Mom (81) has Stage 4 COPD and chronic back pain. What can be done for pain?

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Rx for morphine didn't go well, now on methadone and losing cognitive abilities. On 3 liters O2 24/7. Norco was our go-to Rx for a couple years, but lost effect. Morphine prescribed caused stomach upset, chills and confusion. Doc changed it to Methadone, but over the last month since she was switched to these meds, she has really started to lose her reasoning and short term memory. She is remember things and thinking they happened the other day but in fact was a year or more ago. Vivid dreaming and she awakes, thinking things in her dreams really happened. Yesterday she thought she heard my brother (who lives cross country) and came out looking for him.

She has let me start doing her personal accounting and bill paying finally, as she is aware that her brain is not serving her well anymore. She is having trouble signing on to her electronic devices and distinguishing from email, text or phone calls (I suspect she may not be remembering her passwords or tremors make her enter them wrong). Her appetite is decreased, and she leeping a lot more, but also irregularly. She is also complaining of pain, saying the medicine doesn't help. Her bedroom is upstairs in the house, and she still can make it up and down ok, although slowly. She often comes down without her cannula on, and sometimes I go up and she isn't wearing is so I remind her to put it on.

Her cognitive abilities have declined considerably over the last 2 months, and I don't know if it's the meds or not enough O2 to her brain, or if she is developing Alzheimers, which her mother had. She does manage her meds ok and does log all over her medicines taken and the time in a little book, but I am growing more and more concerned that nothing seems to help her pain, and whether she needs more care than I can provide.

She will not qualify for medicaid for quite some time, yet there are not enough assets to put her in assisted living, as she refuses to spend the CD she is reserving for my brother when she passes. (Note, brother has gambling problem and filed BK twice) we have bailed him out of financial difficulty more than once, but no longer desire to enable him...he is also living with and caring for wife's mom in MIL's home).

I guess what I'm trying to figure out here is if there is something that can be done to help with her pain without putting her in a stupor, if it might be time for hosipice if this is the beginning of the end and I need to prepare myself.

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Amicable, I'm so sorry about your mom's condition. That is really tough. I would discuss it with her doctor. I don't know much about medications for pain, but I do know that my cousin, who has dementia and back pain, does very well on Cymbalta. (It's for Anxiety, Depression and PAIN.) I'd discuss it with her doctor. My cousin had a lot of pain from a spinal fracture she sustained in a fall. Plus, she already had severe disability in her back from arthritis. Cymbalta really helps her and she denies any pain now. Of course, everyone is different. I wish you all the best.
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I wish this site allowed me to go back and edit my typos! Time she has left, I meant.
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Bablou, she has scoliosis and arthritis, and her mid to lower back muscles have sort of "fused" in place knotted up, and I think part of it was from an auto accident many years ago. She does have breast cancer and had a lumpectomy 2 years ago, but it was supposedly not agressive and any further surgery is out of the question due to her pulmonary status. We have tried Fentanyl, but it gave her what I can only call "instant Alzheimers". She also has chronic anxiety, and she is going to a LCSW every 2 weeks, but her issues run so deep I doubt that she can make real progress in the time she has less, especially now given her impaired thinking. It almost seems as if her pain has become a sort of habit that she can't break, if that makes any sense at all. She is very sensitive, and when she gets upset, I think it actually hurts her physically. 3 1/2 years ago when she moved in with us, the pulmonary doc estimated that she had 2 years left...I think just because her anxiety was so bad she appeared worse than she actually was. Xanax and Pamelor have helped some, but she still sort of panics when she realizes she can't think clearly, and she's afraid and angry when she can't make herself understood (which is quite a normal reaction, I think!). It's very challenging to get her out of the house, but most weeks I try to at least take her to get her hair washed or trimmed if it needs it, figuring self-esteem should be her biggest priority now. I just hate that she has to go through this...she has never been a good self-advocate, and when is enough enough?
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Why does she have back pain? Disc issues or does she have cancer that has invaded her spine. Has anyone suggested local pain patches.?
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