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Back Problems Message Board

Back Problems Board Index

Dear all

A month ago my elderly father aged 83 had a great escalation in his back pain to the point of being unable to move in the slightest without excruciating pain and was hospitalized and put on pain medication (Fentanyl patch 25 mcg) and Dilaudid up to every 4 hours as needed, among others).

MRIs and Xrays have given us a conclusion of "multiple disc problems" -- I've been told Spinal stenosis, spinal osteoarhritis with fusions, and herniated discs at different times by different doctors.

Additionally, he has always had a difficult stomach, feeling nauseous and unable to eat at times, and only a limited variety of foods -- and would take antacids and Pepcid regularly.

He has declined surgery for the condition, thinking it is too painful and difficult at his age, so the only option was to send him to a rehabilitation center to try to work with the pain. He spent a week or so in the program, and began to look better and move better, but gave up, because he just feels too miserable. He then refused medications because he figured they were aggravating his stomach even more.

Unfortunately now for the past few days he can no longer eat, but drink only water, and has refused any further tests, feeding tube, etc and is confined to the bed. He is getting weaker and weaker.

Doctor said the Dilaudid, or the pain itself that may have constricted his stomach. And truly, he does sound like there is stuff coming back up in his mouth. Doctor removed Dilaudid upped the Fentanyl to 50 mcg upon informing her.

My father won't take anything in pill form so I wonder if there are some good anti nausea medication by injection that can make a big impact.

I also wonder (since my father vomited after receiving a morphine injection) if opiods like Fentanyl itself are contributing to this inability to tolerate food. Fentanyl is the only medication he's on now.

Any reply is greatly appreciated. This is an urgent situation.

UPDATE: Now the Fentanyl has been increased again to 75 mcg upon my asking. I wonder if we have we been not getting good pain management or is this level appropriate after a month of beginning opiods.
As I said, my father won't take any pills by mouth. No other liquids besides tea/water. I'm not sure how much is nausea, how much originates from the pain or is just loss of appetite. We really cannot tell either way if he won't do an endoscopy, but I tend to think it may be his decision not to eat due to the intolerable circumstances.

Every day I see him alive it still seems like there is a tiny bit of hope but when I speak to him there is no possible means to enter a meaningful discussion on the subject, only to irritate him.

I continue to wonder, Where did we go wrong and how can we get back to that decision point? I honestly did not see this coming..or I would have been there at each moment. I thought he was going to give the rehabilitation a try as a conservative treatment, first, then consider the injections or surgery. I could not really anticipate that his life could end over back pain. Other than this he seems relatively healthy for his age. Yes, the pain is excruciating and debilitating. However, assuming no greater illness is present, can giving up be legitimate if he hasn't really tried any more aggressive treatment, giving himself at least a chance? This isn't end-stage cancer or Alzheimer's, this is osteoarthritis and yes, depression.

It probably has something to do with his outlook on the future as an 83 year old. What can he expect (his return) if he goes through difficult treatments (investment)? More bodily problems associated with advanced age, including possibly dementia, and maybe he feels now is a good point to stop and avoid getting in any deeper.

OTOH, My grandfather at age 90 decided he didn't want to suffer any more and had an operation to remove a cancerous tumor. His thinking is more present-minded, his logic being that the worst thing that could happen was that he died, which would happen anyway without surgery. Though he had a more straightforward operation - cutting into soft tissue. Not fighting intangible pain. Maybe the deciding factor for my father was that the doctor could not guarantee that the pain would go away with surgery.

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