Just some background info first: I have psoriatic arthritis that affects my ankles, knees, hips, elbows and a few other joints as well as thoaric back pain which is from an old fracture. I also have recently been diagnosed with thoracic outlet syndrome. All this at the lovely age of 30. Go me.
I am still working with the rheumatologist to find the perfect cocktail to get my arthritis under control. Currently I am taking methotrexate and naproxen for it. My primary care physician handles my pain medication.
I have been on 60 mg Avinza for about 6 months (was on 30 mg before that). Anyway, two weeks ago I went into his office because I wasn't getting very good pain control with the 60 mg. His first inclination was to raise it to 90 mg. I accepted the rx but the more I've thought about it, the more I'd like to maybe switch meds instead of going to an ever increasing dose.
I shot and email off to him about it, and specifically the patch. He does use it frequently in his practice and said it does tend to have fewer side effects. I am having bad constipation despite use of Miralax and good diet with the Avinza.
I have an appointment with him next Friday to discuss switching meds. I know Shoreline has said Fentanyl is sort of like the drug of last results, since it is the most powerful, and that's what makes me hesitant about moving to it. But I do like that I don't have to take pills. Also, I think with the type of pain I have from the arthritis, the very steady state would help.
Since I have only been on the 90 mg of Avinza a few weeks, I was wondering if I could get away with just using the 25 mcg Fentanyl patch? What do you think? And maybe change from Norco (which I have now) for breakthrough to something a little stronger.
I'd appreciate any advice/insight. My goal is to use the least amount of pain medication as possible. I'm still hoping a med can be found to get my arthritis under control (maybe starting Enbrel soon, which should help) and then maybe one day I wouldn't need a long acting med, only an occasional SA.
The fentanyl patch is outstanding for pain management, but very potent and I found tolerance developed ultra fast. I went from a 50mcg patch two one 100mcg patch and one 75mcg patch in just two years. I also used the Actiq (fentanyl) lolypop for BT pain which was also excellent, but again my tolerance developed dangerously fast. I also had loads of difficulty keeping the patches on as the med made me sweat quite a bit. to answer your question, it's my opinion that fentanyl is much less constipating than morphine.
It's a great pain med, you just have to be very careful. Have you considered OxyContin? That would be a natural step up from Avinza as oxycodone is about 50% stronger than morphine. You could then use the oxycodone liquid, or tabled for BT medication. I use the concentrated liquid (20mg/1ml) and it works great.
Last edited by forginon; 10-23-2007 at 11:42 AM.
Reason: Forgot something
I like the way you think. It's best to use the fewest meds with the most relief and fewest side effects. I am a strong advocate for the patch, I love the pain control. However, during the hotter months I have a very hard time keeping them attached to my skin.
With that said, I have divaticula and had major surgery in June to remove a foot of my bowels. Needless to say, I can not tolorate any knid of morphine, as it seriously constipates me.
As far as breakthrough meds with the patch, I am rx'd Dilaudid. And between to patch and Dilaudid I am as stable as I can ever hope for.
Thanks for the information. So is it generally known that fentanyl causes rapid tolerance or has that just happened to a few people? I thought people were able to stay on it a pretty steady dose.
Are there any different long-acting drugs that might cause less constipation than the morphine?
As far as oxycontin, I'm really worried about the stigma with it. The same with any of these meds, actually. I'm afraid at how the docs will look at me. It's weird though, because they have no bones about prescribing short-acting norcos and stuff, which have a much higher abuse potential.