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Old 03-18-2004, 07:36 AM   #1
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Scared to start duragesic patch

I am scared to start the duragesic patch. My doctor has prescribed it for with two Perc. 5's a day for my back pain. With my tolerance, this isn't much! But what can I do~
Ok, for my question~ I am scared of the withdrawl of the duragesic patch because I have heard that it is just terrible. Has anyone been though this?
Also, I am prescribe Lorcet from my neorlogist for miagrains and the patch and Perc's by my family care doctor. Am I going to have a problem with the pharmacist or insurance?

Last edited by scaredandnpain; 03-18-2004 at 08:04 AM.

 
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Old 03-18-2004, 08:06 AM   #2
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Re: Scared to start duragesic patch

Can I say ditto to this message?? I was just prescribed the patch yesterday and am not real sure as to what to expect in terms of pain relief and eventually coming off of it. Any info from experienced users is welcome.

Thanks
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Old 03-18-2004, 08:26 AM   #3
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Re: Scared to start duragesic patch

NEWBIE, HI, SORRY TO HEAR ABOUT YOUR BACK PROBLEM. I DO KNOW IN PA ITS ILLEGAL TO HAVE DIFFERENT DOCTORS PERSCRIBING NARCOTICS(ITS CONSIDERED DOCTOR JUMPING). YOU MUST MAKE SURE EACH DOCTOR KNOWS WHAT THE OTHER IS GIVING YOU. ONE DOCTOR SHOULD BE MEDICINE MANAGEMENT FOR NARCOTICS AND PAIN ISSUES. I HAVE A FAMILY DOCTOR WHO DOES (COLDS,FLUS, DIABETES,FAMILY DOCTOR STUFF) AND MY PAIN NEUROLOGIST GIVES ME MY MEDS FOR MY RSD AND PAIN CONTROL.

YOUR PAIN DOCTOR MAY NOT WANT YOU USING A DURGESIC IF HE DIDN'T PRESCRIBED IT. YOU CANNOT SEEK OUT 2 DOCTORS FOR TREATMENT FOR THE SAME PROBLEM WITHOUT EACH DOCTOR KNOWING IT. I WOULD CALL THE PAIN GUY AND TELL HIM THE FAMILY DOCTOR GAVE YOU THESE MEDS IS IT OKAY TO USE THEM. SOME OF THE MEDS YOUR GETTING MIGHT BE DOING THE SAME THING AND YOUR DOUBLE DOSING.

I'M NOT TRYING TO SCARE YOU I'M TRYING TO HELP YOU. HOPE THIS INFO HELPS.

 
Old 03-18-2004, 08:31 AM   #4
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Re: Scared to start duragesic patch

THE DURAGESIC WORKS GREAT FOR ACUTE PAIN. IF YOU HAVE CHRONIC PAIN AFTER AWHILE YOUR BODY WILL BUILD UP A TOLERENCE TO IT AND THE DOSE WILL HAVE TO BE INCREASED. THE PATCH STAYS ON FOR 72 HOURS AND TAKE SOME PAPER TAPE AND PLACE OVER THE PATCH, THAT WILL HELP HOLD IT IN PLACE. LIKE ANY OTHER NARCOTIC, THIS IS FENTAYL AND IS HIGHLY ADDICTIVE. BYE

 
Old 03-18-2004, 09:25 AM   #5
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Re: Scared to start duragesic patch

My doctor offered me a patch for back pain about a year ago. I didn't take it as I wanted to figure out the cause first.

We had a newsarticle on tv just last night about how easy it is to use the patch. It just seemed a little too easy to prescribe and use to me.

After listening to the newsarticle I would have thought that you would have to go through all other options first and be prescribed by someone other than a GP but it was his first choice for me. Is this the new buzz word? patch?

Keep us updated if it works without a lot of side effects as I know someone who does need one.

