End-Stage Liver Disease physical pain

[joe10jo]

My mother has end-stage liver disease. My question is how much pain goes along with it?  Enough to need a prescription of methadone? The reason I ask is b/c my mother has a history of drug addiction & while her liver specialist isn't prescribing the methadone to her, another physician is.  She recently spent 3 weeks with me and was absolutely fine, which means her ammonia levels were normal, she was sleeping throughout the night, up most of the day, even went shopping a couple of times, - BUT, the minute she went back home and got her prescription filled (she was without methadone the entire time she was with me b/c she forgot to bring her prescription with her) the ammonia level went back up, she's been acting clumsy, slurring her words, foggy state of mind, etc..., etc...  So in my mind, this is all related to the methadone.  While she was staying with me, she complained about some pain; however, she wasn't moaning & groaning, and certainly didn't seem to need anything as strong as methadone.  Also, she wasn't going through withdrawals from anything else, so I know she isn't taking the methadone to treat another addiction.  What's your opinion?

[desrt]

To answer your question: quite a bit of pain. One fella I knew was at the point where the liver no longer produces whatever it is that holds your blood vessels together, and had large bruises on his arms and legs. Took 30 mg. morph. to get out of bed in the A.M. and go to work to earn the $5,000/mo. it took to buy his IFN and pay for his tests (this was before they started giving it away). Then continued through the day with more morph, oxycodone, and hydrocodone.

[desrt]

To answer your last question: if I were an ex-addict in end-stage, I probably wouldn't tell my family about everything I was taking. It would just worry them.

[desrt]

To answer your last question: if I were an ex-addict in end-stage, I probably wouldn't tell my family about everything I was taking. It would just worry them.

[Kalio1]

Just because she isn't "moaning and groaning" is a poor measure of her pain level. I have been through some painful situations (broken discs) and even at my worst pain stages I was not "moaning and groaning" but I was in a tremendous amount of pain. On treatment I have enough pain to require pain med use as do many others on this treatment. I don't know if she is on treatment, but just having advanced liver damage can be painful. If her doctor feels she needs it, I'd listen. It can be very painful to go through what she is going through.
If a person has had a past drug addiction, does that require they must suffer from pain forever? I can understand your fears but withholding pain meds seems cruel. Methadone is commonly used for pain control. Now if her use increases or she takes them incorrectly or something, that is another story but as long as she is following the doctors orders carefully and the pain meds are working for her and she feels better, that is what counts.

Drugs can be "stronger" and the patient can get a more profound reaction due to the liver not functioning optimally, maybe a reduction in dosage would keep her pain at bay but not cause some of the issues you describe?

[chcnme]

Sorry to hear about your mom.  If she is being prescribed meth (methadone) for pain control, it would be unusual for her to not have it with her while visiting you.  Anyone who's been on meth for pain management usually isn't going to forget it, and so - I'm not sure what may have been going on at your house.  Meth (to my knowledge) will not cause ammonia levels to rise to the point she is suddenly out of it from ammonia when she gets home.  ESLD can be painful.  I don't know how "end stage" she is though, and so I can't assume her pain or lack of.  Whatever is going on, I hope she'll be OK.  Methadone is well... methadone, and as you know it's potential for misuse and abuse is very high (and especially so with your mom's history combined with what might be her feeling of hopelessness now over her liver.) Wishing her the best.

[joe10jo]

Me again........   Okay, the reason I'm trying to get to the bottom of this, i.e. is she in enough pain to need methadone - is because when she's completely out of it, my family doesn't know what to do - like, is it her ammonia level making her act like this or is it the painkillers or is it the ambien (I've read that ambien can induce some pretty strange behavior as well).  Again, I don't think she's addicted to other painkillers - trust me, I'd know because my mother's had drug addictions for most of my life (dilaudid & cocaine).  I'm to the point of calling the doctor who's prescribing the methadone; however, if she really needs it for pain then I'd hate to screw it up for her - again, that's why I'm asking:  could the pain from end-stage liver disease be so intense as to warrant that strong a painkiller b/c I'm 99% sure she isn't being treated for an addiction to hydro's or anything else.  And like I said, the whole time she was up here she didn't appear to be in that much pain.  I seriously think this is one of those doctors who'll prescribe anything to anybody & it seriously pisses me off.  Her life affects all of my family & I'd hate to think the methadone isn't necessary b/c if it's causing her ammonia levels to go up then in effect, it's killing her.