggests regarding alcohol.
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I can feel your frustration and her pain! My Mom has similar osteoarthritic and osteoporosis issues, and she is on a Fentanyl patch as well as 2 types of morphine (not vicodin). One morphine is instant release, and the other is an extended release. Much higher dosages at age 88, and neither one of them make her drowsy. The idea is to start with the lowest effective doses and increase over time as tolerance to the drugs build up and the pain worsens. In my Mom's case, her pain issues were long-standing - over 30 years (I think she built up an iron constitution to these drugs over the years). The past 10 years she had a pain management specialist and we worked very closely monitoring and adjusting dosages and timing, until they came up with the right combination. Up until that point, when we would take her out, she often soon started writhing in pain, and we would have to leave and take her home early. I think anxiety over the possibility of pain was part of the issue and that contributed to the onset of the pain (tensing up). So it wasn't a matter of her having to live with the pain, just that at that point, the drugs were not strong enough to last through a few hours outside enjoyment. I would definitely nix the wine, due to interaction with drugs, and although wine can be relaxing, it can also promote inflammation in the joints. I would suggest getting her to a pain management specialist. I don't think your Mom has to resign herself to living with the pain.
One other thing I will risk mentioning - purely speculation and maybe entirely off-base. You say Mom has accepted that she will have pain all her life, and that sometimes she is in so much pain that you cannot leave the house even to go out to eat for a couple of hours? Any possibility (with all due respect), that she is maneuvering to keep you at home with her because she may not want to admit she is afraid to be home alone? If that is the case, it's another issue to deal with. Hope not.
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If she enjoys the wine let her have it. Stop obsessing about Mom's pain. As long as she is of sound mind she can make her own decisions about what she is able to tolerate. Maybe she just as soon would prefer not go out to eat but does not want to offend you by refusing your kind offer. When you have that much pain and disability it can be embarrasing to eat in public because you can't sit up nicely and use a knife and fork normally and perhaps have to hold a cup with both hands and lean your head down to your plate to get the food into your mouth. It can be very uncomfortable eating out too. The chairs are hard the table too high, the wait for the food is agonizing and forget the difficulty getting out of a booth after you have sat for an hour. After she has been on the low dose patch for a while she will get used to it and be less drowsy so the dose can be increased and her pain better managed. If she adamantly refuses the fourth Vicoden at least try and have her take one at bedtime. There are an umber of other narcotic combinations that can be tried and although they may make her unacceptably drowsy initially most people get used to the side effects.
The bottom line is she does not have to take anything she doesn't want to but must be prepared to endure the consequences if she does not make use of what is available.
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She may benefit from seeing a pain specialist, they have a myriad of injectables that help add fluid to the joint or localize the pain relief. Some of the applications are off-label and insurance won't cover a $300 first visit, but the relief is there.
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It may sound crazy, but if it were my mom, I'd get her to try acupuncture, which has been shown to help osteoarthritis. If you google "acupuncture and osteoarthritis", you'll find a bunch of scholarly articles about the benefits. I would also wonder if a TENS unit would help her? It's a little device that gives electrical stimulation to the affected area to confuse the brain about the pain. You can also google "TENS and osteoarthritis" and look at info about that. Those are two non-narcotic approaches I'd at least investigate. They won't hurt her and may help her. Good luck!
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@sonswife: your doctor is wrong and has an attitude. I can testify to the fact that NOT so many people with arthritis are alcoholics. Besides, what's wrong with one or two beers?

I would change the doctors at this point.
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The way the pain meds are prescribed, are on the as needed basis. It's not like you have to take them 3 or 4 times a day; it just doesn't work this way. What the doc meant, your mom can take no more than 4 vicodin tabs a day, but whether she takes them or not, is totally up to her. If she thinks that she can do without, partially for the reason of the side effects, so be it. It's her choice. As well as a glass of wine, if it's Okay with her.
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