When pain meds wear off, what can be done for bursitis?

Essie, I sympathize with you and your mom. While I wholeheartedly agree—she’s 94, let her have her meds and live out the rest of her days pain free, the FDA doesn’t agree with that. I think most are now aware that they’ve changed their guidelines and they are really cracking down on doctors that prescribe too many opioids. Because of this, many doctors are really adhering to the guidelines and their patients are suffering in pain because doctors don’t want to get in trouble. Have you thought about having your mom evaluated for hospice? I think her age alone would be a qualifier. Since she’s not dying, it would be palliative at this point, they would just make sure she’s comfortable all the time.

If your mother qualifies, get her into hospice care. Much easier to get pain relief.

I don't know where your mom's bursitis is: hip, knee, elbow, etc.? Regardless, see if her doctor will prescribe methadone for baseline pain and use Norco only as needed for breakthrough pain. Ask about a corticosteroid injection and/or an oral corticosteroid like dexamethasone. Over the counter remedies would probably be limited to NSAID's like ibuprofen or naproxen. You can get these in a cream form that you rub into the area.

Hi, thank you for your input. Hospice came out a year ago and evaluated her. At that time they said she was not ready for hospice intervention. I'm wondering if i should try again? It's been a year now. Thank you all for good advice.

Absolutely—have her re-evaluated for hospice!

It is safe to take both ibuprofen and acetaminophen, usually alternately, so I would ask for that at the very least. People have also mentioned pain patches - I have no experience with them but they might be a good alternative to oral meds. Frankly this NP's worries about addiction in a 94 yr old with chronic pain makes me think s/he is a bit of a quack, you could ask for an opinion from a pain specialist.

she shouldn't have to ask for ibuprofen or acetaminophen. She can just go to the drug store and buy both over the counter.

You might inquire about prescription lidocaine patches. I have them and they do provide some relief, at times more so depending on the severity of the pain yet definitely a relief. Is there another doctor perhaps in another category that she deals with at all that you could approach with this issue? I have found that doctors can vary greatly with sympathetic levels regarding a patient's ailments.

Sorry I assumed your mother was in a facility, your options in administering OTC meds are a little more flexible when you are caring at home.
My mom found pain reliving creams like myoflex or volaren to be helpful also.

To the people recommending OTC pain meds, just because it's OTC doesn't mean it's safe. It depends on the person taking them. Some of you have recommended NSAIDs. For someone elderly, a NSAID may not be safe due to other issues. Acetaminophen is generally safer but you really have to watch the dose. Acetaminophen is in a lot of drugs you don't even think it's in. For the elderly, the maximum dose per day is lower than the adult dose for someone younger. Even with OTC drugs, it's best to check with a doctor to make sure it's safe for that person.

OP, in this case talk to your mom's NP about diclofenac sodium gel. It's a topical NSAID for joint pain relief. Because it's topical, the medication isn't distributed systematically through out the body. Thus the concerns about using NSAIDs are greatly reduced. That is as long as the area it's applied to isn't overly large.

NTWH -
Yes, all OTC meds all have dosing levels and precautions that need to be heeded, that definitely needs to be considered.
And I agree that opiates have too often been given pro forma when other meds could do the job just as well - neither myself or my BIL came home with a script for any opiates after surgery, and we were just fine.
I too wondered if addiction and withdrawal could be behind at least a part of the OP's mother's distress - the thing is I don't think this is the appropriate way to tackle the over prescription of opiates, what gain can there be in withholding meds for a person this age no matter why she has come to depend on them?

Good point about addiction and withdrawal cwillie. My husband was on norco for years because of a significantly herniated disc in his lower back and last October, workman’s comp decided he had been on it long enough so the pain management doctor refused to keep prescribing it. The first few weeks were horrible because of the withdrawl. I didn’t realize it until much later that it wasn’t the pain causing certain things, it was withdrawl effects. I can only go by what i witnessed and what my husband experienced but it does not seem that doctors care much. They did cut back my husbands monthly allotment of norco for a month or two and then cut him off completely. And they didn’t give him anything else until he started pleading for anything—not opioids but anything to help with the excruciating pain. Pain so bad he spent most of his days laying face down in bed because the pain was so bad and that position was the only one that he tolerate. He was given muscle relaxants which made him sleep but didn’t touch the pain. Prescription strength Advil which was the same as 4 OTC Advils. Patches. He even tried a TENS machine. Nothing helped.

And as far why patients are left suffering in pain.....that is America for you. Sure there are definitely doctors that are overprescribing but the solution isn’t to cut off people with documented painful conditions. Unfortunately what is happening in this country is that people are being cut off from opioids and left to suffer debilitating pain and what is happening is that many of them suffer until they can’t take it anymore and they commit suicide.

I can understand why doctors are afraid to prescribe opioids these days but.....cutting people off isn’t the answer. Most people who OD on them obtained them illegally in the first place.

