need help understanding pain (quad)

[Vickie Neal]

My brother is presently on several medications:
Baclofen/Morphine Pump
Neurontin (3 times a day)
Soma (twice a day)
Vallium (twice a day)

I'm not sure about the mg on each of these medications. He still maintains that he cannot sleep at night for the pain he's feeling in his body. I do not understand this and we have had many confrontations over it resulting in harsh words. I know he likes narcotics, he was on them prior to his injury and abused drugs, so I don't know when to believe him in regards to his wanting more. He says he needs more oral meds for night time, so I had doctor give him an Ambien at night for sleep. Didn't phase him. He had been taking Methadone (2 pills) three times a day prior to his spinal cord injury. This was taken away when morphine was put into his pump. His neuro doctor had allowed the methadone and even wrote a prescription for it (ONE pill every 8 hours), but when he came back home, his primary care physician took it away (too many narcotics he said). So we have two doctors differing in their opinions too. All I know is, he cannot get enough in his system now to knock him out for a good night's sleep. His night sitters confirm the lack of sleep, but I know that he sometimes sleeps during the day (maybe 3 hours) while in his power chair too.

He is an incomplete quad and has certain feelings all over his body and seems to feel inner joint and muscle pains very much. He has degen. arthritis in neck and shoulders to boot.

My question is this: Do you think he might need something for "break through" pain in addition to what he's getting above? If so, can you suggest some kind of remedy, if indeed morphine and methadone don't mix as is indicated by his primary care physician's actions.

Could one of you doctors or nurses please give me a suggestion here? I just know he seems to be hurting, and I'm tired of fighting him over it and am willing to try (again) to get him something for this pain. I guess I just need some input - what do you think?

Thanks
Vickie

[rfbdorf]

I'd suggest he needs a single doctor to handle all of his pain medications - preferably a pain specialist, not a GP. One that is aware of his tendency for drug abuse. His other docs should be aware that they should not interfere with the pain specialist's prescription, no matter what he tells them. Putting it (whatever is used) ONLY in his pump might be the most effective means of eliminating abuse. That makes treating breakthrough pain problematic, but he may be stuck with that, given his prior history.
My wife has used methadone, with morphine for breakthrough pain. Over the last year she has cut the morphine use way down, and the methadone down a little (and planning to reduce more). Her pain is mostly - not all - relieved, and her mind is clearer than before, when other narcotics were used. We did not notice any problem with "mixing" the two meds.
- Richard