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Old 12-08-2010, 12:37 PM   #1
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Question Patch ? from new member

Hi!

I am new to the forum and new to the Duragesic patch. I hope some of you more seasoned users can answer a couple of questions for me.

First a little background:
My pain issues stem from a car accident over 10 years ago in which I crushed my ankle and lower leg. I also have back and knee issues that come from walking with an altered gait for so long. After a slew of surgeries, two years ago I had the ankle fused to tide me over until I am "old enough" to have the joint replaced. I have been on 40 mg a day of Methadone for the last two years and am pretty tolerant. Its been a long time since I could say I have had any real pain relief.
About two weeks ago my doc started me on 50 mcg fentanyl patch. The Mylan brand. The results have been dissapointing to say the least. I am getting even less relief than I did with the Methadone, have been having some mild withdrawl symptoms, and have an all over feeling of yuckiness.

Is this what I can expect of this drug or does it get better? Is this something that takes a while to work? You would think that a pain med would work pretty quickly but who knows. Any help or advice that you can offer would be great. Thanks so much!

 
Old 12-08-2010, 07:00 PM   #2
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Re: Patch ? from new member

It might be that you need a higher dose, but it could just ve the xrossover period, doing a sudden swap from methadone tto another narcotic can be difficult, as methadone effects some receptors that conventional narcotics dont.

So, it might be that you need to use the patch starting with a low dose and slowly increasing, and also take methadone, at a highish dose, slowly decreasing, till you get to the point where you are taking no methadone, and the patch is giving you the relief you need..... this might be 50mcg patches, might be more (might even be less). You should probably also have a "rescue" medication, a rapidly acting painkiller you can take for quick relief of sudden spikes in pain, Vicoden, Percacet, etc

Adding adjuvant drugs can help..... NSAID's like Mobic, antihistasmines like Atarax/hydroxyzine, antidepressants like amitriptyline etc, also somthing to speak to your doctor about.

Some of the others know a lot more about this than me, but thats how I see it.

Best of luck
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Last edited by jonnstar; 12-08-2010 at 07:01 PM.

 
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Old 12-08-2010, 09:37 PM   #3
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Re: Patch ? from new member

Hello Mimamma, Welcome to the HealthBoards!! I was switched to the Duragesic Patch about 2 and a 1/2 months ago. First we tried 25, then 50-that's where I'm at now. I was on 60mg of Oxycontin. I really thought the patch was going to give me much better coverage then the Oxy. Afterall, it is the most potent of them all. However, I was very disappointed in it. I do not get anywhere near the pain coverage I got with the Oxycontin...janiee

 
Old 12-09-2010, 11:11 PM   #4
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Re: Patch ? from new member

The 50 mcg patch is probably just not a strong enough dose for you. when I war using the patch , I was using 100 mcg patches and adding a new patch every two days leaving the old one on for three days (for a one day overlap.) Even with that, I was using antidepressants and anti-seizure meds to deal with severe nerve pain. You may need to add something like Lyrica to reduce your sensitivity to pain.

 
Old 12-10-2010, 06:44 PM   #5
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Re: Patch ? from new member

In Australia, taking a narcotic by it self is rather unusual, we tend to use the layerd or multimoidal pain releif method, utialising paracetamol/acetaminophen and antiinflamatories at the base, adding narcotics if needed, and using aduvants like amitriptyline or Lyceria with them.

Controlled studies have shown that tyhis results in better pain coverage than narcotics alone, and allows all of the drugs to be used in lower doses than if they were taken alone, which means less side effects.

Simple acetaminophen/paracetamol has been shon to improve pain releif by about 20% when added to a narcotic in theraputic doses..... thats an improvement worth having when you consider that its safe, cheap and has virtualy no common side effects.
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Old 12-10-2010, 07:23 PM   #6
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Re: Patch ? from new member

In North America (USA and Canada,) it is also very rare for a chronic pain sufferer to use narcotics by themselves. I suspect the person posting the questions here is also taking other meds, most likely a combination of antidepressants, antispasmodics, anti-anxiety, and/or muscle relaxants in addition to traditional pain medications like acetaminophen, ibuprofen, naproxen sodium, COX-2 inhibitors, and other prostaglandin modulators. I suspect the other meds weren't mentioned because the only change that the writer thought to be relevant was that of the narcotics.

(Note to jonnstar: I have read many of your other replies, and know that you are keenly aware of the limitations of narcotics as solitary treatments, and you appreciate the use of adjuvant therapies. It's a good idea to remind people of the value of adjuvant treatments. Something as simple as acetaminophen or clonidine can be very helpful when added to first-line therapies.)

 
Old 12-10-2010, 10:27 PM   #7
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Re: Patch ? from new member

Very true - its a shame some doctors over estimate the value of adjunctive treatments and try and use them alone when narcoticr realy are needeed - I think it tends to give the adjuvants a bad wrap.
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Old 12-12-2010, 10:45 AM   #8
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Re: Patch ? from new member

Wow! You guys are amazing! Thank you so much for your replies. Yes, I am taking a couple of other meds along with the patch. Ibuprofen and Buspar. I was taking Lyrica but did not tolerate that well. Thanks again for all of your help!