 
Old 03-18-2004, 10:02 AM   #6
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Re: Scared to start duragesic patch

I thought that the duregesic patch was to be used only for chronic pain and never for acute pain, and like any narcotic your body will eventually build up tolerance to it, sometimes it takes a while sometimes not very long at all it all depends on the person. Someone may build up tolerance to the patch very quickly where as another person it may take a long time it's like that for all opoids.

As for worring about coming off the patch don't worry about that right now when the time comes just make sure your doc weans you off them the right way and you should not have any problems, I did not have any withdrawl at all coming off the patch I was on 50mcg and I just went down to 25mcg for a few weeks then I folded it in half and taped it down so I was getting 12.5mcg for a few more weeks and then switched to Oxycontin.
Even before that I was on 25mcg of the patch for a few months and switched to oxycontin and had no withdrawl.Switching from one narc to another without tapering down first can work without having withdrawl as long as you do the proper conversion. If your wondering I switched back and forth once from duregesic to oxycontin then back to duregesic at a higher dose but found I was having to take a ton of breakthrough pain meds And I was tired all of the time as well, so we went back to Oxycontin at a higher dose and it is working really well for me. But everybody is different some people one drug will work for and somebody else it may not, I did like taking the patch though it was so easy just slap it on and Away you go for the next 72hrs but after a while it would only give pain relief for around 48hrs so I was changing it every 2nd day and taking a pile of bt meds, you will find that most of the drugs that say they last a certain amount of time don't, example Oxycontin I take 3 a day instead of what it say's it is supposed to cover twice a day. ANyway I am just rambling on, good luck and give the patch an honest chance and don't worry about the withdrawl just MAKE SURE YOUR DOC WEANS YOU OF WHEN THE TIME COMES, SEE YA.
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Old 03-18-2004, 11:31 AM   #7
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Re: Scared to start duragesic patch

Hi Scarredinpain, A couple things, It's not doctor shopping if you have 2 doctors prescribing opiates for 2 different problems. It wouldn't be any different than me having a kidney stone and my urologist giving me some Demerol until it passes.

However you do need to be honest with both docs and let them know what you are on and what the other doc is prescribing because it looks like doc shopping at first glance and that me be the only glance you get before being cut off.

IF your GP was an actual PM doc he would likely have you sign a PM contract that would either prohibit you from seeking treatment and meds for the same problem he is treating and the contract would explain about no early refills, doc shopping, physical dependence Vs addiction, he may require UA's or may insist you see a PM counselor to learn some relaxation techniques.

Because you have two pain generators doesn't mean you need two docs. Duragesic and Percocet work just as well on headaches as they do back pain. So talk this over with your GP that's treating your chronic pain so you know you won't run into trouble.
Honestly it would be better to have a PM doc handling both issues and all your opiate scripts.

A nosey pharmacist could certainly cause trouble with your docs by accusing you of doc shopping, your not actually doing anything wrong because your being treated by 2 docs for 2 different things as long as they know about each other. I doubt the neuro will be happy to prescribe additional opiates when he knows what your GP is prescribing. That's not exactly the way to fly under the radar to prevent problems.

It's a problem waiting to happen and hopefully you would get the chance to explain before being discharged from both practices and cut off cold turkey. All it takes is one call from a pharmacist questioning a docs prescribing practice for some docs to back right down and discharge you if they feel there is any validity to what the pharmacist says. Because the next call the pharmacist makes will be to the DEA or the Board of Pharmacy.

I guess it's nice your GP is treating your Chronic pain but how much experience does he have with Fentanyl? Although it's so much more potent than morphine it's measured in Micrograms it doesn't make it any more addicting just more dangerous for a doc to prescribe that has no clinical experience with the med.

The reason why people experience withdrawal is because Fentanyl binds to opiate receptors that other opiates don't. Mainly the Kappa receptor, although the package insert says it's a strong MU agonist just like morphine when you switch to morphine you loose all the Kappa activity which can cause differential withdrawal.


continued on next post...

Last edited by Shoreline; 03-18-2004 at 11:35 AM.

