Question: What is the best opioid pain reliever for a 91 year old on oxygen, with congenital heart failure, kidney disease, who experiences severe pain of the knees, and other joint areas such as shoulders?

Yes, Dr., I meant "congestive" - thank you. During her recent hospital stay her renal numbers (creatinine) ran from 4.4 to 4.8, her heart efficiency had declined to 32% from the 57% it had been when presented at the emergency room in July 2014. She had a gastro bleed that was the reason for admission on December 22nd last year, which resolved, however is a recurring condition although has not recurred since late December. She has had shallow breathing for over 15 years since she had a triple bypass and was discharged with the diagnosis of congestive heart failure, probably recurring kidney function partial failures, with other age related disfunctions. She discharged from the hospital with creatinine at 4.4 and we had been strongly advised to treat her in palliative with hospice care, which we rejected and admitted her to a rehab nursing facility. She was unable to walk and could barely talk. She had to have a thickened liquid and puried food diet -- after 4 days she woke up yelling at the nurses and letting us all know it was time to take her home -- he creatinine level had declined to 2.2 (which has been her base line for years) and we were able to start her on rehab -- after 30 days we were able to take her back to the assisted living facility where she has friends and is playing Bridge again. We have the medical team at the facility taking responsibility for administering her drugs morning and evening, and I just found out that she has been enduring severe pain (normal that she has pain that over the years has been controlled by taking Hydrocodone only when needed) without telling the MA's -- found that tramadol has been prescribed prn but has not been administered in 5 days -- she had not taken it prior to once 5 days ago and I wanted to research it before allowing them to administer it again -- reason for my inquiry, Dr.



Thank you, Dr. Banerjee, for your thoughtful responses to my question regarding the pain treatment for my mother-in-law. This is the first time I have tried this offer to ask a Dr. on-line for advice and am so pleased with the benefit you have provided, for what I know is such a small amount of compensation for your time and knowledge. I am a financial manager and planner with a number of physician clients, which gives me an opportunity to see what you medical providers are up against in this very difficult transition environment. One of my clients is a pediatrics practice here in XXXXXXX XXXXXXX with five providers. They have been a client for over 23 years and I provide business consulting and financial advisory services to them as well as am the financial manager/planner for the founder and his family. I have seen them go through some tough periods as they have first fought against the changes and then shifted to working hard to change their practice and the way they deliver medicine. Thank you, again, for your help with this pain med issue!
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