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Advice for pain management of senior (80+)
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brickwalls posted:
My 80 year old grandmother has been suffering with lower back pain past 2 months. My mother has been massaging my grandmother's specific pain area which provides temporary relief. My grandmother is unable to lie down or walk for long periods of time due to pain. Her primary doctor says to call EMS and have her transported to the emergency department where there is pain management. My grandmother is stubborn and is not willing to wait for long time in the emergency department. Her friends says she might need cortisone shots to her back area.

1. What is the positives and negatives of my 80 year old grandmother taking cortisone shots to her back?
2. What is some ways I can find specialists in the NYC area that I can schedule an appointment for scans/MRI and is knowledgeable in senior pain management? I'm having a tough time finding an office or hospital I can just go for advice.

I just want to get my grandmother some help and relieve the stress my mom is going through right now.
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davedsel57 responded:
Hello.

The only way for your grandmother to know what is going on in her back and to get proper treatment is for her to be evaluated by a doctor. Cortisone shots do present some risks to patients of any age and are usually never the first course of treatment for back pain.

Unfortunately, the questions you pose here can only be answered by her own doctor and a spine or pain management specialist. It seems to me that the best way for your grandmother to get the treatment she needs is to be transported to the emergency department where there is pain management. It is against the rules for us to recommend specific physicians in any WebMD Community. There is an option to search for doctors at the top of the screen under the search bar.

I pray your grandmother gets the treatment and relief she needs soon.
Click on my user name or avatar picture to read my story.

Blessings,

-Dave
 
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dianer01 responded:
I completely agree with Dave about your grandmother needing a thorough evaluation.

Ask your grandmothers primary care doctor for a referral to a spine specialist. This is probably the most efficient way to go. I also don't know if a pain management doctor will treat without a diagnosis.

If your grandmother starts having problems with uncontrollable pain, foot drop or incontinence, then by all means call ems and get her to the hospital, as this is an emergency.

Even in NYC you may not find pain or spine specialists for the elderly. I think I would look for the best spine specialist in general then make decisions from there.
 
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brickwalls replied to dianer01's response:
Thanks for both of your replies. I figure if she wants this taken care of, she would need to go to the emergency room. I think it's now a matter of trying to convince her. She's 80, so if she wants to be stubborn, all I can do is try.
 
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trs1960 replied to brickwalls's response:
I recently read a complete study about geratrics and pain managment. Geratrics present special problems when it comes to chronic pain, from communication to the stubborness you describe.

I'll look for the study and try to post a link.

Tim
 
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trs1960 replied to brickwalls's response:
Somewhere in here in the physicians tools http://www.painknowledge.org/physiciantools/ there's a section on treating geriatric patients with chronic pain. I read the entire thing a few months ago and I think there may be some stuff to help you with your grandmother. There's a section on FPs (Functional Pain Scale) and how you need to adjust it for the elderly.

I want to thank you for caring for and about her. I know she's your grandma, but so many people just ignore their elders. It's sad. We used to be a society that cared for their families. Now it's all about "me."

My employer held a pain sminar lunch. Ironically I was out for my anelgesic nerve block, but got to catch the last part over Webex. My employer tries to offer some great tools. If I have any work problems it's usually the middle managment type that wants to be someone important and they just don't get the message.

That and as Dave mentioned, coworkers that are ignorant and think you're getting away with something when you take a half day off to go lay down.

I think Dave and I have been through many of the same battles. (I'm sure many of us have) I'm still working, but I know I probably shouldn't. Then again I like working and being around my friends. It feels great when I'm productive and I am providing income and health insurance for my wife and our girls, but at what cost?

Your grandma has already paid her dues and she shouldn't suffer un-needed pain. Good luck helping her.

God bless you.

Tim
 
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dianer01 replied to brickwalls's response:
Hi Brickwalls:

You are not alone in trying to care for a stubborn person. We are caregivers for my husband's cousin who is 88 and has many issues including an Alzheimers diagnosis, degenerative spine issues and congestive heart failure.

Dear cousin was complaining about back pain so the next doctors appointment we asked about it and because of his age and medical history they are basically not going to treat his issues. The doctor suggested he take some tylenol and dear cousin said, "oh no. I already take too many pills."

So how do you argue with that logic? If he starts grumbling, I ask if he has taken the tylenol and if the answer is no, I walk away. I can only make myself so crazy when someone is going to be too stubborn to follow very conservative advice.

So my final advice is don't let your grandma control your mother and if she is unwilling to do anything to help her situation, then there is little you can do for her either.

I don't want to sound cold but there comes a point where you have done all you reasonably can and the person in pain has to accept help from professionals.
 
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brickwalls replied to trs1960's response:
The link is very helpful. I'm going to use the scales and logs to track my grandma's day-to-day progress. Maybe if she wants to go to the hospital or feels up to seeing another doctor, the logs will give the staff helpful information and cuts down on the repetitive questions and visits and get down to just making her feel more comfortable.

Thanks for thoughts, advice, and prayers. I didn't expect too many helpful advice, but I was wrong. Thanks. I have at least some direction.

I'm not sure if I should post this as a separate post, but one doctor was suggesting cortisone shots and repeat visits to see how she reacts to the cortisone shots to determine followup shots. I'm just wondering what are the side effects and effectiveness of cortisone shots on the elderly with back pain? I prefer less trips to the office as possible. It seems like rest is helping, but trips to the office just aggravates the back pain condition and the cycle starts over again.
 
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trs1960 replied to brickwalls's response:
AHHH!!! I was just about to submit my repsonse when my daughter called me and I hit something on my keyboard that closed the web page! Doh!!! User error!

OK, Steroids do have some bad side effects. WedMD has a medication section that includes side effects and drug interactions.

Continues steroid use will thin your tissues, but they're great at reducing inflamation. I've had great results for things like tendonitus.

Find out which steroid they want to use, read about it on Webmd, talk to your pharmacist about it (they're a great resource) and armed with all your new knowledge talk to the doctor. Sometimes I write down the important qestions I have so when the doctor comes in I can get right to it.

I'm glad the study helped you. I found it interesting and the FPS is interesting. Especially when applied to the elder patient. It's pretty cool that the company I work for tries to provide tools for health.

Good luck.

Tim


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