 
Old 03-18-2004, 11:33 AM   #8
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Re: Scared to start duragesic patch

There is a way to lesson the withdrawal when switching or discontinuing the Patch. The amount of med delivered is based on the amount of patch exposed to the skin. Each strength patch is larger and larger and is able to deliver more meds through the transdermal portion of the patch.

Jansen will send you Bioclusive covers to hold the patches down if you have a problem with adhesion. It's just a large clear adhesive cover that covers the patch and additional skin. They are free if you ask. The first time you call jansen and tell them you have a problem with adhesion they may make a recommendation, if that doesn't work, call them back and they will send you the Bioclusive covers at no charge.

Fentanyl is no more addicting than morphine or Oxycodone, But when switching, because it hits different receptors people do experience some withdrawal. Fentanyl is the most potent opiate any doc can prescribe. It's just a matter of what strength he's prescribing. It doesn't necessarily make Fentanyl more addicting or dependence any worse than any other opiate.

However, IF your GP doesn't know anything more about the patch than what the factory rep told him, that is scary. Reps aren't docs and they don't know anything more about what they are selling than what they have read. Meaning no clinical experience with this med. Just because every doc has the ability to write a script doesn't mean every doc should be managing chronic pain with potent opiates.

Just like any doc can prescribe antidepressants, It doesn't mean every GP should play psychopharmacologist with a patient and meds he knows little about. Antidepressants without counseling are no more effective than counseling without antidepressants.

If you had cancer would you go to an oncologist or trust in the friendly GP that has the same ability to order tests, therapy and meds because he has hospital privileges.

What is your neurologist doing that your GP can't. Having only one doc prescribing opiates will not raise flags at the pharmacy. Having two docs from different practices will raise flags. Regardless if it's legal and legit or not.

Being able to use the excuse that the Neuro is treating a different problem won't protect you or your docs from investigation although you may come out of it fine, you may still endure some of the accusations which isn't cool. It may look like doc shopping but technically it isn't.

However CP patients don't have the luxury of making those kind of waves and expect their opiate therapy to be continued while something very questionable is being investigated. It's easier to just cut you loose and say go to rehab if you have a problem with detox. The best way to continue your PM is to not make waves.

Talk to your GP about additional meds if the patch and the percs don't help the headache, Both are stronger pain meds so I don't know why you would need the Hydro from the Neuro? Can the neuro manage all your pain needs, is he a PM doc or just a neuro that treats headache patients with abortives and a few vicodin a month. If you need more than one doc can supply, you need a real PM doc.

Having 2 docs prescribing opiates may lead an investigation to both you and both doctors. No, you are technically not doing anything wrong. But I have seen PM patients cut off without the chance to explain why they see a neuro that also gives them opiates. It's just asking for trouble although technically not illegal.

As far as discontinuing Duragesic it's a matter of how large are the steps when your coming down. Going from 100 to 75 isn't a horrible step because it's only 25% but going from 50 to 25 is a 50% reduction. How you make those steps smaller comes from your doctors clinical experience with this med. I can tell you how to do it, but I would bet your doc has never done it because he's a GP not a PM doc.

All you have to do is Apply a 25ugh patch with only half the backing removed. You need the bioclusive cover to keep it from waving in the air like a tab. By only exposing half the designed area of the patch to the skin, you can effectively cut the strength of the patch in half.The amount absorbed is based on the amount exposed to the skin, cut the amount exposed by half , by not removing half the backing, creates a patch half the strength.

Yes, you need to tape it down and when you remove it there will be plenty left in the patch but the waste is better than the withdrawal. Do not force the gel onto the exposed side of the patch, Just apply and leave it alone. Then remove it at your normal interval.

So if you were to step down from 50 you would wear one 25ugh patch normally, and one 25ugh patch with just half the backing removed and exposed to your skin. Use a Bioclusive cover to hold it down and you have effectively created a 12.5ugh patch, cutting the step down by half. After you are used to 37.5ugh you can go to a 25ugh patch. Once you are used to the 25ugh, you go to just a single 25 with only half the backing exposed to the skin. Now your step down is only 12.5ugh. Making withdrawal much smoother.

