Pain Management

Hello,

I am new to this board. My father is 57 with stage IV PC with mets to liver.  First diagnosis  was 2/07.  Recently my father is not doing well as his tumar markers are sky high.  He is on Fentnl patches 100 mcg  and Ms Contin 120 mg every 8 hours.  He is still experiencing pain from time to time.  When I bring up the issue of pain with the oncologist he just tells me to take more MS Contin  (time release) as long as it is not sooner than every 8 hours or double his patches.  I am afraid my father will overdose.  Can anyone tell me if what he is on now is extremely high? 

 He also has started a new treatment of Alimta.  Does anyone have experience with that?  

Hi there -

You have to get your doc to be very specific and provide you with as many options as possible for pain mgmt.  If the doc seems too busy - see if they have a nurse who has more time and can discuss options for you.  At this point pain mgmt is the most important thing -- is your dad currently taking treatment like chemo?  If not, you might want to consider inquiring about hospice as they are specialists when it comes to pain mgmt.  Best wishes to you and your dad.

I was also going to suggest hospice.  My mother's doctor has definitely taken the time to explain things to us and one of the things he really wants us to consider is hospice because they work directly with the doctor to make sure the patient has the right pain medication for his situation.  Thankfully we're not at that point yet but we are looking into it, first I'm trying to get my mom on the CAP-DA program where she just came on the waiting list.  This helps in providing home assistance and once I have them, I'll get hospice involved for when I do need them.

Sorry if this sounds rough, but with Fentanyl and MS, what is the problem?  

 

Don't worry about addiction.  At this point, it's OK

 

I guess my question is, since he is still having a lot of pain on the dosages currently prescribed can he just take more as needed?  Or could  he end up with a drug overdose.  Should the doctor be writing a script for that?

You really need to involve hospice. They were great for my husband, He claimed not to have pain but I found that hard to believe.On her first visit, I told the hospice nurse that I was afraid my husband was lying about not having pain. She checked him out, watched his face carefully, listened for tell-tale sounds. Then she said he was NOT in pain but that he was agitated. She told me to give him two oxys to help him relax. He dies quietly and peacefully an hour later. How grate I was that he was calm and peaceful at the end. If the hospice nurse had not told me what to do, it might have been very different.

The hospice personnel know what they are doing. They can help with pain, anxiety, sleeplessness in a way that you alone cannot. They have time to devote to you that a doctor does not. Please call on them as soon as possible, for your sake and your dad's. Don't wait. My husband was much closer to death than I realized. Even though she came only once, I'll forever be grateful to the hospice nurse.

In all of my research, I have found that what works for 1 doesn't work for all.  My sister has stage 4 PC, and is on 100mcg patches now, with dilaudid as needed.  Speak with the doctor, let him or her know your concerns, the medications may need to be adjusted.  My prayers are with you. 

Yes, that is a high dose, but this is also a very painful disease.

As a chronic pain patient, (post Whipple) I use the fentanyl patch every day. It was a blessing to find something that did not require me to take a pill or to feel drowsy or groggy after I adjusted initially to the dose. I use a 50mcg patch but for the record, the higher the pain is the more pain medicine you seem to be able to tolerate without side effects. The life threatening side effects with these drugs are breathing problems. It depresses the ability to breath so over medication results in shallow breathing. (delayed, slow, shallow and could actually stop someones breathing.) So you can watch for these symptoms when they sleep. Fentanyl patches can only be used by someone that already has tolerance to opiate drugs. Your tolerance continues to grow with time even if the pain doesn't increase and soon I will probably need an upgrade in the patch even though my pain level is probably not increasing. With this form of aggressive cancer though, the pain is growing which is different from someone with a chronic ongoing problem.

My mother in law had pancreatic cancer and we were able to care for her at her home with the help of Hospice for the last weeks. Her pain level changed quickly too from my experience and the Hospice nurse was a great resource to be able to recommend a plan (with your drs approval of course) to recognize and address the pain with medication. They have been close to these patients and pain management is a huge focus of the program.

In the end, we still had difficulty controlling her pain. I am not sure she was ever completely comfortable when she was awake and even when she was asleep she cried and moaned as if the pain were still pretty great. Even in the last days when she was not really conscious and we were using a great deal of dilaudid via suppository to control her symptoms but I still think she was in pain. I did worry about over medicating her and when she died I even wondered if I had given her too much medicine even though it was ok'ed by her doctor. The nurse and the doctor assured me after her death that the medicine had no impact. 

I understand why you would worry. It seems that pills are more easily to adjust until the pain seems bearable. You can gradually increase the dose until the right mix is found or the maximum recommended by the doctor is reached. The patch takes about six hours to take full effect and when you take it off it takes some time for the effects to wear off as it is slowly absorbed into the skin. Doubling the patch does seem extreme but I assume if you double the patch you wont use the MS Contin? I would get clarification from your doctor if you didnt understand whether to discontinue the MSContin.

I know we are programmed to think that these drugs are horrible for us, but they are required in this situation (and others) and certainly an addiction problem is the least of the worries. I think the bottom line is that pancreatic cancer is a very painful condition, and whatever can be done to eliminate suffering, should be done to allow the person to have some sort of comfort and dignity should be done. Adding extra pain medicine may put the person to sleep for most of the time. It may be disturbing for you to lose that time with them, but it seems kind to try to keep it under control if you can. I don't believe in blindly following medical advice but certainly an experienced oncologist has seen this condition and understands the risks of medicine vs. the benefits.

Your family will be in my thoughts and prayers.

 

 

On 2/28/2008 4myPapi wrote:

Hello,

I am new to this board. My father is 57 with stage IV PC with mets to liver.  First diagnosis  was 2/07.  Recently my father is not doing well as his tumar markers are sky high.  He is on Fentnl patches 100 mcg  and Ms Contin 120 mg every 8 hours.  He is still experiencing pain from time to time.  When I bring up the issue of pain with the oncologist he just tells me to take more MS Contin  (time release) as long as it is not sooner than every 8 hours or double his patches.  I am afraid my father will overdose.  Can anyone tell me if what he is on now is extremely high? 

 He also has started a new treatment of Alimta.  Does anyone have experience with that?  

My brother (52) is also stage IV with mets to his liver and linig of this stomach.  I just posted my brother's pain meds, but accidently left our the dosages.  He is on 900 mg (300, 3 X/day) of MS cottin; 200 Mcg fentanyl patch (2 patches, changed every three days), 12 mg of Dilodid via a pic line/every hour, and 225 mg Lyrica (75 mg 3 x/day). Unfortunately, pain is still an issue for him and we are trying to figure out what's going on.  He still functions at this level, though is no longer allowed to drive.  He continues to walk on his treadmill when he feels well enough.  Your dad may develop an opiod tolerance, as my brother has, which may neccessitate a higher dose down the road.  I wish him much luck in his fight.