24th October 2007
Dear Pax949,
Yes, as wheninrome1313 stated...too much of an opiate can depress the entire breathing process! So, it's good to be careful.
One thing to take into account is the whole "geriatrics" concept. I always HATE calling people "old", but when treating elderly people--medications can act differently than younger people expect.
What you've stated about your Mother's (a word that deserves CAPITALIZATION) medications doesn't make complete sense to me. BUT...I don't have and/or claim any sort of professional knowledge. In fact, I would be thrilled if I had 1/12 of ANY knowledge that would be helpful!!
There is a little bit of medication info that might help, but please know that I am 37--even though my Systemic Lupus and Lupus Anticoagulant make me feel older! FIRST OF ALL, common knowledge on this board says that fentanyl is approximately 70 - 100 times more potent than morphine. But, I think that is referring to an exact mg to mg (or mcg to mcg) basis. When it comes to morphine--many people take long-acting morphine. The fentanyl patch is absorbed (I think--and someone correct me, if I'm wrong) on a mcg (microgram) basis. The fentanyl lozenges (brand name Actiq) are measured in micrograms, also! I still assume that the reason behind this is due to the common knowledge "fact" that fentanyl is 70 - 100 times stronger than morphine.
Can you imagine? I'm actually getting to a point. If your Mother is still hurting (from the hideous conditions she has), why would they reduce the pain relief medication(s)?
Now, others on this board have pointed out that different opiates place themselves on different portions of the pain receptors. If you could take fentanyl, hydromorphone, and oxycodone--they would relieve pain on different portions of the nerves (pain receptors). This is probably why different medications relieve different types of pain.
HOWEVER...AND THIS IS A REALLY BIG HOWEVER...I don't understand why a physician would mix opiates (at reasonably high doses), amitriptyline (a trycyclic that makes a person sleepy by itself), and Valium (another reasonably potent medication [a benzodiazapine]) in someone who is 81. Don't misunderstand me...I am extremely tolerant to everything it seems. But, I am 37 and have been on practically everything since my early 20's! I started Pain Management in 1996, so I'm used to taking a great deal of medication.
People who are approaching older age have a changing physiology--they react differently to medications. Some people don't need as much "stuff" to help them. BUT...I get the feeling that your Mum's doc was still concerned with the pain around her neck and shoulders. After all, she was Rx'd the fentanyl patches and lozenges--the strongest opiates available. So, maybe the physician thought something else (like the Valium, which is a benzodiazapine that should relax muscle tension--around the neck and shoulders) would help that.
Please expect many better responses! This board has members who know a great deal about Pain Management of all sorts. So, keep checking to see what others come up with. We wish you the best.
Take care,
Jon (Conductor)
P.S. I don't mean to offer excuses over and over, but I apologize if I've given poor information and responses lately. Unfortunately, I enjoyed the pleasure of a "right basilar skull fracture" that occurred on June 1st of this year. Truly...the recovery is exceptionally slow! PLEASE PARDON ME CONCERNING THE MANY ERRORS I CONTINUALLY MAKE, OK? For this forgiveness, I am thankful.
Yes, as wheninrome1313 stated...too much of an opiate can depress the entire breathing process! So, it's good to be careful.
One thing to take into account is the whole "geriatrics" concept. I always HATE calling people "old", but when treating elderly people--medications can act differently than younger people expect.
What you've stated about your Mother's (a word that deserves CAPITALIZATION) medications doesn't make complete sense to me. BUT...I don't have and/or claim any sort of professional knowledge. In fact, I would be thrilled if I had 1/12 of ANY knowledge that would be helpful!!
There is a little bit of medication info that might help, but please know that I am 37--even though my Systemic Lupus and Lupus Anticoagulant make me feel older! FIRST OF ALL, common knowledge on this board says that fentanyl is approximately 70 - 100 times more potent than morphine. But, I think that is referring to an exact mg to mg (or mcg to mcg) basis. When it comes to morphine--many people take long-acting morphine. The fentanyl patch is absorbed (I think--and someone correct me, if I'm wrong) on a mcg (microgram) basis. The fentanyl lozenges (brand name Actiq) are measured in micrograms, also! I still assume that the reason behind this is due to the common knowledge "fact" that fentanyl is 70 - 100 times stronger than morphine.
Can you imagine? I'm actually getting to a point. If your Mother is still hurting (from the hideous conditions she has), why would they reduce the pain relief medication(s)?
Now, others on this board have pointed out that different opiates place themselves on different portions of the pain receptors. If you could take fentanyl, hydromorphone, and oxycodone--they would relieve pain on different portions of the nerves (pain receptors). This is probably why different medications relieve different types of pain.
HOWEVER...AND THIS IS A REALLY BIG HOWEVER...I don't understand why a physician would mix opiates (at reasonably high doses), amitriptyline (a trycyclic that makes a person sleepy by itself), and Valium (another reasonably potent medication [a benzodiazapine]) in someone who is 81. Don't misunderstand me...I am extremely tolerant to everything it seems. But, I am 37 and have been on practically everything since my early 20's! I started Pain Management in 1996, so I'm used to taking a great deal of medication.
People who are approaching older age have a changing physiology--they react differently to medications. Some people don't need as much "stuff" to help them. BUT...I get the feeling that your Mum's doc was still concerned with the pain around her neck and shoulders. After all, she was Rx'd the fentanyl patches and lozenges--the strongest opiates available. So, maybe the physician thought something else (like the Valium, which is a benzodiazapine that should relax muscle tension--around the neck and shoulders) would help that.
Please expect many better responses! This board has members who know a great deal about Pain Management of all sorts. So, keep checking to see what others come up with. We wish you the best.
Take care,
Jon (Conductor)
P.S. I don't mean to offer excuses over and over, but I apologize if I've given poor information and responses lately. Unfortunately, I enjoyed the pleasure of a "right basilar skull fracture" that occurred on June 1st of this year. Truly...the recovery is exceptionally slow! PLEASE PARDON ME CONCERNING THE MANY ERRORS I CONTINUALLY MAKE, OK? For this forgiveness, I am thankful.