But these are techniques that actual PM docs use, I doubt your GP has ever done it, so convincing him of using a Fentanyl patch in a way it wasn't designed may be tough. If he has no clinical experience doing this , he may not be receptive to the idea. So by using a GP for PM your more likely to have bumpy rides when you switch meds because they don't have the experience with the meds they are prescribing.

I don't know why people are so pleased to have their GP who has virtually no clinical experience with intractable pain and long acting meds handling their chronic pain issues. I wouldn't want my mothers GP handling her pain issues if she was in a hospice. Those folks have the experience to deal with whatever problem, reaction, increase in pain, tolerance, or issue that may happen. It's the same thing with CP.

Just because a doc can write a script for Duragesic, the day after the Jansen rep stops by, just means you are his guinea pig and if you have a problem, you likely get to just suck it up.

What will your GP do if your allergic to the adhesive, what has he done with his other chronic pain patients using Duragesic? Does he even have anyone else using Duragesic?
If you start vomiting does he know how to handle opiate side effects or will you just get a relayed message to take the patch off and you will stop throwing up.

My advice would be to find out which PM docs are in your network if you have to use a network. Then call their office and explain your situation. You have a neurologist that has helped treat your headaches and now your back has deteriorated to the point of needing around the clock meds. Your presently using Duragesic. Can the PM doc take over for your Neuro and GP and handle all your needs.

The front staff will usually be pretty clear about what methods the doc uses. Some PM docs won't prescribe a Tylenol 3, some will prescribe Duragesic. It's just a matter of finding the right PM doc with the experience to handle all your PM needs.

With your GP handling your PM he may have to ansqwer, Have you had surgery? Have you ever tried any non opiate method to manage pain? Have you seen a PM doc to try any other method? Have you learned self hypnosis, any relaxation technique, Bio feedback,YOGA, Guided imagery, used TENS, TINS, Acupuncture, PT, or any other method besides opiates?

PM docs need to chart all the other efforts to manage your pain besides opiates before they can prescribe opiates comfortably without worrying about being asked, did you try any other method before prescribing such powerful meds? That's how docs get shut down, by simply being a pill mill with no other effort having been tried.

I don't know what exactly is wrong with your back or what other methods you have tried, but it is unusual for a GP to prescribe Duragesic unless he referred you to a PM for consult and the PM sent you back with a treatment plan and he is simply following that plan. In that case it's fine. The PM doc would handle any changes in meds or condition and relay the changes to your GP.

That's just my experience. I've been seeing PM docs long before there was OxyContin and opiates were an excepted way to manage pain. Back then you were taught self hypnosis and given some Prozac and trigger point injections or epidurals. Opiates for me were the last stop. Nothing else worked, 3 surgeries failed and I was bed ridden before anything opiate was even offered. Things are different now but I still don't think most GP's have any buisness prescribing Fentanyl unless he has some extra training, did an anethesiology residency or fellowship. Other than Duragesic, Fentanyl, Afentanyl and Suffentanyl are only used in anesthesia.

It is the top shelf med that most docs really don't understand the potency of. They think you can switch from Duragesic to MSContin without any problem as long as they follow some equienalgesic chart. And that's not how it works. Charts are just guides, they aren't a replacement for clinical experience.
JMO
Good luck, Shore

 
Old 03-18-2004, 02:28 PM   #9
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scaredandnpain HB User
Re: Scared to start duragesic patch

