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4'9" mother fractured 3-4 ribs and her collar bone July 9th. Doctor now wants to lower the Fentanyl dosage to 50 for 6 days and then 25 for 6 days, to wean her off Fentanyl... but he wants to add an anti-depressant/pain pill called Cymbalta at 30mg, 2x/day. Does anyone know if this is a good decision. I have a high aversion to anything "anti-depressant" because we have been that route before, and she's done way better without anti-depressants. Any recommendations/input, please?

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Hello again, Joselyne. I have only limited experience with an anti-depressant, but I'll be glad to share it.

After my father had several acute and life-threatening illnesses, he spent 7 months in a total of 2 hospitals, 2 long term care hospitals, and a SNF before he came home on tube feeding, unable to eat anything as a result of having been on a ventilator for about 6 months.

His doctor wanted him on Buspar. I'm theoretically opposed to anti-depressants unless natural remedies (music, pets, meditation) don't work, so I wasn't necessarily agreeable. However, at that time Dad was 86, was relieved to be home but had been told by each of his speech pathologists that he likely would never be able to eat but would be on tube feeding for the rest of his life. He was very concerned about this, but intended to do everything he could to reverse the situation.

So I agreed to the Buspar. After Dad got home and we started pet and music therapy as well as home OT, PT and nursing, his mood began to improve. He did have some depressing days when the home speech therapist also said she didn't think he could compensate for the muscle deterioration, and agreed that tube feeding was the likely outcome for the rest of his life.

After a few depressing days, he aggressively threw himself into the speech exercises, doing them faithfully 3x daily. Eventually he began to improve and was subsequently relieved of the feeding tube.

Sometime during that process I asked and the doctor advised how to D/C the Buspar. I don't remember if was a few weeks after he first came home or after he began to make improvements during the speech exercises, or even if it was after the pet therapy began.

I do think it helped at that time b/c of the situation, but I also think that just being home and back in a neighborhood setting helped immensely.

But this also was a very unique combination of circumstances. Dad's since had 2 hip fractures and took only Oxy for about a month, then gradually decreased it himself. Never once did I notice that he was depressed; in fact, he relished in the attention he got in the SNF, but he was elated when he was discharged.

I should add though that he has a military attitude - he's tough and he's not going to rely on medicine other than the absolute minimum. At almost 97, he still plans to continue working in his beloved workshop.

If sounds like you're leaning toward not adding an anti-depressant. You know your mother better than anyone else. Perhaps you could raise your concerns to the doctor and suggest that because of past problems, you'd prefer not to add it right now, but reserve the right to ask for it later.

Will she be coming home to live with you when she's discharged?
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Five years ago my husband (72 at the time) needed the patch for collapsed vertebra due to Multiple Myeloma Cancer. He started with the 200 mg. patch, plus hydrocodone. After 2 months we started decreasing the patch potency by halves down to 12 mg. and then off completely. The hydrocodone was gradually reduce also to a stop in about the same period of time. At the beginning he was unable to walk, but physical therapy, acupuncture treatments, healthy nutrition and vitamins and supplements have made his recovery a lot easier. He took B-50 complex; vit-C 3000 mg, a day; Fish oil, vits E and D3; CoQ-10 100 mg.; Shitaki-Maitaki-Reishi mushrooms; Colostrum; Turmeric; Ginger, and a few others I don't remember. In less then 3 months he was walking with a walker, and soon after he graduated to walking with a cane, which he still uses today. He never took an anti-depressant or a single pain killer after he got off the patch and the hydrocodone.

His oncologist congratulates us very often on the fine results from our natural approach to treatment. My husband continues to take his 10-12 vitamins a day and his cancer has not showed up on tests in the last 3 visits. Appointments been changed to every 4 months instead of every 2 months. We are really grateful.

