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Pain relief for pressure points

BReilly2

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I joined this forum so I could be a support for my niece, who is caring for my sister with ALS. I received this request today and am hoping someone has insight to share. Thank you, in advance! "A few days ago, one of her aides identified a possible emerging pressure sore on her sacrum area (like where the base of her spine meets the top of her bottom). Since she’s having more trouble breathing/swallowing, she’s sleeping with her head more elevated at night - I think that may be contributing to this pressure point. Regardless, she’s starting to call me down to her room multiple times a night complaining of pain and pressure (and in other areas as well - her elbows, back, all over), and I don’t really know how to help her, especially since I can’t identify anything obvious (sheets and nightgown are smooth, skin looks fine, etc.). She tried an alternating pressure air mattress a few months ago and HATED it, but that’s the only suggestion I can find."
 

nona

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Does she take any anti-inflammatory meds before bed? There are topical ones by prescription. I have pain at night and I take Tylenol and ibuprofen before bed.
 

BReilly2

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She does via her feeding tube at night. But she will only take the most minimal dose and is extremely resistant to taking meds for relief on any kind. I was not aware of a topical option though. Thank you for that hint!
 

lgelb

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Nona, since Tylenol (acetaminophen) and ibuprofen are both NSAIDs, by taking both, esp. together, you are increasing your risk of internal bleeding and ulcers.

B, you may want to have a look at some of our recent threads on positioning support in bed. ALS changes the anatomy and we weren't designed for immobility, so the body needs more help as ALS progresses. Depending on the person, that could include foam under the forearms, elbows, knees, heels (pressure boots), and around the hips, as well as potentially a latex or other supportive mattress overlay and a pillow that is also latex or other foam. You are looking to take pressure off the bony joints and equalize it over the body.

Heat and moisture are enemies in the fight against pressure injuries, so your sister may want to take another look at the nightgown and sheets. Some PALS use a fan all night as well. And of course hygiene is always important.

Best,
Laurie
 

BReilly2

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Thank you so much, Laurie
 

nona

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Nona, since Tylenol (acetaminophen) and ibuprofen are cousins, by taking both, esp. together, you are increasing your risk of internal bleeding and ulcers.

B, you may want to have a look at some of our recent threads on positioning support in bed. ALS changes the anatomy and we weren't designed for immobility, so the body needs more help as ALS progresses. Depending on the person, that could include foam under the forearms, elbows, knees, heels (pressure boots), and around the hips, as well as potentially a latex or other supportive mattress overlay and a pillow that is also latex or other foam. You are looking to take pressure off the bony joints and equalize it over the body.

Heat and moisture are enemies in the fight against pressure injuries, so your sister may want to take another look at the nightgown and sheets. Some PALS use a fan all night as well. And of course hygiene is always important.

Best,
Laurie
Hmmm, my PCP and a separate ARNP have recommended the combination rather than exclusive use of either.
 
Last edited by a moderator:

KarenNWendyn

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Nona, it’s true that an NSAID such as Ibuprofen can be used in combination with Acetaminophen. They have different mechanics of action, so the combination can be quite effective.

We used to view Acetaminophen as being without stomach irritation but have since come to realize it can sometimes bother the stomach. So when it is combined with an NSAID, there is a bit more risk for gastric bleeding. Just something to be aware of. The NSAID should always be taken with food.
 

Vincent

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I have a mattress with a Roho insert in the middle 1/3. I have no more issues with pressure on my ITs or sacrum. Do not treat the pain with drugs, fix the pressure issues.
Vincent
 

affected

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I do agree with Vincent - pain relief is good, but solving the cause of the pressure is more important in the long run because a pressure ulcer is an evil you can do without. Even when needing to sleep semi upright you can take measures to relieve pressure from the sacrum but partial turning, wedges to relieve pressure and gentle massage and ROM in between position changes.
 
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