NTWH has mentioned diclofenac sodium gel for bursitis. I have bursitis in my foot and found that CBD lotion helped more for it than the prescription gel. Also I now take 2000mg turmeric daily which is helpful for bursitis and the pain in my foot which made it hard to walk, is much more manageable. Just a thought.

I agree with the diclofenac and CBD creams. You can also ask for a palliative referral. A NP from a pal care agency is more comfortable usually with pain and symptom management. They make house calls one or 2 times a month.

It's a problem bc she IS 94. It's the respiratory breathing issue that could arise even with what she is already taking. Increasing her dosage could be problematic depending on how she is doing otherwise...flu, infection,etc.

Dof is more worried about in this case your mom's breathing than addiction worries

I feel for you. No one wants to see their loved one, in pain.

You're right, she's 94. Give her, what she wants. The Dr might be covering his/her butt, by "over" prescribing.

Have you tried OTC patches? I'm an in home caregiver & my client swears by "Salon Pas" patches (sold everywhere but best buy is at Costco). Also, Lidocaine patches 4% is OTC. So is Aspercreme patches.

My client also swears by Vinegar. She applies it liberally to her feet. (Takes away her restless leg pain) She also wears sweat bands on her wrists, to help with pain in her wrists & hands & fingers (just regular ol' sweat bands. We got a whole pack of different colors on Amazon) So cheap but they work (for her)

She's also on Tramadol but still needs these other products.

You name it, she's tried it. She's 92

Hope this helps.

If your mother has been diagnosed with bursitis by an orthopedist, why didn’t he give her a cortisone injection in the joint affected? That and/or physical therapy is the usual treatment.

It makes me so angry that people and especially the elderly are under treated for pain. I’m a retired registered nurse and full time caregiver for my husband who suffers with Multiple Sclerosis and chronic pain. First: is Mom getting any anti inflammatory meds—Aleve, Advil, Ibuprofen? These are all OTC. Inflammation is a major cause of pain in bursitis, so these can help a lot, and can be taken with Norco (2 tabs daily is useless). Second: stop the heating pad and switch to cold packs 15 minutes on/ 15 minutes off. Heat only aggravates the inflammation. Third: People who are using opioids to treat physical pain (and not to get high) do not become addicts! And I agree, at 94 years old, so what? Finally: consider getting Hospice/Palliative care at home. They are much better about managing pain as they’re goal is comfort care. They don’t flip out over giving opiates. I had my ML on hospice for several years. (She died at home last March at 98 years old.) I hope this is helpful to you and your Mom. Warm regards.

Id like to suggest looking into Hospice pain management care,Hospice is Not just for people on there way out..its About Being Pain free and comfortable, My Family member(80yrs) has been on Hospice care,and has Medications for use to manage the Pain..What I've noticed that helps So much is Atavan..it helps to relax her..Hope my suggestion helps.

I would request a referral to a pain management doctor.

They will actually treat her pain.

As a retired NP, I am embarrassed with the response from your mom's NP.
My sister is on Meloxicam (RX) for severe arthritis of her knee. She remains ambulatory. Might ask her NP/PCP to consider/try it.

Yeah. So now patients are victimized by the insanity and the pain is left inadequately treated. I would be tempted to tell the nurse she will be more worried about malpractice for not treating the patients pain! Just kidding. I'd be checking to see if there is a pain management dept of the closest large medical facility. Or touch base with a hospice program. This is the stuff that makes me crazy.

Norco is a combo drug of acetominophen and hydrocodone. Usually it is administered every 4-6 hours to manage moderate to severe pain. Does mom get Tylenol (acetaminophen) or another NSAID (non -narcotic over the counter pain med) on a regular schedule to manage her bursitis? Have you tried analgesic creams? I use Voltaren cream 1% (prescription medication) for my arthritis when it flares up.

Seems a pain management doctor referral would be a good start. He/she can try other non-narcotic approaches: oral prescription meds, prescription creams or gels, steroids, heat/cold applications... He/she could also help you with finding the best dosing schedule for mom's narcotic.

The problem all health care practitioners must consider with older patients is that narcotics can decrease respiration and older folks clear medications much more slowly than younger folks. That is probably the reluctance your NP has to adding more narcotics to your mom's regimen.

Just wondering, does mom live with you or in a facility? If in a facility, they keep the narcs under lock and key. If mom lives with you, please keep her meds secured.

You should try CBD oil. My Dad, 87 years old, has taken it for his bursitis. He helped while other medications didn’t.
There is no THC in this oil. I hope this helps! My dad takes it every night to help him sleep. He is in an assisted living facility. It has helped him to not be so anxious. He also has dementia. His cardiologist and primary care said it was fine for him to take it.

Essie,

I do not see a reply where you mention where Mum has bursitis. I have had it in my right hip for 5+ years, when it flares up, I must walk funny and I get a flare up of Achilles tendonitis in my left ankle. Flare ups last up to 6 weeks and I treat them with Ibuprofen. Large doses that were approved by an Orthopedic Surgeon.

All medication needs to be reviewed by attending physicians, none of us here know what other medications Mum is taking, nor what medical conditions would preclude some treatment options.

