Morphine substitute
 

:) Greetings all! My domestic partner is 71 yrs old and been on morphine for about two yrs now. She had a mini stroke around thre yrs ago and diagnosed with PN after that. They tried all kinds of pain meds, everything edit her made her deathly sick or she had bad reactions. Morphine is only thing that helps the pain and she can tolerate. She's also been taking topomax for her migraine. Today neurologist took her off topomax because of memory loss and thinks pain doc should cut down on her morphine to get her memory loss under control. Tests show it's NOT dementia but due to meds. Anyone know of a good sub for morphine? She's on 120mg a day. Is that considered a lot? We go back to pain doc in a few days.

I would like to ask this .... is your partner taking a statin for cholesterol? These are given after a stroke or heart attack.

Statins cause dementia like symptoms...so this has to be considered. You can Google, Statin memory loss.... and see the FDA warnings on it etc.

People with chronic body pain following a stroke, usually have what is called central pain origins. This is why the opiates work best in these people.

There are other possibilities but all in high dose would affect cognition to some extent. Fentanyl patches, are one possibility.
They are best given to opiate experienced patients, and 120mg, a day of morphine is experienced IMO.

But that decision would be a doctor's and your partner's.

There are many drugs one would not think of...that are common that affect elderly cognition. One is Zantac/Pepcid, and others are any anticholinergic drugs, for urine control, and antihistamines, like Benadryl etc. If you can list all his/her meds I can look up some issues that might be present and not yet considered. Even giving an antibiotic like Cipro in moderate to high doses to the elderly result in confusion and delirium.

Lisinopril for blood pressure goes into the brain, and can cause dizziness and confusion. Lots of drugs work differently in the elderly than in other age groups.

I agree--
 

--that if this symptomology occurred after a stroke, a diagnosis of Central Pain Syndrome or spinothalamaic pain syndrome needs to be considered; there are a lot of physicians who are not familiar with it, but it involves damage to the central system relay neurons in the spinothalamic tracts of the lower brain and spinal cord.

Take a look at:

www.centralpain.com

http://www.webmd.com/pain-management...-pain-syndrome

http://centralpainsyndromefoundation.com/