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Opioids How to improve cognitive functioning on opioids

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UpInFlames

Bluelighter
Joined
Sep 3, 2015
Messages
141
My friend is dying of bone and liver cancer. She's been given a few months to live. Luckily, her doctors are willing to adequately manage her pain.

She is 78. Currently, she is on 20 mg of roxi 4x daily 10mg morphine liquid PRN up to 3x daily, ..5mg alprazolam as needed for anxiety.

The meds are helping the pain though she will have to increase shortly. The problem is that the meds, combined with several mini strokes are turning her brains to mush.

She is aware of this and very upset by it. I was wondering if there were any supplements, etc., that she could take to help with cognitive function while on narcotics. She is also having a hard time eating due to nausea from the cancer and (IMO) the narcotics.

Even Zofran isn't holding the nausea and vomiting. I suggested MJ, but we don't have MMJ in our state, and she had a bad experience with MJ in her younger days and isn't open to trying it at this point.

We are in the process of finishing up getting hospice care, in home at this point, set up for her.Her niece has POA and is a retired medical professional, which helps.

Anyone who has any ideas on how to minimize the negative effects of heavy narcotic use, please speak up. We're for all the euphoria we can get, and of course, all the pain relief, but would like to try to minimize the cognitive effects.
 
Dexamethasone can cause a huge reduction in bone pain and nausea. It also increases appetite and alertness. I work in hospice/palliative care and have seen this drug do wonders at the end of life.

Honestly, the cognitive deficits are most likely from the TIA's and not the narcotics.

Marinol (oral THC capsules) are available by prescription most places and can help with appetite and nausea but can sometimes effect mentation. Haldol is helpful for resistant nausea as well.

Lorazepam is usually tolerated better for anxiety/shortness of breath in the hospice population unless already sensitive to benzos/have used Xanax with good effect in the past. Any benzo can effect mentation though and if she is taking a lot of the Xanax that may be more to blame then the opiates. She's on fairly small doses of both oxy and morphine at this point.
 
Chemo. And other anti-cancer agents also have a tendency to cause what is known as Chemo brain. A friend who has been through 4 rounds of cancer has progressively deteriorated in the mental aspect because of this. Reducing or changing some of her meds might help to a degree but if she's had chemo it could be a lost cause....sorry to phrase it so bluntly.
 
Bone and liver cancers also frequently metastasize to the brain causing cognitive deficits. Dexamethasone would be the palliative treatment of choice for brain mets as well as bone pain, nausea, and poor appetite.
 
UpInFlames said:
My friend is dying of bone and liver cancer. She's been given a few months to live. Luckily, her doctors are willing to adequately manage her pain.

She is 78. Currently, she is on 20 mg of roxi 4x daily 10mg morphine liquid PRN up to 3x daily, ..5mg alprazolam as needed for anxiety.

The meds are helping the pain though she will have to increase shortly. The problem is that the meds, combined with several mini strokes are turning her brains to mush.

She is aware of this and very upset by it. I was wondering if there were any supplements, etc., that she could take to help with cognitive function while on narcotics. She is also having a hard time eating due to nausea from the cancer and (IMO) the narcotics.

Even Zofran isn't holding the nausea and vomiting. I suggested MJ, but we don't have MMJ in our state, and she had a bad experience with MJ in her younger days and isn't open to trying it at this point.

We are in the process of finishing up getting hospice care, in home at this point, set up for her.Her niece has POA and is a retired medical professional, which helps.

Anyone who has any ideas on how to minimize the negative effects of heavy narcotic use, please speak up. We're for all the euphoria we can get, and of course, all the pain relief, but would like to try to minimize the cognitive effects.
Click to expand...

The only thing I can think of that would wake her up is Dexedrine, but her heart wouldn't be able to take it even with large amounts of Clonidine. She's just not in a position where she can be sharp anymore.
 
My dad is currently going through this, he just started chemo, they got him on a 25mcg fentanyl patch with 5mg IR oxycodone for breakthrough pain, he's still in pain, though the other day the patch must have been working a little bit because he was nodded the fuck out. But he's pretty depressed about how sluggish it makes him too.
 
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