low dose morphine with increasing dose to achieve pain control
antidepressants like SSRI can help much along with antiinflamatory drugs if inadequate response
In the last stage ( Foetaal attitude with high tone (paratonia) NSAID give the most positive effect on the possibility to get movement in the body throught an oush away orthrosis. With Morphine the tone was less but there was no movement possible. Movement gives an total tone decrease and often also an better cognition.
Please read the fascinating research article on treating Paratonia in AZ with BONT. Reference: A Randomized Placebo Controlled Pilot of Botulinum Toxin for Paratonic Rigidity in People with Advanced Cognitive Impairment by G. Kleiner-Fisman, MD. PloS one 9.12 (2014).
Article A Randomized, Placebo Controlled Pilot Trial of Botulinum To...
In my experience, morphine works better than NSAID. BONT is always tempting, but when you look at the article Lisette provided, they took 10 persons, and injected 300 IU in one arm (or two arms). Given there are flexed legs, one could easily achieve 500 -1000 IU. So the risk to be confronted with iatrogenic botulism rises. There have been other small studies claiming this approach inefficient. So I would stick to morphine.
Antiinflammatory or morphine ?
This question does not make sense. It depends on the cause of the pain.
Antinflammatory, morphine, antidepressants, antipsychotics ? Pain as BPSD-equivalent ?
I have now an patient with an toral feotal attitude . The only respons is the push away othese that gives an decrease on tone in the whole body, She is lying on an firm matras with het best side to the wall.
When she lioes in this orthese she looks angry and push with there feet the orthesis away but when this movement occur the re face is ligthing and the tone decrease and here cognition is increase. No medication was given
In this case there was the feeling of instabvility and that is no poain but fear !!
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