Ask Questions Below

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4 thoughts on “Ask Questions Below

  1. I’m terminally ill with end stage COPD and heart failure(FEV1 >20%, resting heart rate near 120bpm). My inhaled medications are mostly ineffective, and I have chronic pain and other comorbid conditions which overall subject me to a very high burden of symptoms. At this point I’m interested mainly in palliative care. My pain doctor is reluctant to prescribe opioid medications for fear of respiratory depression. As you are no doubt aware, this effect is dose dependent, and I feel that at this late stage the risk of adverse events is far outweighed by the potential benefit both of pain reduction and relief from the distress of constant air hunger sensation. Is there any way to initiate this discussion and present my opinion on this without appearing to be a drug seeker? Should that even be a concern in a patient with an unpredictable but no doubt severely shortened life expectancy due to an advanced incurable illness? Of course, start low and go slow is the protocol, and I would be appreciative of even the lowest effective dose of morphine, as it would at least slightly reduce my pain, but greatly improve my distress from my breathing difficulty. Should I even mention the beneficial side effect or simply focus on the issue of pain relief?

    1. William, I am sorry to hear about your condition. It sounds like you are interestes in end of life care. A general rule of thumb, for at least hospice care/palliative care is a terminal diagnosis with given less than 6 months to live. I would approach your primary care provider and ask for a palliative care consult. Once you get on palliative care service they will be managing your pain medications to include pain medications. As a pain doctor, this plays a very important role, but palliative care will trump pain med provider most likely. Another benefit to palliative service is they offer in home care, medical supplies, a palliative care provider who will prescribe all your medications to include pain medication. At this point, end of life care is to keep you comfortable. So, see your primary family doctor, ask for a palliative care referral. Hope this helps. If not, id be happy to elaborate or clarify. Adam.

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