Thanks so much for all of the advice. I have had some major back pain since I have lost alot of weight. Thus, sent for an MRI and they have found "two broken facets, DDD L4-5 & L5-S1, pseudo disc at the L5 -S1. Can't confirm true herniated disc from this exam. Conus medullaris apears at the T12-L1 leval. Central canal is rather capacious. Spondylolysis and spondylolisthesis L5-S1.
Ok, that is what the report says, now what it means, I don't really know. Hopefully a new PM doctor will tell me.
I had been a PM doc about a year ago that landed me in detox with a major reaction to a high dose of Methadone that he prescribed, along with MANY other narcotic meds all on my first visit. Needless to say, this PM doctor was/is under investigation with the DEA and has since had his license revolked. Basically, as I was going through a three day panic attack with my tongue swollen twice it size and tiny blisters all over it, this PM doctor told me that my tongue wasn't going to fall out and called me in 130 Lortab's.
Ok, so I haven't been treated by any doctor regarding my back since except with some Lortab 10's here and there with no continious treatment. I injured my back in a fall at the begining off the month and this, the patch and perc's, is what my GP gave me. I went back for my follow up visit and said that they really helped my normal back pain that I live with daily. She then wrote me for more of each. I didn't know that she was going to do this and my neuro called in more of my Lorcet's. Now it is time to get my prescription filled of the Percs, since she only gave me enough for two weeks, and I am suppose to keep the Lorcet's, on-hand for miagrains. So, basically I am waiting on an appt. with a PM doctor and she, my GP, is treating me until then.
Ok there is my deal~ just being safe instead of sorry~ Thanks again~

Last edited by scaredandnpain; 03-18-2004 at 02:32 PM.

 
Old 03-18-2004, 07:59 PM   #10
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Re: Scared to start duragesic patch

shoreline: hi, i got labeled a doctor jumper and drug seeking behavior at a IME doctor's visit. I wasn't getting any drugs but looking for answers what was wrong with me, I have rsd. I might add I'm sueing this doctor for defamation of my character. I would never misues drugs and I'm the last person anyone would call a drug seeker except this nut doctor who seen me 20 minutes. You just can't fix something said like that, it plants a bad seed in everyone who reads the report, my employer, etc. I'm just saying be careful. toodles

 
Old 03-18-2004, 08:53 PM   #11
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Re: Scared to start duragesic patch

hi scared
shore and jokehakk are right i had went to the dentist 3 years ago note he is also a friend i ave done some work on his vehicle at the dealership i worked at i didnt charge him i told him next time me or my family needs dental work not to charge me well about 3 months later my jaw swelled up and my tooth was hurting so i called him and he told me to come in right away he looked at my tooth and said i had an abcess and he couldnt do anything until infection was gone and asked me where my pharmacy was and i told him where it was and he said he was going to call in some antibotics to pick them up on my way home and to get some hydrogen peroxide to gargle with well the pharmacy i go to has all my ins info on file and went and picked up what i thought was antibotics only well when i got the bag i noticed that there was 2 bottles to my surprise there was also 30 lorcets in there as well for pain
little did i know this was going to cause me a problem a couple of weeks later i got a call from my dentist he said the prescrition card company called to warn him that i was a drug seeker that i had multiple prescriptions for opiates from different doctors filled at that pharmacy and told him not to write anymore scripts for narcotics and to report me to the dea my neurosurgeons office also called me as well tell me that they would no longer see me as a patient on my next visit to my pm dr he conforted me about this and i explained the whole story to him and he told me if it ever happened again that he would wean me off send me to detox and would never see me as a patient again this left me with a friend upset with me my having to find a new neurosurgeon and a pm doc that now didnt trust me and drug seeker and doctor shopper probable written on all my med and ins files so please heed everyones warnings
bob
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Old 03-19-2004, 11:16 AM   #12
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Re: Scared to start duragesic patch

Hi Scared and all, Bob's experience was exactly what I was trying to explain can happen. Something that may look suspicious and many pharmacists are suspicious anyway,can cause so much trouble because there are folks that do abuse prescription meds.

Every pharmacy has a couple addicts they must deal with and every docs office has a couple that make things harder for the real pain patient. Bob was lucky his PM doc let him explain. Some patients just get a letter in the mail saying they are no longer welcome at their practice do to their drug abuse.

I was also labeled a drug seeker after 2 failed surgeries, I was foolish enough to ask a PM doc for pain meds, Silly me, I thought a PM doc would try to help me with the pain. But that wasn't her philosophy. She was into antidepressants and relaxation therapy.

I have waited months to see the head of a physical medicine dept only to be told I don't treat pain with pain meds and there isn't anything I can offer you haven't already tried.

