TM
The elderly tend to have a fear of pain medications. Keep gently talking to her and letting her know that there is relief available. If you believe her pain levels have risen, and she won't admit it, have one of her nurses sit and explain to her that medications given for pain will not make her "loopy" or whatever after a couple of doses for her body to get used to it. IF she's been on low doses, increasing them won't make her out of her head in any form. She'll still be able to visit family ect. For many they fear they'll be so loopy or sleepy that they'll miss visits and talking to family. I had to really talk to mother in law over and over and explain to her it would improve how she felt and she would get more pleasure out of those visits. Once they find some pain relief, it's pretty much downhill.......it's getting them to take that first big step.
You can also talk to the nurses about cues that signal her pain levels have increased. They can still request doctor to increase medications......and can still give her pain medications unless she flat out refuses them.
I'm so sorry hon. This is so very very hard. I hope your mother in law's pain can be managed and she passes with dignity and grace.
Keeping all of you in my prayers.
((((hugs)))))