Itching is a side efect of all opiates, kinda like constipation,stuffy nose, urinary retention, pin point pupils, etc etc. Once you feel the dose is safe as far as respirtory supression, Bendryl is the easiest way to manage the itching. Ideally you shoul become acomadated to this side efects in a few weeks or months.
good luck, Dave
I have had Fentanyl both in IV and with a patch. When given in an IV it just helped with the pain and I really did not have any side effects from it.
When give the patch form, I put it on and I started to itch all over my entore body. I dod not have hives or anything, but itched really really really bad. It drove me absolutely crazy! I had decide to change PM docs and the new PM got all wierded out because in my past I was an active addict and alcoholic. (street "speed" was my thing). He took me off all the percocet and muscle relaxers I was on and put me on the patch. Then he did an Injection in a different place than what was ordered. He also dictated in his little tape recorder whil I was trying to answer his questions. He also would finish my sentences for me and then dictate wrong info into it.
So all these things coupled with the fentanyl experience I decided to go back to the PM I had had during a workers comp case before my neck injury.
I called the pharasist and he oked me to take the patch off and go bac to taking whatever the meds I had been on before untill my the PM appt. with the old PM.
I am not a doctor, but I do think everyone's body handles things differently.
I hope you will get it straightened out and be on your way to no more Itching!!!
Just started having problems with itching - never had any problems before. I've wondered if sweat and heat are contributing to the problem. Are you talking about under the patch or itching all over? The latter is common when starting opiate therapy. You may have better luck with a different brand of patch as well...
Benadryl is good for itching, but it will make you pretty sleepy, Zyrtec is also pretty good for this and is much less sedating. I've used both for hives etc., and I think it would work for this too. Another option would be pepcid, zantac, or something like that. I've used these before as directed by my allergist for hives. Strange as it sounds it does work.
For those with itch from opiates, an option that exists, but is rarely used is Naltrexone. I have used it for over three years. There is a bit of research out there on this.
To start off you use very small quantities of naltrexone, mine was prepared at a compounding pharmacy and was in an almond oil base. Over time the dose of Naltrexone required increases and the compounding pharmacy can make it into capsules. Note that my opioid dose did not increase.
It is a little challenging because you have to balance the itch and the tendency to go into withdrawal. It sounds scary, but it isn't really that bad because, for me anyway, I get signs of warning before withdrawal.
The itch for me was so bad, no amount of benadryl, reactine, antidepressant, etc would help. My Chronic Pain specialist had tried this for a few other patients for other side effects, but I was the first patient he tried it for to reduce itch.
It also considerably helps the other side effects, like constipation.
I wish I could refer you to a published research article, but I can't. Like I said I have seen reference to this treatment in a few articles but for the most part they talk about it as if they don't know whether it works. Well I know it works, and has allowed me to continue living my life.
Best of luck to those of you with itch and pain; but hopefully your specialist can help you with this method also.
Last edited by Amarylis; 08-23-2008 at 05:40 PM.
Reason: grammar error
I believe you are also getting a very valuable benefit from the miniscule amount of naltrexone added- I *think* (unfortunately, I can't recall for certain), that very low dose naltrexone has been found to help protect against increases in tolerance. There are some other agents which also help with this. Not sure why they are not used more frequently in PM. If I'm wrong, feel free to correct me.
Last edited by Mod08; 08-23-2008 at 04:36 PM.
Reason: no need to quote the message - address response to that user directly in order to save server space.
Hey Confused, What prevents tolerance is that the more you take the more antogonist your getting which further limits the agonist benefit. S o increasing has the oposite once you reach a certain point.
Using meds like Suboxone may end up being the first line medecine in another 5 years. It makes sense for many reasons, The biggest is that it would certainly be an esier trial if withdrawal wasn't included due to years of pure opiate use. However it just hasn't been around or used in this manner long enough to become a protocol. If anything it's seen as more of a last resort that's used on patients that haven't been able to stabalize for whetever reaon. Why not use it as a first drug, allow people to benefit from the pain relief without going through withdrawal and potentially reduce the risk of abuse if progression isn't needed.
