I don't know anything about what happens at the end, but I'm starting to learn. We don't know why mom is having pain, but hospice says it's the process of Alzheimer's/dementia. She's been in and out of hospice many years, but has never been in pain this long (3 weeks) and was recently prescribed and is taking Norco 3 times a day. She looks good/comfortable and briefly here and there clasps her hand tight. Should I be concerned about this amount of Norco? I know it makes her feel better, but I don't want it to cause her other ill effects. Sorry if sound silly asking this. I just worry about her.
Norco can cause constipation, but not sure how much your Mom is eating at this point? Constipation can cause some pain and cramping high up near the ribs and anywhere below. Talk to the hospice nurses or your Mom's doctor.
The dying process itself can be extremely painful as the organs start to shut down, so be grateful that hospice has found a medication that keeps her pain down. That is a blessing for sure.
At this point it really doesn't matter what "ill effects" it may cause her if she seems to be resting comfortably.
Enjoy whatever time you may have left with her and make sure that you leave nothing left unsaid.
We know that people can form "pathways" of pain out of habit.
We know that some pain medications can cause rebound pain in some patients.
But with all we know, we still know very little about pain. Add that to a diagnosis of dementia in which the patient cannot even give a GOOD account of pain, where it is, what level it is, what its characteristics are, and basically you have come to the point where, in a case like your mom's, the only answer is RELIEVE IT.
Your Mom is elderly, on hospice, unable to describe her pain. There is no reason not to relieve her pain. BUT there are side effects to most pain meds including constipation that can actually obstruct a bowel. That is to say, it can kill. As you are at a level where "something" is going to kill, I think the important thing is that on hospice and end of life care, your mom has relief.
Every person, every patient, is a mystery. And we do not always solve it.