Then when My brother died, that became the cause for all my pain according to the PM doc I was seeing then. Forget the 2 surgeries I already had and the 4 years of non opiate PM, It was now all in my head because my brother died.

Lets see.. I took a script from my NS about 4 weeks after my second surgery to my regular pharmacy, there was a floater working and she first filled a script for 80 Percocet with 40 percocet, when I went back in and said you made a mistake, there is no way 80 percs will fit in this tiny bottle filled to the rim, She called my surgeon, said I was taking too much because I was filling the script he wrote that day. She said it was 2 days before I should have been out according to the pharmacies calculated day supply. Each time you take a script to the pharmacy they calculate a days supply, So anyway, My doc was ****** he was called at 8pm on a Friday night and said cancel the script if he's filling it too early. That was his way of preventing the pharmacist's next call to the board of pharmacy because this pharmacist was hell bent on stopping all prescription abuse.

She didn't know me from Adam, didn't know when or how many surgeries I had. But pharmacist have the power to create havoc so as CP patients we need to fly under the radar. The pharmacists put a red flag on the computer for every script to be called and verified after that night. I changed pharmacies shortly after, but even that looks suspicious.

The next time I was called a drug seeker was 2 months after my 3rd fusion, L1-S1 and my surgeon felt that I shouldn't need pain meds 8 weeks post op. He called my GP and now there is a note in my family docs records that the surgeon believes I have addiction Issues after years of surgery and use of pain meds.

You can be the most legit patient in the world and it doesn't protect you from squat. You can't argue with a pharmacist, and arguing with a doctor is a waste of time. The pharmacist can just flat out refuse your script and tear it up at their whim.

My advice is to Have a surgical consult, The problems you listed are pretty severe. Stenosis is when the area the nerve passes through narrows from bone spurs or arthritis or calcification after fractures, that causes nerve impingement. The spondylolisthesis is when the vertebrae are pushed back or moved forward and the vertebrae are out of alignment and unstable, They won't stay in place and when the vertebrae moves forward or back it stretches the nerve root.

So instead of referring you for a surgical consult she is masking the pain with very potent meds. Although I'm not a big fan of back surgery, using potent meds before you know if you need surgery, will scare surgeons, If they get a patient that they feel already has a drug problem they may insist you detox prior to surgery, This way, you respond better to the post op pain meds and they won' worry about you continuing to ask for pain meds after they cure you with surgery "sarcasm"

But that's how surgeons work. They operate, they have fixed you , so you shouldn't need pain meds. If they fuse you, there isn't a test known that will tell you if the donor bone is alive and growing or dead and just sitting there. The only way they found my fusion's failed was after I broke the hardware. I have broken 2 sets of Titanium hardware.

They didn't believe me when I said things were moving and crunching and squeaking until they actually saw the heads of 2 screws floating away from the shaft of the screw that's embedded in each vertebrae.

I was treated like an addict every time I complained of pain because no surgeon wants to admit his surgery failed. When the hardware snaps it's a pretty good indicator that the fusion never took so the 2-3 years in between surgeries when I was being called an addict and the pain was all in my head, I was right, the fusion's had failed and it wasn't evident until the hardware snapped. If the fusion is successful the hardware no longer takes the brunt of your weight, walking or lifting and it won't break because it's no longer needed to stabilize things after the bone grows and fuses.

Although you have some pretty apparent problems, surgeons don't tend to want to operate on your back to relieve back pain. If you have nerve pain or radiculopothy, pain down your leg or legs, foot drop, or lossed reflexes or loose bowel or bladder control. Then they have a good chance at relieving that by decompressing the nerves or realigning your vertebrae with fusion's, but it doesn't do much for back pain.

The first 2 surgeries relieved my leg pain when I woke from surgery, But it wrecked my back. The last one which was a fusion from L1-S1 damaged the nerves and now I'm numb from my hips to my knees. The last 3 surgeons I have consulted with have told me , what makes you think a 4th surgery will work, You have had 3 , all have failed and left you in worse shape then you started. So no surgeon will touch me now and all I can do is treat the pain. I'll take the physical dependence in order to walk.