Voltaren is OTC here in Canada, and it helps with the Achilles Tendonitis, but cannot get deep into my hip joints.

There has been discussion by prior posters about the benefits of heat or cold. I worked for physiotherapists for 11 years. Although the general rule of thumb is cold for inflammation, it does not apply in all cases. Some people tense up when cold is put on them, defeating the purpose. Many people respond well to alternating cold and hot packs.

Mum is a volunteer in our local hospital. A couple years ago she met an elderly (probably younger then Mum) woman who had become addicted to Oxycodin, post hip replacement. She was in a terrible state, trying to deal with withdrawals.

Every single person's 'pain' is THEIR pain--just b/c you came home from a surgery and needed only Tylenol and it was effective DOES NOT mean that everyone has that same kind of pain tolerance. Chronic pain takes the absolute soul out of you--when you can only lay in bed and cannot walk, exercise--even get UP b/c the pain from whatever is so bad--then why would your dr withhold an opiate? Keeping the pain cycle under control is the goal of most caring doctors. Once it's out of control it takes a long time to get it 'back'.

And yes, drug addicts and 'street dealers' are still getting their stuff. The 'war on opiates' has been an epic fail. You know who abuses drugs more than anyone? People in the healthcare field. Drs and nurses---anesthesiologists are the 'worst'. And I know this b/c my DIL IS an anesthesiologist and when she goes to conferences--this ALWAYS comes up.

I have to see my PCP every 3 months to renew my scrip for Tylenol 3. I have arthritis in every joint in my body. Ibuprofen has caused me to have some kidney function issues and my PCP is very judicious in prescribing. I WAS on Norco until 2 back surgeries fixed the back problems, but the arthritis is a lifelong problem and isn't getting better. B/c it's throughout my whole body, covering myself in some gel or putting cold packs on the 'sore spots' and trying to function on Tylenol alone? I'd spend everyday, all day chasing down the 'hotspots'.

Nobody's pain is like mine and mine is not like someone else's. I wish we didn't even have to have these discussions. I'm 100% functional and feel capable of doing in a day what needs doing.

I won't live to 90, but I HOPE I will be allowed to manage my pain with the compassionate care of a good dr. Arthritis does NOT 'get better' as we age.

My Papa is 92 and has chronic pain issues, in addition to Parkinson’s and pain from dozens of falls. His family doctor took him off his pain medicine, which is insane. He said that, unless you are a Pain Management Specialist, you will “warned” by the government if you prescribe opioids. So the elderly get to suffer. Same with benzodiazepines, like Xanax.

Since bursitis is caused by inflammation, ask her doctor about an anti-inflammatory. That sound make a significant difference. I take one twice a day, I was really surprised at how much it helped.

I got the same nonsense from my mom's doc about addiction. Having said that, addiction is real and withdrawal is a nightmare. But legitimate pain should be treated. My mom broke a vertebrae and was in agony and the doc gave me the song and dance about addiction and I wanted to strangle him. So I basically said what can you give her? And most importantly, the nurse at her ALF talked to him as did the head med tech so then he gave her a fentanyl patch. That is strong stuff and imho way more addictive than percocet but whatever. She did have problems on the fentanyl with auditory hallucinations and being out of sorts and I so wanted to switch her back to pills and the doc just wouldn't budge. She did adjust though and now I'm wanting to decrease her fentanyl because I think she's doing much better and I don't want her to develop a tolerance. Her bones are dust so its a matter of time before she breaks another one and if she's already tolerant it will take so much more pain medicine to get her comfortable. Guess what doc says, NO he wants to keep her at the higher dose because he's worried about her pain. Ugh. Neither of us likes her doctor but I can't get her out and he does do housecalls so we're sort of stuck. So I'm mostly venting but try to see if doc will prescribe something else that THEY are more comfortable with. Also try to get someone else to advocate for you - the PT, a visiting nurse, anyone but you sometimes will help.
Good luck

Would a lidocaine patch be strong enough to relieve her pain? Or a cortisone shot?

EssieMarie, we tried pretty much everything for my 95-year-old mother's arthritis pain. From Celebrex to hydrocodone to PT to morphine and nothing was helping, or at least for very long. After hearing from one of the former nursing staff at her ALF on how well it worked for this woman's grandfather, I sought out CBD oil. I'll admit I was pretty skeptical and worried about trying it. I spoke with her doctor to make sure it wouldn't interfere with anything she was taking, and was told blood pressure meds were about the only bad interaction. While my mom isn't on any of those, she is on Lasix for CHF. A 20 mg dose around noon seems to keep her out of pain, has helped with her cognitive issues, and has mostly stopped the sundowning. There's no THC in it, but unfortunately, it's not regulated. If you decide to try it, my best advice is to start with small doses.

And if you're not happy with how it's working with the NP, try another. A second opinion never hurts. Sending hugs!

Try rubbing DREAM CREAM into her painful areas. Active ingredient is Histamine Dihydrochloride. It is over the counter at CVS. Besides the addiction issue there is an increased chance of her falling.