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    Suggest remedies for severe knee pain in an elderly person

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Posted on Tue, 24 May 2016 in Medicines and Side Effects
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?
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Answered by Dr. Arnab Banerjee 3 hours later
Brief Answer:
please follow the advises....

Detailed Answer:
Hello XXXXXXX Welcome to Health Care Magic,

I really appreciate your concern for your mother in law.

Well to clarify a few things first , you meant 'Congestive' Heart failure and not 'congenital' - right ?

Please describe in details what kind of kidney disease she's suffering from and what is the current Renal function (you can upload all her latest reports so that I can take a look at them for a better understanding).

This is important as you should know that many pain killers primarily get excreted by the kidneys so a proper functioning is vital otherwise they tend to accumulate in the body causing lot of side effects.

The Second important thing is Cardiac as well as liver function. Now understanding the fact that she's already dealing with Heart failure , I'd like to know what is present cardiac status(latest 2D-Echo and ECG reports as well as routine trend of Heart rate and BP).

Now coming to your query , till date FENTANYL is one of the best Opioid analgesic available . It's available in various forms , among them the Trans Dermal patch(Skin Patch) will be most suitable for her , in dosage like 25 MCG/HR to start with and each patch lasts for about 72 Hrs so no need to change every now and then .

But make sure the Cardiac function remains maintained(as by thumb rule Opioids specially Fentanyl is prone for causing slowing of heart rate to proper monitoring is required ). Also there should not be any element of drowsiness.

Also it's prone for respiratory depression so if you feel she's having rapid shallow breathing, taking less than normal breaths then it's better not to use it at home . Since she's already on Oxygen so I believe you must be having Portable Pulse Oximeter at home (which if you don't , I'd strongly recommend to buy as it'll monitor the heart rate also).

Since you've particularly asked for Opioid , that's why I've mentioned all these . Apart from opioids , there are several other options available also.

But since Fentanyl comes under narcotics, so it's not recommended to use at home , and Proper Prescription is needed to purchase so you need to check into your Local physician to get that.

Also be cautious of any overdose, tramadol should be avoided to be on the safe side initially to see how she's doing with that only.

Please make good use of these information, wish you all the best.

Feel free to discuss anything.
Kind regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Dr. Arnab Banerjee 1 hour later
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!
XXXXX
YYYY@YYYY
doctor
Answered by Dr. Arnab Banerjee 20 hours later
Brief Answer:
You're always welcome to have my suggestions..

Detailed Answer:
Dear Mr XXXXXXX Thanks a lot for your kind responses,

Well personally I feel , be it online or in-person, if a Doctor is well-read and well-trained as well as well-experienced , he/she can diagnose +/- treat the patients' irrespective of the situations(with just a few circumstantial exceptions which none of us can control, you can understand what I'm referring here)..

Me being a Critical Care specialist always face death and life from so close day in and day out , still always try to maintain a positive outcome in this regard regardless of the situation..

Every day I see so many patients in and out of ICU and Emergency , with so many of them are dealing with the same kind of problems (myself been to several countries so far but let me share some inside info's with you, be it USA/UK or any third world countries, the root of the problems are always the same), me too believe that with proper and timely intervention, we can reduce the disease burden a lot , but the fact is there are too many of them(diseases as well as patients) and too few of us, so the battle is definitely hard but yes definitely possible..

Yes , once again , irrespective of places, mal-practitioners are always a curse of the society and always have some strong political/illegal supports. They are every where in every field, so we need to be vigilant about them and hit hard right in the beginning .

Take Care of your mother-in-law , yourself as well as your family..
Wish you all the best..

Best Regards..

You can always be in touch with me with any kind of concerns, through my direct link which I've already shared..

Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Answered by
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Dr. Arnab Banerjee

Critical Care Specialist

Practicing since :2012

Answered : 1320 Questions

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