Chronic pain conditions affect about 30% of elderly people. The first line of treatment they are given when they see their doctor is either an immediate or extended release opioid medication like hydrocodone with acetaminophen.
Elderly patients with chronic pain usually develop insomnia which in turn can make pain worse.
Benzodiazepines are often prescribed for insomnia and anxiety. These would be medications like Klonopin and Ativan. Insomnia and anxiety can both occur with chronic pain.
Older patients have an increased sensitivity to Benzodiazepines. As we get older we don’t metabolize medications the same way we used to. This can cause an increase in sedation and memory loss. Unfortunately too many people are unaware of this.
With the opioid addiction crisis becoming more of a problem the CDC came up with a set of guidelines for prescribing opioids for chronic pain.
The guidelines are intended to improve communication between providers and patients about the risks and benefits of opioid therapy and reduce the risks associated with long-term opioid therapy.
Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain. Clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient. If opioids are used, the should be combined with nonpharmacologic therapy.
Clinicians should prescribe immediate release opioids at first and at the lowest dose. For acute pain 3 days or less is often sufficient, more than 7 days is rarely needed.
Clinicians should avoid prescribing opioid pain medications and benzodiazepines concurrently whenever possible.
My Dad has always had severe anxiety. He never told a doctor about it, I think he only discussed it with my Mom and me.
When he had to go on dialysis he found that towards the end of the three and half hours he felt the overwhelming urge to get up and leave. He couldn’t keep his legs still. He’s always had problems with his legs being restless. He’s always been a light sleeper and now the restless legs were causing him to get no sleep at all. He finally mentioned it to his Primary Care Doctor. His Doctor put him on Klonopin, 5mg three times a day or as needed. I know my Dad, he wasn’t going to take them three times a day and I felt comfortable with it being a low dose.
His health became worse and he was under more stress. He wasn’t sleeping at all and his legs were moving all the time. His Doctor prescribed Restoril 30mg. I wasn’t aware he was taking this medication until he was on it for a few months. I started to notice a change in his behavior.
Restoril is a benzodiazepine. Now he was taking 2 benzodiazepines but this one lasts longer in older adults. The other problem is how these medications work when you’re on dialysis. His Doctor has a habit of not taking this into consideration or looking it up. During the day he was off balance at times and sometimes sounded like he was slurring his words. I was pissed about it and told my Dad he shouldn’t be taking both medications that there were better alternatives, but he was so afraid of going back to not sleeping he wouldn’t listen.
My Dad hurt his back a few months ago. I repeatedly told him to go to the doctor but he refused. He finally went to his Primary Care Doctor who of course prescribed him Hydrocodone on top of everything else he was already taking. I didn’t know he was getting 90 at a time.
My Dad came home a few weeks ago extremely upset. He had crashed his truck into a guardrail and didn’t know how. The truck was brand new and completely totaled. He took out 200 feet of guardrail and both air bags deployed. He refused to go to the Hospital even though his ribs hurt. If they had tested his blood they would’ve found Klonopin, Restoril, and Hydrocodone in it and he would’ve been arrested. He had no idea the medications were still in his system and effecting him as much as they were.
You would think this would’ve scared him but it really hasn’t. He’s in so much pain from the compression in his back and the previous fractures that he can’t sleep. At 75 and being on dialysis he doesn’t want to have surgery and I don’t think anyone would do surgery. The doctors he’s seen have been useless.
I sit here and watch him fade away. He’s down to 149 pounds, he’s all bone with a sunk in face. He doesn’t look like my Dad. He’s getting up in the middle of the night and saying scary things like how he wants to die. He has no memory of what he says or does from the night before. I can’t remember the last time he said something positive.
I don’t know how much longer I can watch him pop pills slowly killing himself. I’ve done this already with my Mom.
I feel so guilty for wanting to have a life of my own. I’m also petrified because I’ve never been away from home.
I don’t want to be 75 and alone. My Dad has had a wife who adored him, children who love him, a job he loved, travel experiences, a lot of good memories. It’s sad that only 1 of his children worries about him but that’s most families. My siblings think I owe my parents because of what I put them through when I was younger. First, my brother was way worse than me. Second, I think I’ve more than made up for my mistakes in ways they will never know or understand. I did it with love, understanding, being there when needed, listening, and on occasion I made some of their dreams come true. I’m proud of that.
But it’s time for me to have a life. I won’t survive mentally watching my Dad die. He’s always been my hero I don’t want to think of him as anything else.