Dear Ares,

Please do not assume that your mother's problem is opiate addiction.

The Flexeril, Soma, Klonopin combination can be quite debilitating. These medications are given as muscle relaxants, however, both Soma and Klonopin are tranquilizers. Klonopin is very much like the tranquilizer Valium, and Soma is metabolized into an old-school tranquilizer (named Miltown) that has not been available by Rx for over 20 years because of its toxic side effects.

Flexeril is a strong anticholinergic agent that also causes drowsiness, dry mouth, and disorientation in many. It is chemically similar to another old-school class of medication that effects the autonomic nervous system known as a tricyclic antidepressant. Tricyclics are used to treat pain by some doctors, but generally they cause too many nasty side-effects in the population. They react strongly with alcohol, and if your mother enjoys even a couple of glasses of wine in the evening while taking this medication, it can very well create a situation where she would be reluctant to awaken.

Many doctors consider opiate use safer for the treatment of chronic pain, even with their potential for abuse, to the use of these types of medications I've discussed because of their side effects.

I would suggest that your mother's doctors explore reducing or eliminating these three medications, especially the Klonopin, if your mother is have problems with extreme drowsiness. There are now alternative muscle relaxants that do not effect the central nervous system, but work directly on the muscle fiber. A good spinal surgeon may choose to use something like dantrolene (Dantrium), which is an effective muscle relaxant, but has no neurological side-effect.

As far as pain control goes, the daily 90mg dose of morphine with Lortab prn are well within norms for patients with moderate to severe pain. People with pain are not debilitated by strong opiates like so-called normal people, for a number of reasons, which I will not explore here. Please talk with your mother's pain specialist about this.

You describe a syndrome that sounds more like chronic depression than addiction. Spinal surgery, implants, and chronic pain for patients who do not consider themselves elderly can ruin their quality of life. No one handles disability at any age without undergoing the process of loss. Perhaps grief counseling, as well as therapy with a chronic pain psychologist is better suited to her condition than Welbutrin or SSRI therapy?

One key to managing chronic pain is change. Patients who suffer from disabling chronic pain require constant evaluation and adjustment of therapy. If a therapy doesn't work, move on to something else. If a doctor is unable to find the proper answers for your mother's various syndromes, find another. These days, some doctors who practice in this particular area have dual specialties in both spinal surgery and pain management. See if you can find one in your area if you are not satisfied after speaking with your mother's doctors.

The American Pain Society can also help you find resources to help you manage this condition. Google their website for more information.

Finally, I appreciate your interest in your mother's care, and I encourage you to follow this up with an open mind. Most people jump to the conclusion that the opiate medication is the problem because of our conditioning from the so-called war on drugs, however, many prescription medications are disabling. The variety of pills you describe would knock anyone down.

Read and learn about the interactions of these medications so that you can talk with doctors about these things. Learn to read drug inserts and ask questions if you don't understand what you're reading. Don't accept simple answers to your questions like: that's a muscle relaxant. Ask, how does it work? How does it interact or potentiate the opiate medication? Why does she need three muscle relaxants? Etc. I know that doctors hate this kind of questioning, but never forget that the patient is essentially responsible for their own health. It sounds to me like you are considering taking up the banner for your mother's well being. I support you in this and encourage you to learn all you can about the medications she is being prescribed.

Good luck.