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My mom is 97. She fell recently and has a compression fracture of the first lumbar. Tramadol and Tylenol 3 have very bad side effects on her which led to two more falls resulting in three broken ribs and a nasty bump and a staple on her head. The pain has made her crazy but the pain meds have made her crazy and mean to the point of violence. She is currently in the hospital with restraints and occasional haldol so she can rest. What else can be done?? Everyone including doctors seem at a loss. Prior to this she had minor age related dementia with no diagnosis of dementia. Now she is full blown dementia with paranoia, hallucinations and violence.

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This is a tough situation. She could be allergic to the codeine in the Tylenol 3.
Maybe ask for hydrocodone or oxymorphone which are synthetic forms of codeine which may not have the same adverse effects as codeine in her case.

Also a lidocaine patch to the area or a low dose fentanyl patch may work.

There are many other meds to manage pain other than Tylenol3 which is first level & often doesn’t work with conditions such as a fractured vertebrae.

Try repositioning too. The less she sits or puts pressure on the area the better.

Her bones are quite fragile at her age. I would try to avoid any extended movement to prevent further injury to her lower back. ALWAYS arrange for someone be with her if she gets up to walk to the bathroom.

Ask for a lumbar brace she can use when she is ambulatory and have it available to use at your fingertips.

This is so sad to me as I really get bothered when someone is in pain & medical providers don’t take it seriously. A body in pain won’t heal quickly. This whole opioid “crisis” withholds pain medication for people that really need it.

But bottom line she can just as well be allergic or sensitive to any new pain medication synthetic or not, so proceed with caution. Low dose first.

Good luck to you both.
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It sounds like the pain meds are causing psychosis. Cwillie mention a nerve block that might be a good call.
Does mom have an infection? Infection of the menings can cause this" although rare, can still happen. Also has she be tested for a UTI? I know you are probably thinking what one has to do with the other but the body is one system made up of many systems. UTI can also cause this type of behavior in older people. I am just throwing more ideas out there.
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We went through a similar thing with my mother last year. Your mom needs a kyphoplasty or a vertebroplasty. And quickly - Medicare won't pay if it's been more than 3 months since the event, as the benefits of the procedure decline as time goes by. We were fortunate to get in to a neurosurgeon just before the time ran out, and Mom's back was better instantly. However, then we had to detox her from the opioids she had been taking. Plus, she got something called "ICU dementia" (I'll leave that to you to Google), and it's taken about a year for her to recover from that. The kyphoplasty is a quick, minimally invasive procedure - the pre-op took longer than the procedure. Good luck! ETA: Here is a place in your city that does such things: https://txspineonline.com/territories/midland/
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cwillie Dec 2018
I first read about those procedures here on AgingCare - more than one person has had a loved one with similar psychosis that was the result of poorly treated pain and medication side effects.
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Have you tried a Chiropractor (I have a crushed lumbar 1 & 2 and a Chiropractor helped He also helped evaluate whether or not a TENS unit would help -- Believe me it does and relieves the pain enough that I can control it with Tylenol and Aspirin, Also try Lidocaine Patches, Menthol Patches (Salonpas), you can also get both in lotions and they work wonders.
They are not addicting and should not cause any mood changes. The patches are OTC (over the counter) I buy the Lidocaine Patches several boxes at a time over the internet to get the price below $1.50 per patch, the Menthol Patches are more reasonable -- I would say get a box of each and see which helps the most.
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I'm just tossing out some ideas...

Ask about surgical options - vertebroplasty or kyphoplasty.
People have mentioned pain patches rather than using oral analgesics
Medical marijuana?
Nerve Block Injections?
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Tramadol should be banned, it is a terrible drug with wicked nasty side effects. I cringe every time I hear someone has been prescribed that poison.

I would not let them tell you she needs to be placed in a memory care facility. She needs her medical issues addressed. This is a tough time to be in hospital. I would request a spinal specialist and a pain specialist. I would also request that they rule out any type of infection.

I had to be a raging b!÷@h when my dad was in hospital to get his medical needs addressed, I don't know why they think people are there, holiday I suppose. You are dealing with the bottom of the barrel when you are dealing with hospitalists, these are the doctors that can't have their own practice because patients meet them once and run the other direction. Stick to your guns and get specialists called in.

Best of luck and may God give your mom pain relief. That can make a person crazy beyond belief.

She needs her pain dealt with, maybe something topical to get it calmed down.
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Has she been tested for a UTI? It sounds like there is more going on here than untreated pain.

Tramadol was a Godsend for my mom, obtw.
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There are a multitude of options to try for managing the pain and the hospital/doctors should be on top of this, it really concerns me that they aren't. It is so important that her pain get under control/managed so she can heal and get back to her baseline. Several good suggestions here, another option you could try is acupuncture and or homeopathic or Essential Oil and other Eastern, more natural remedies but they do take some time and due diligence. There are more and more doctors and hospitals using some of these pain management tools in conjunction with Western Medicine so it might be worth investigation there at the hospital. Otherwise if you do explore any of these make sure you find reputable info there are far too many advantage seekers out there now...however these can be very powerful, miraculous even remedies, I speak from personal experience.

I see you are already thinking and investigating UTI, good because it is very likely more than one thing going on here now, so often any hospital stay at an advanced age now means several rabbit holes to follow...the cognitive decline/signs and symptoms being common which is why it is so helpful to have someone that knows them well around to advocate for them a lot. This is not always because the hospital is a bad one or the wrong place for them even it's just a fact of life for the aging I think and yes some hospitals and facilities are not great places to have to be many of them are very good too but still new surroundings and any imbalance in their bodies are things our minds just don't deal well with as we advance in age.
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My dad had bone pain from metastasized prostate cancer. Doctors tried many pain relievers and relaxants that were ineffective and/or had horrible side effects. His behavior (dementia) was out of control from pain and drug side effects. He finally got relief both physically and mentally from the lowest dosage 3-day fentanyl patch. Occasionally he needed regular tylenol for breakthrough pain on the third day, just before the patch was changed.
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Have you talked to anyone about CBD oil?
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