Tramadol Question

Rob's Daughter · July 10

Hi All -

So my mom is in assisted living on Hospice care for over a year now. She is in a Broda chair and they now use a Hoyer lift getting her into bed/shower etc. She is down to 95 pounds. I would say late stage 5 or early 6.

She has been taking Tramadol 2x a day (morning and night). A Hospice nurse called and said that after a shower or maybe it was during a shower the aid noticed my mom was in pain. The hospice doctor examined my mom and now she will be taking Tramadol a third time or at lunch time each day… so now 3x a day.

I asked the nurse as to what pain my mom is in…. and her answer was just that she is so thin. I don't think that's the reason…. but can anyone explain the pain a patient can be in? My mom is wide eyed and stares straight ahead… doesn't make eye contact… doesn't really speak too much, only when spoken to. They usually put her back to bed after lunch… trying to get her off her hips (since she has no fat cushion) and is usually asleep in the afternoons. Is this a side effect of the Tramadol… What can I expect of this 3 dose?

Its all good… I want her comfortable as possible… my mom is safe and cared for. Just more curious…

Quilting brings calm · July 10

It’s possible that your mom being so thin is contributing to pain because she has no padding. It’s possible that your mom is making noises or gestures and the staff is assuming that means she is in pain and unable to communicate it.

JulietteBee · 2:34AM

It is possible that your mom is grimacing whenever the caregivers lift, turn, or bathe her. Tramadol can make someone a groggy so having it a 3rd time in the day may make her groggy for most of the day. However, it will keep her comfortable for most of the day as well.

SDianeL · 3:42AM

I would trust the hospice nurse. They will increase meds as necessary to keep her comfortable and pain free. Being so thin and bedridden causes pain. The hospice nurses will also answer any questions you have.

towhee · 5:47AM

I remember the main side effect with my mom was sleeping, and from a quick search that does seem to be the most often mentioned. You might want to monitor whether she starts sleeping thru supper. If so, they might want to give a third dose as needed before a shower, or look to a different pain med. However, she is on hospice, and if this seems like too much micromanaging for you, as you say comfort is most important at this point.

harshedbuzz · 11:55AM

@Rob's Daughter

I am sorry your mom has reached this point.

A couple of thoughts:

Is dementia the terminal condition for which mom qualifies for hospice as opposed to having some other life limiting condition (severe CHF, stage Iv cancer, etc) as well? If so, she is well past "late stage 5" given the weight loss and need for a Broda chair.

The nurse is likely spot-on that mom's weight loss is contributing to pain/discomfort. My MIL died from other causes, but was a very slight woman who'd lost even more weight in the final year of her life. She was in considerable pain; my BIL (who was a physician and a primary caregiver with his wife) explained that the loss of fat and muscle tissue that cushion organs from bone and each other can result in considerable discomfort. It can also result in pressure sores which can also be painful.

Nurses who work in hospice or with late-stage patients with terminal conditions are generally very adept at reading nonverbal communication in their patients. Facial grimacing, changes in breathing patterns and posturing may indicate pain even if she's at a stage where she's still quite vocal as MIL was until the last week of her life.

While sleepiness is a side effect of Tramadol, many late-stage PWD who are not using it or something similar do require a lot of sleep. My dad, who died hours before his hospice appointment and wasn't on any pain medication, slept upwards of 18 hours a day despite being conversational. In her final months, my aunt was only awake to eat briefly and probably slept or dozed 22 hrs. out of 24.

It sounds as though this facility and hospice are being very proactive around her care and pain levels. At that weight, you might want to ask for an alternating pressure mattress to avoid bedsores if she doesn't already have one.

HB

Rob's Daughter · 3:39PM

@harshedbuzz

Thank you so much for your reply….

Yes, dementia is the terminal condition and why hospice stepped in. I'm really happy where she is at and my hospice team has been wonderful to say the least. I do feel they are on top of everything, I am very luck in that aspect.

It makes sense now, when the nurse said, "she's just so thin". I honestly didn't think that could be a reason for pain…. And yes, she has the mattress in place already. I think that is why sometimes they move her to bed, its more comfortable then the Broad chair and moves her in a different position to rest.

She doesn't have much of an appetite. I spoke to another nurse yesterday and she said I don't think its pain that is causing her not to eat much, its just the will to live. She feels my mom is just ready to go.

This disease is awful…. I am sorry for your losses.

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