 
Old 12-20-2010, 07:41 AM   #9
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Re: Patch ? from new member

Hello! My name is Frank, and I have been on Fentanyl patch for 6 years. I have tried all the brands, and Mylan is definitely the best. It is the safest too, since there is no gel reservoir of gel / fentanyl that could leak. The trick is to clean the area (I use the right side of my upper abdomen below my chest). First, remove the old patch, and using a warm water washcloth with the water squeezed out of it, begin scrubbing the area vigorously. Remove all the old adhesive, and get it to look red, but don't cause bleeding. But you really have to clean and scrub an area a bit larger that the patch. The Mylan has 2 cover slips that come off, and expose the adhesive backing. The backing is split, so you can remove the smaller split first. Get it started, and press & rub from the center outward in both directions. Then remove the larger piece of backing and press into place while removing the larger backing. Take the palm of your hand, and press hard, while tightening your abdomen muscles. Again, roll the palm of your hand from top to bottom on the patch very firmly with strength. I am a diabetic, so I then use an insulin bottle as a "roller" to roll on the patch from side to side with strength. Cleaning, and aggressive application are key. Make sure the area is clean and very dry, and I can't stress this enough. If the area is not clean, the patch will not stick, and it will not give you maximum effectiveness. Work great for me for pain relief, and only minor side effects. Remember, it takes 4 hours for initial onset of action, 6 for definitive action to set in. It also takes time for your body to begin to get an effective blood level of the medication, so give it a few months. I also use Percocet 7.5/325 4x day for break through pain. Cheers!

Last edited by hb-mod; 12-21-2010 at 04:03 AM. Reason: Removed Quote. Please use "QUICK reply" rather than "QUOTE reply". Thanks!

 
Old 12-20-2010, 10:22 AM   #10
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Exclamation Re: Patch ? from new member

Frank,

I'm glad you've found a system that works for you, but I have to caution others to try a different method. You are absolutely correct about site preparation (clean and dry,) but two things you are doing might not be advisable for others. The first thing I want to point out is that each patch is supposed to be placed in a different area from the previous patch. The adhesive can irritate the skin, so having at least one other location for a subsequent patch allows the previous area to heal. The medication and its "vehicle" (a substance added to the medication to transport it through the skin more effectively) can also change your skin's structure in that area if the patches are always used in the same spot.

The second thing I'm concerned about is the vigorous rubbing. It's okay to do so in order to remove all residual adhesive, but this leaves the skin more susceptible to irritation. Rubbing the skin also increases the blood flow to the area, and the medicine in any patch put on the area shortly afterward will be absorbed more rapidly than normal. While the effect may not result in an ovedose, it is still not a recommended practice. If more of the medicine is absorbed because of this, the patch may not provide the expected duration of relief, and you're in more danger of going into withdrawal before the next patch is due to be applied.

I recommend rotating among at least three or four areas, and have found that baby oil (or mineral oil) applied with a cotton ball is effective at removing adhesive residues with the least irritation to the skin. If the new patch is applied to clean, dry skin, there's very little chance that any of the oil will get near the patch.

Anyone using medicated patches of any kind should read the package inserts or other instructions carefully, and discuss any questions or anything that is unclear with their doctor or pharmacist. Also be sure to dispose of used patches so others or pets cannot come in contact with the medicine. There can still be enough medication remaining in a "used" patch to affect people or pets who have not used the medication (or similar medications.) This is particularly true for extremely potent narcotics like fentanyl, where even brief contact with the active side of the patch can transfer enough of the medication to pose a health hazard.

My best wishes for a happy and safe holiday season.

Last edited by hb-mod; 12-21-2010 at 04:04 AM. Reason: Removed Quote. Please use "QUICK reply" rather than "QUOTE reply". Thanks!

 
Old 12-21-2010, 03:54 AM   #11
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Re: Patch ? from new member

Hello mimamma. Hope I spelled your name right. You can try Gabapentin(neurontin)if lyrica does not help you. Lyrica does not help everybody.

I am on a low dose of Gabapentin(neurontin). I can tell you it helps some.
There is also Clonazepam which helps nerve pain pretty good, this is addictive though, just like any narcotic meds though. (Just like the patch)
It is called anti-convulsulant, anti seizure meds.

You can add a low dose of the above to your fentanyl? patch.

I wish you the best

 
Old 12-26-2010, 08:06 PM   #12
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Re: Patch ? from new member

I am thinking the 50 mcg. patch isn't strong enough. I don't know if your doc would be willing to increase the dose by 25 mcg. until you get the relief you need but that is what my doc did. As for the withdraws you are going through, chances are it is the methadone you were on. It works fairly well for pain control but if you ever need to get off or switch to another pain med you will have a miserable few days.

 
Old 12-26-2010, 09:07 PM   #13
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Re: Patch ? from new member

hey there mama...ill be damned..someone else with similar obstacles....of course, everyone here has the pain issues, but, how did they come by it. i had a car accident, broken neck, severed spinal cord, and also had an ankle fusion from failed reconstrucion attempts years earlier... ihave taken every narcotic on the market; some will work a little, some better, and some not at all. everyone is different. I did not have any luck with fentanyl( 200 mcg's /hour)....lyrica or neurontin idn't work either....opana has worked best for me, but is very expensive(about 1/3 stronger and costs about1/3 more as well). is your pain pretty much nerve related? i have read that some amphetamines work on pain as well...that is my next step...good luck with evthing, and if sumtin doesn't work, move on to sumtin else...bryan

 
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