So if surgery isn't an option, then pain management is. But by jumping passed every non opiate method to manage pain you become dependent on opiates. Unless there is no surgical solution and no other way to manage you pain, Physical dependence is a pretty hefty price to pay for relief.

If your GP refers you to a surgeon, it's very likely the surgeon will say stop the Duragesic and use Lortab or Norco until surgery, because your post op pain will be harder to manage because your tolerance is now higher than the average person. Then you are put in the position of going through withdrawal switching from the patch back to norco or lortab.

I came home from all 3 spine surgeries with 2 percs every 4 hours. You are already taking more than the average post op spine patient.

If your not a candidate for surgery, how long is your GP going to prescribe Duragesic, Forever? Without trying any other method of pain management. It's not that your doing anything wrong. Your GP really doesn't have any business masking the pain with Duragesic before she knows if you need surgery. It creates all kinds of problems.

I imagine you have medical insurance through your employer. If you back worsens, and your dose goes up, eventually you will be disabled, then you loose insurance after 18 months of paying cobra and then you can't afford the meds. Duragesic and all the long acting meds are extremely expensive. Only meth is affordable for those who don't have script insurance.

It's very unlikely someone will die from opiate withdrawal, docs know this so they have no problem cutting you off without warning and telling you to go to rehab if your having a hard time without the pain meds.

The first call your GP gets questioning her prescribing Duragesic, she will stop and refer you to a PM doc. If your lucky she will keep you on the patch until you see the PM doc, But what if you run into one of those docs that doesn't believe in the use of pain meds. Finding one off the bat is pretty rare unless you know someone already being treated for pain with opiates and can see that doc. It's easier now than it was 10 years ago but there are still plenty of PM docs that wouldn't prescribe you a Tylenol #3

It took me 8 years, 3 surgeries and a dozen different PM docs and every non opiate method I mentioned before finding a PM doc to manage my pain. I'm still disabled but can contribute around the house. It took 2 years for Social security to approve me for disability, went BK, sold our house and now I pick and choose which meds I can afford to fill.

If your first PM doc doesn't believe in opiates, you get to go through withdrawal and jump through every hoop placed before you until you find a way to manage the pain or you find a doc willing to take you on for life because you have no other options.

Filling a script from your neuro for headaches while taking percs and using Duragesic is asking for trouble. I wouldn't do it. I have been labeled an addict when doing a whole lot less then getting a third narcotic while taking Percs and using a fentanyl patch. It aint worth it. Especially since it seems neither doc knows what the other is prescribing. It would be better to call the neuro and say you hurt your back and have pain meds for that and you will let him know if you need additional meds for the headaches down the road when your back problems are straghtened out. Thats just my opinion though. Some folks have to learn for themselves.
Good luck, Shore

Last edited by Shoreline; 03-19-2004 at 11:23 AM.

 
Old 03-19-2004, 12:15 PM   #13
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scaredandnpain HB User
Re: Scared to start duragesic patch

Shore~ Thank you so much for your wonderful advice. EVERYTHING you have said has and will be taken into great consideration. I am basically waiting for an appointment with a new PM doctor. Hopefully, it will be within a few weeks. She said he "works" pretty fast for her, my GP. Something funny~ the neuro. approved the refill of the Lorcet's even knowing that I was taking the Percs. But I don't plan on getting anything else from him except the basic non narcotic meds for my miagrains. And I waited to get this script filled for the percs until what should have been time for a refill from the neuro.
Thanks again for ALL of the wealth of information!!!!! I will keep you posted as to when my appointment with the PM doc is and what he says. But I know he is an injection kind of doc!
Have a great weekend!!

