FENTANYL PATCH

[SCOOTER819]

My mother (80 years old) has been on the Fentanyl patch for some years now for chronic back pain She has gone from 50s to 75s trying to see which one handles her pain. For a while she was on the 50s and was having break- through pain. Dr. prescribed Lortab at night. Then the Dr. moved her to 75s and also continued with the nighttime Lortab. When I visited recently(in assisted living), it appeared the nurses were dispensing the Lortab whether mom was having break-through pain or not. I have now stopped the Lortab and ask that Dr. prescribe E-tra Strength Tylenol PRN. Her break-through pain seems to be handled very well by Tylenol PRN. Since the Lortab has stopped, Mom doesn't seem to have the feeling of being so sad, teary-eyed, depressed.  I should also say that she has been on anti-depressants for many years, Zoloft(although we have tried others).  Mom's short-term memory has gotten progressively worse. I think it has to do with the Fentanyl patch, but Dr. says it is dementia - her parents had what we now know is Alzheimers and he feels it is hereditary. She lives in a very small town and I am afraid that she is being diagnosed with dementia when the short term memory is drug-related.  She doesn't seem to exhibit any other traits of Alzheimers except short-term memory loss.  Except she does seem to get very cranky and negative at times with the brother or sister who is the primary caretaker.

Can the Fentanyl patch be the cause of the sever short-term memory loss?  I do think the Lortab was over-medicating. When I think back, her memory seemed to get worse when she the patch was upped to 75s with the Lortabs.  She was sleeping way toooo much also with no drive or interest in anything!  Now that the Lortab has been discontinued and it has worked out of her system, she appears to be functioning better.

Any thoughts would be helpful.

[Tuckamore]

Hi Scooter,

Welcome to the Pain Mangement Forum. I am glad that you found us. Your description of your mother is very close to my mothers although I provide most of her care.  

Our elderly do not always tolerate medications (any medication) as well as the younger population. As we age our metabolism slows down and can change. Their bodies do not utilize and excrete drugs as effectively as it once did.  Drug toxicity is a more common occurrence in seniors.

Yes Fentanyl or any narcotic can effect our short term memories, regardless of our age. Physicians walk the fine line of memory impairment or pain management. It is my guess you would rather see your mother with some memory disturbances instead of dealing with chronic pain that would make her days and nights absolutely miserable.

It is impossible to guess if her dementia is drug induced however in my opinion I would be more inclined to suspect she has dementia that is made worse with the fentanyl. So again in my opinion the next question is do you put her through withdrawal to determine her pain level and the effect if any the fentanyl may be having on her memory? You may have hit on the best solution by simply having the Lortabs discontinued, as long as she is still able to maintain the same comfort level. Another consideration would be to trial reduction in the fentanyl dose to determine if her pain would still be controlled and to evaluate any difference in her memory status.

Crankiness and negativity can often come with the aging process. It is a challenging adjustment to lose one's independance, friends, home and the activities that was once enjoyed. Some segments of our society tend to view seniors as non-productive members and often less important. That fact alone can make one "cranky" and depressed.

Again in my opinion, especially at 80, your mother deserves to be as comfortable as possible. If you are concerned with her medications and diagnosis there are Gerontologists that specialize in treating our seniors.  A consult may ease your mind and benefit your mom.

I know how difficult it can be to know what is best for ageing (aging) parents, when to step in and when to second guess their physicians and medical providers. Family support and frequents visits are important. I wish you all the best. Please let us know how your mom is doing.

Peace,
Tuck