Things were so differnt just 10 years ago, who knows what things will be like in another 10. When you have CP it is a lifetime process. 10 years may seem like eternity but I've had failed afer failed back surgery since 93. The difference in treatment in 93 compared to know is like comparing a black and white TV, which some members may have never seen in their home to a fairly inexpensive 50 inch plasma high def TV's on the wall. The meds were talking about simply didn't exist or weren't used outside of terminal cancer patients, even then those patients were suffering which more than likely opened the door door for change and Pharama companies became proactive in lobbying for Pain relief changes not to mention profiting hugely from it.
The one sure thing is that things will change.
What's tolerable to one patient may be completely intolerable to another. HOw long has she been at that dose, was there a brand change, and her own individual chemestry. It's not like if the ptach doesn't work there aren't other choices. Personally I titrated up tp 150ugh and had no ill side efects, just no pain relief.It was a misrable 6-8 weeks, but we generally aren't harmed by the process of trying something that doesn't work.
So I switched back to meth and it's nasty side efects but what was tolerable then wouldn't be tolerable now as far as the efect meth had on my mood and personality.
Take care, Dave
Yes, I too wish that Opioid Antagonists like Naltrexone were used more often in pain management. I don't know whether opioid antagonists influence tolerance, but they certainly make life easier for me.
As I mentioned constipation is greatly reduced, so is nausea. For females who experience what I believe is called the "estrogenic effect" of agonist opioids, they will find with the addition of an opioid antagonist those effects are lessened or eliminated.
What upsets me is how many people I know who have severe itch or other untolerable side effects from opioids and consequently have to either live in constant pain or endure surgeries without pain relief. This seems extremely cruel to me especially when this is such a reasonable answer.
I remember reading about this option over ten years ago, although the article did not suggest a particular antagonist drug. Why so much time has passed with so little improvement I cannot say?
A friend who works as a nurse in Labour and Delivery has told me that many women get severe itch after epidurals and an that an opioid antagonist is routinely administered to correct the situation. So why is this used routinely in one area of medicine and not in others?
One reason I can think of for why this method isn't used more often is that the drugs required are already available and at "reasonable" cost, in other words there is no profit in it for a drug company.
The other reason is just that there is so little information in respected journals about it. Although, I forgot that years ago, I put together a list of URL's to journal articles about this. If a moderator can tell me that it is okay to post those URL's I will do so.
I hope that Shoreline is correct and that this method will become expected protocol soon.
Hey Amarylis, I restrained myself from responding to Shoreline's post and yours b/c the thread is basically about itching and a discussion of opioid antagonists and the lag time between research findings and use in clinical practice is basically off topic (I felt somewhat responsible for pulling it off topic with my brief comment - it wasn't my intent to move the thread off of itching]. I'll respond briefly, but think that we should start a new thread if we're going to broaden the discussion beyond itching -otherwise, we are hijacking the thread, and the original poster isn't likely to get as many responses to her query as she might otherwise get. On that note, before responding briefly,
So, as briefly as possible- you're probably right about the influence of profits though naltrexone is pretty well known [and used, at least for recovering addicts].
I've read that there is often a lag of 10-15 years on average before research makes it's way into clinical practice - I can understand some lag time, but this seems excessive. I don't think most practicing clinicians have time to keep up with research and reading journals - generally, I think you need to see someone who is at a teaching hospital and conducts research while practicing medicine if you want to be exposed to the latest innovations. Tolerance is a huge problem/issue and, as you can read on this board, many people will limit their dose increases and continue to suffer pain so that they don't get to too high a level on the meds and find that nothing is available to help. Yet there are studies indicating that low dose ketamine [this I remember clearly], not only stops tolerance from developing but can actually reverse it. I imagine this is still experimental, but it would be interesting to see clinicians give this a shot. There are some many other interesting research developments as well that we just don't see in clinical practice...Ok, seriously, if we're going to continue the discussion on research findings and clinical practice or adjunctive medications, we have to open a new thread. Please post a new thread if you'd like to keep talking about this....I don't think we can post url's to articles [I think we'd see more if we could], but you might check the posting rules again or email one of the moderators - I'm not sure if you will get a response here. Nice to meet you!
Last edited by Confused089; 09-10-2008 at 11:39 PM.