Pain Management suggestions | Final week of radiotherapy

Hi Narisa. Sorry to hear about your husband. I don’t have experience if buprenorphine I’m afraid. I had MST long acting morphine twice daily which dealt with background pain topped up with oramorph and paracetamol alternating every two hours. You can take a heck of a lot of morphine so I upped the dose to suit, sometimes taking 10 ml and having the odd swig out of the bottle  I was told I could take it every two hours if needed. It does make you pretty sleepy and you need to increase the laxatives. 
Do you have mouthwash preps to help. You can get lignocaine lollipops if you have a pharmacy which will make them up. I have a friend who swore by them.
There is a preparation called antacid with Oxetecaine which numbs the mouth. You can swallow it so it helps the throat as well. I had that to help me eat.
The canker sores are radiation burns. Is he keeping his mouth clean? I used soda bic and salt mouthwashes.
I hope some of this helps.

Oh and there’s always ibuprofen. We underestimate the power of the common analgesics. 
PS. Some people here had fentanyl patches. 

Hi can’t add much to Dani’s post had said. I had mouth ulcers for a good 3 months after treatment I had gelclair it’s worth asking for that as well as Dani’s suggestions. I was on 8 x30 mg cocodomol every 24 hours plus 40 mil sometimes more if oramorph. His he using a feeding tube or a ng tube medications are easier going in via thise than trying to swallow. Oral hygienie is vital gad he bern checked for oral thrush we are prone to that. I too gargled well swilled a saline solution round my mouth. My oral hygiene took up to 45 min at night. If he’s using duraphat toothpaste  you can buy a gentler one Ora nurse many of us used that in the early days. Tge dursphst is ful of sls which csn also irritate 

sorry you’ve found yourself in thys pisition the next few weeks are hard but eventually there’s a chink of light at end of tunnel. For dry mouth there products to use after treatment has finished. 
xyimelts are what many of us still use. 
Hope this helps Hazel 

Thanks for your replies. I tried giving him household Ibuprofen in week 1 before he was given 500 paracetamol but there was hardly any pain at this stage. He does have Lidocaine mouthwash that you mix 5ml with 5ml of water and that works well for an hour but once it wears off it leaves him with a terrible red raw and stinging throat and that takes a while before he can shake that by drinking lots of cold water. Must be something in the Lidocaine that burns when you gargle it. Lidocaine lollipops sounds interesting THOUGH! I wonder if I can make them up at home myself. 

We were previously prescribed MST long acting Morphine, x3 tablets twice daily, which dealt with background pain but not the throat, canker sores and nerve endings  pain causing the tooth aches, jaw aches and ear aches so the doctor prescribed the patches and I'm beggining to think that was an error of judgement because its less effective even though its meant to be stronger.. I don't think my doctor will use Fenthanyl patches but I'll ask..

I was wondering if anyone has any suggestions for other mouthwash peeps or anything that can keep the mouth wet or moist through then night? I have Biotene mouthwash but it's fresh mint favour and that burns my mouth. The same applies to Oxetecaine moutwash I was given.

My husband is using his PEG feeding tube exclusively now because he can no longer eat with his mouth since the beginning of the week due to the pain in his throat and the sores. 

Hi sadly  nothing that can keep the mouth moist at night. I used to wake and sip a teaspoon of water lots if time during the night whilst in treatment I’m almost 5 years post radiotherapy and night time dry mouth can still plague me. There are xyimelts but you do need a tiny bit of saliva for then to work. They are available online make sure you get the plain ones though. If he can’t use them now they will be useful for later on in recovery. 
Have you gelclair for his ulcers which are unlike normal ulcer radiation induced ones don’t react with normal U.K. et meds if yiu coukd use them. Mouthwash try plain salt water one teaspoon to a litre . I also used bioxtra diluted 50/50 with bottled water as I couldn’t stand tap water that hurt me.

The gelclair and bioxtra are prescription, the xyimelts online. 
 Check tomorrow he hasn’t got oral thrush as that makes the mouth hurt as well. Try changing toothpaste to oranurse no sl sin that. Yiu can switch back to duraphat later. 
Is all his medication going in via tube ?

Hazel x

Hi, 

Yes, he has Xylmelts, the plain ones, because the mint ones burnt his mouth and they're OK for a few hours, I guess but he was hoping they would be better based on the rave reviews but he has zero saliva function right now so in time they will become more useful. Unfortunately, he still wakes up 3 or 4 times a night to drink water, lubricate his dry and very sore throat and go to the toilet etc.

He does have Gelclair but we were wondering what this is meant to do exactly? It has been a bit hit and miss for us. We will take your advice on Bioxtra and get some and will change the toothpaste. 

We will speak to the doctor tomorrow to see if he has Oral thrush because his throat does seem very, very sensitive to swallowing even his own saliva after sipping water and that seems to last a while.

Thank you 

Oh and yes, his medication like. Oralmorph and paracetamol is going on via the tube only and then he has Buprenorphine 15 micrograms/hour 7 day transdermal patches.

He is also exclusively eating X7 Ensures a day via the feeding tube.

Hi the gelclair can be taken neat  of dilute from memory I mixed it with 15 mil of water and  swilled it round my mouth I had ulcers full length of my tongue and all way down the  back of my throat. It coats  the ulcers. It puts a protective coating on the ulcers. It’s a rinse and spit exercise then nothing orally for 30 mins to allow it to work. My night time and mornjng plus afternoon oral routine used to take uo ti 45 minutes. I too woke many times in the night. It does improve honestly. But at the moment he is in the peak part if everythjng. Xyimelts are a god send later on.  Like I said I still use them 5 years almost  at night tkne. I’m now down to 1/2 of one. 
Hszel 

Yes ensures kept me alive after treatment and during treatment. Eventually week 3 of recovery I ditched the feeding tube and orally slowly sipped 6 ensures a day allowing me to experiment with food. My blog below might help you 

Hazel 

Good evening Narisa, sorry to hear of the pain your husband is going through, I had cisplatin and radiotherapy after my surgery, i don't think I was ever in this amount of pain or discomfort, maybe because he has started to use the PEG it will not give him as much or worsen the pain. The strongest pain medication I was put on was Oxycodone in liquid form and Fentanyl patches, what these dr/consultants dont understand is that its not them who are in pain and don't know how it feels, as Dani mentioned the dosage can always be upped to suit the pain level. I hope you manage to get better pain relief, all the best, take care.

                                                                                       Chris x