Peace.
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The restrictions and rules for the Drs to order the pain patches are ridiculous. My husband has had the insurance company interfere and say that they will not pay for patches the way that the dr ordered. The store can not by law fill a Rx for the patches even 1 day earlier than 30 days, the maximum time the dr can prescribe the patches for. Contact the dr to be sure that it is him making the change first. These patches are highly addictive and highly sought after in the illegal drug trade. Same with oxcodone, because of the illegal drug traffic we have all kinds of trouble following the rules for that Rx also. Cymbalta worked great for my husband's pain but in his case he had to go off an anti-depressant he was on for depression in order to try it. He went into depression and had to go back on his regular med and drop the Cymblta. My husband suffers from peripheral neuropathy and has been on meds for pain for 8 years now and wow have the the laws changed for using opioids. There is a tremendous risk of your mother not being able to move her bowels or empty her bladder the longer that she is on pain meds also, so the sooner that she can off the better. I wish your mom the best!
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Weaning off of fentanyl is a good idea for a 93 year old tiny woman, it is not the best pain med long term in a geriatric patient and can cause hallucinations and other side effects. Because of the transdermal delivery it also absorbs at varying rates depending on placement and body temp. Have you considered discussing an alternative pain med to replace the fentanyl rather than an antidepressant? If she is not showing signs of depression it would make more sense to switch to perhaps an oral liquid rather than transdermal, assuming she may be having some difficulty swallowing? There are many options, type of pain and communication with her doctor is key, and if needed request the help of a nurse advocate to help with that.
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Having just fractured my 9th rib 9-11-15, I am well aware of pain! However, Fentanyl is addictive and a very strong narcotic which should be lowered at intervals. If she fractured bones in July there is a 6 - 8 weeks healing period and she should already be feeling better. Ribs heal on their own and a clavicle (collar bone) sets with a collar sling or nothing, but bones in this area will probably not heal and she will be left with a bump (husband broke his in '93). If she is not in pain, Ibuprofen can be given for inflammation. Unless she is depressed why is the doctor prescribing Symbalta? Bones start to "remodel" on their own within seconds of a fracture, and pain medication only impedes natural defenses. Yes, I am in pain, but with a little ibuprofen, I am still moving about because I know if I do not use my body it will atrophy. Some down time is necessary for the muscles and ligaments to repair themselves, but since it is Sept. her repair internally has already taken place. I do not advocate going against her doctor's orders, however, I would discuss the reduction in Fentanyl and anything else he/she is prescribing. What does your mother say about her pain when she does not take the Fentanyl?
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I can't speak to the Fentanyl patch, having only had one for a few days following abdominal surgery. Didn't even know it was there, until the nurse removed it. I am familiar with Cymbalta---at a 30 mg dose, that is the lowest dose it comes in. It is an anti-depressant that is supposed to help with chronic pain. I started taking it 8 weeks ago after back surgery and major foot surgery had caused me to sink into a depressive state that was scaring me...it has worked amazingly well. I have been on an antidepressant before, and it worked for several years, I weaned myself off of it on my own (with drs approval). I went ON the Cymbalta with dr's approval and have been grateful everyday that I did. Chronic pain is horrible--and it's real, so no amount of music therapy, cuddling a grandkid or pet could have helped me. Don't not try it b/c you are scared of what it might do. Like I said, 30mgs is small dose (your mom is a small woman, too) give it a try. If she is in pain, this may help. Give it a few weeks, it's not a "same day" cure. You may notice that she's sleepier for a few days upon starting it--that's normal. Also, a couple of weeks into it, you may see another bout of sleepiness. Let her sleep! I was so anxious and sick that I WELCOMED the sleep. Cymbalta is an SNRI, which is slightly different that the SSRI's which is probably what your mom took before. Good luck--hopefully once she's out of chronic pain she can move a little and get some PT. I'm sorry she's hurting still---just b/c they say that broken bones heal in X amt of time doesn't mean that's a hard and set rule. Your mom sounds pretty fragile. She may really need longer and it may truly really still hurt. Hope you find a happy medium...keeping our parents out of pain is becoming something of a challenge with the new (stupid) rules they have now,
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No, she's not coming back home. Mom needs 24/7 care... too prone to falling, and on oxygen. When they called to tell me of the change, I said wait, and I'll get back to you. Well, apparently, calling is just protocol... they did it anyway and I don't like what I see. Mom's left side is hurting again, and she seems much less coherent. It's pretty obvious to me they should have left things well enough alone.
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I agree with answers given here. Fentanyl is great for acute situation and especially since it bypasses the central nervous system like a narcotic. However, at this point your mother needs to move towards wellness and use of her arm and other alternative tx. Has she seen an Occupational therapist? You can ask for an order to see one in outpatient and start to look at ways to relieve pain through other means, allowing this acute pain not to be a chronic situation.
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Jocelyne: I'm confused. You said your mother's not coming back home and then you said you'll get back to them. For what?
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Update from earlier post. After I wrote my post, I went to our spa and sat in it for about 10 mins. and it did wonders! After re-reading some of the posts, I wasn't away she is in a nursing facility. They may or may not have a hot whirlpool available, but I am moving much better (due to my fracture) and taking just 400 mg. of ibuprofen. I'll cut that later this week to 200 mg. Hope she feels better. Fractures are no fun, but one must keep moving and allow the body to heal itself without much chemistry.
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