 
Old 03-19-2004, 03:44 PM   #14
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Posts: 2,139
injured betty HB User
Re: Scared to start duragesic patch

Wateful tick:
I saw in your signature line that you have a pinched nerve at c-7. Did an MRI show that? I am curious 'cause my husband's MRI doesn't and he is a lot of pain. I read the MRI results and although he has herniated disks, it is not on a nerve. The DO is worried about the nerve situation. He has an appointment with a Neurologist on the 23rd. Meantime, he is in a lot of pain. He took off work early today due to pain. I set him up for physical therapy today. Is that the right move?
I know that this is the pain management board and not the back pain board, but your signature is what drew my attention.
Also, Neurontin, ever tried it? Work or not work?
Does a pinched nerve lead to nerve damage?
What tests should he be getting. So far all they have done for him is prescribe drugs. As an recovering addict we hate to do that unless absoluetly neccessary.

Any other suggestions for pain management? Sometimes I look at him and think that he could be chewing on nails and this is a guy who is usually laughing.

 
Old 03-19-2004, 04:19 PM   #15
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Join Date: Jun 2003
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Shoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB UserShoreline HB User
Re: Scared to start duragesic patch

Hi Betty, I saw your question about a pinched nerve and I wanted to answer that one.
A pinched nerve is kind of a catch all term. It doesn't exactly tell you how impinged and what is causing the impingement.Can it be fixed?

But if you have a ruptured or bulging disc and you let it go untreasted for years, yes it can do considerable damage. In my last post I admitted that although surgery has screwed up my back, I did awake from each surgery with all the leg panin relieved, What wasn't relieved is now numb.The internal material of a disc is also caustic to nerve tissue, so a glob of disc anulus jammed into a nerve root can do some real damage not to mention the pain it would cause all along the nerve pathway. All the way to the tip of a toe or a finger, or wrap around and cause chest wall pain.

But anyway, If you put off surgery say from a ruptured disc where a fragmnant is impinging a nerve or narrowing an outlet "the Formina" you can do permanent damage to that nerve to the point that normal sensation never comes back or it takes months for the damaged nerve to repair itself. It's been 5 years and I can put a cigar out on my bare thigh, Neat party trick but you don't want to fall asleep smoking, If not for the smoke I never would have woken up to put the fire out in my own lap. I have 5 burns that look like gunshot wounds from burning so deep. Luckily it didn't hurt to debreed, or I couldn't feel it.

My older brother put off back surgery for a good 5 years,. He built up a healthy tolerance to valium and all the short acting meds including Dilauadid. But he didn't wake from his surgery which was minimally invasive to reduce the impingement with the pain in his legs relieved. He's still hurting.

Because it was damaged so long, it did actual damage to the nerve root and there is the philosophy about engraining pain. If you don't treat post op or injury pain agressively, or at all. You can actually engrain that pain signal in the nerve tissue so that it continues to send the pain signal to your brain.

The nerve has fired the pain signal so long it's not going to stop. There are also conditions you can develop from not treating an injury or pain for example RSD that can throw your entire neuro system out of wack from not treating pain properly and you can develop complex regional pain syndrome, same thing basically.Your entire nervous system constantly fires off pain signals.

So Masking the pain for 3 years and then having surgery can greatly reduce the odds of a successful surgical outcome. It's been 6 months since my brothers surgery and his legs are still lit up like a christmas tree, which I understand well. He's taking lamyctyl because it's supposed to not only disrupt the pain signal but speed the time of nerve recovery.

Nerves can actually regenerate at a set numnber of MM per month. I would have to do some more research to remember that number, But say you damage a nerve in your neck that runs down to the middle finger. They can actually measure from your neck where that nerve root starts to the tip of the finger and predict how long it takes for restoration of nerve function.

Although nerves can regenerate, It doesn't mean that the pain won't be engrained if you put surgery off for 4 or 5 years with the use of meds, Then you have a harder time with post op pain due to tolerance and a harder time finding a doc to cut and he will certainly want you to try to DC all meds to see if the surgery relieved your pain. After 5 years you need a slow taper and surgeons tend to be fast and furious.

If your a CP patient, it would be best to have your PM doc manage post op pain or be in on the decision how to manage post op pain.

Hey,I think I answered a question in less than 10k characters.LOL
Take care, Shore

 
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