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Old 05-02-2010, 12:02 PM   #1
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Dr moved me from MS Contin to Fent Patch, I'm in horrible pain..need advice!

I have been on MS Contin for several years, and Morphine Sulfate Instant Release for somewhere around 10-12 years...because of all the meds, the MSIR works the best.

Well, may back has been getting worse and worse for the past several years and doc kept upping the MS Contin to the current dose of 100mg in am and 100 mg noon and 200 mg at bed time. I have a terrible fear of putting these pills in my boby, cause once they are in there, it's pretty hard to get them out...without dying of OD.

So I stopped dropped the 200 mg down to 100 mg at bedtime. So I have been down to 300 mg a day for the past few months.

While I could tell the MS Contin was working, the side effects where killing me. I'm not talking pain. I'm talking dry mouth....just broke my second tooth, even after using every dry mouth aid available. I'm also talking about the disconectedness of my family. I have kids that are going to be leaving home before long...one in a few years and one in 8 years...I JUST WANT TO ENJOY MY TIME WITH THEM WITHOUT FEELING ALL DOPED UP and TIRED and ANGRY ALL THE TIME B/C NO ONE CAN FIX MY PAIN. I'm sure you know how hard PAIN is on the family dynamic. (Was considering a pain pump...but finding one you can trust is another issue entirely...read up on it...I was surprised.)

OK...back on point. I was so SICK of the MSContin side effects that I asked dr to try something different. I had been on the patch years b4, and thought I had rembembered that it worked. Well my doc agreed with me, and moved me from the 300 mg MS Contin...dr knew I had dropped down from the 400 mg to the 300 mg.

So she switched me from 300 mg MS Contin to 100 mcg/hr fent patch. And instead of giving me my normal amount of MSIR...which to me is my main pain relief med because it has ALWAYS helped the most...she shorted me a weeks worth of the MSIR pills. Don't now why...been on the same dose for years...never any early refills/lost pills/etc. I usually look at the script b4 I leave the office, and I did...but though that maybe this change was because the patches were way strong. Could kick myself for not asking...

So...This is where I find myself now. The patches are not even close to relieving my pain. I can't sleep, my arm burns where the patch is, I can't hardly sleep due to pain and can't take MSIR for btrough..incase I run out. I am constantly just having to sit in inappropriate places when I am out in public... because the pain is too much. And...I'm talking at embarrassing places, like the grocery store check out line, at my son's ball game when I was walking to the bleachers..Pumping gas. THIS IS GETTING SO STUPID! I try to make it look like I'm tying my shoes..but for 5-10 minutes until I can walk again?

I thought I would give it a full months try...because I think that's a fair accessment period. But now...I am having second thoughts, b/c I don't know if she didn't match the doses when she switched the meds from the MSC to the patch??? But I do know that the fact I have had to decrease my MSIR doseage...AND THAT hasn't helped at all.

So...anyone been switched over from the MS Contin to the Fent patch? BTW...it's taking me almost 15 years to get to these high doses...so if you are just going to tell me that I am on too much meds or doctors never prescribe those doses..then that's not the kind of help I'm looking for.

I fractured my pelvis in three places, had it heal in more of an L shape..than the traditional "V" shape. During the operation to try and fuse the SI Joint....The graph doner site had fractured because the surgeon dug to deaply...leaving chunks of bone and arthritis floating around. I've had operations on my legs and knee, due to the muscle damage from limping for so long. I've had failed fusion surgery in two places in my back...and so many injections, nerve denervations, tens units, 3 yrs PT while they did myofactial relase amonst other things...and tooreally many other things to even remember right now.

All I know is that I am in pain, horrible, horrible. If you know somthing first hand about these two meds and switching..then PLEASE help me. I am literally ready to go out of my mind. I know my dr does't work on Mondays and I don't think I can stand this another 2 days...so I'm considering just taking off the patch and going back on my MS Contin....because despite all of the side effects... I was never forced to have to sit down on a grocery store floor and have people look at me like I had mental issues.

If I do go back to the MS Contin...how long do I have to leave the fent patch off (This one's been on for two days now) before I can return to taking the MS Contin.

So sorry for the novel...but I can't ever remember being this desperate before.

As far as the ER, if anyone was going to suggest that...Sorry, I just spent a week in the hopsital for an fall on my back and an infection in my elbow and even AFTER they confirmed what meds I was on by calling my doctors office AND pharamacy, they decided to give me what they wanted. They took over giving me all of my meds.

They shorted me on one MS Contin a day...so down to 2 a day and then only gave me ONE of my breakthrough pill of MSIR in 6 days, ONE PILL...when I am prescribed to have 1 or 2 every 3 hours as needed. I had to beg for that one because it was after they inserted a pic line. They lost my trust...and my doc was furious with them as well...one pill in 6 days.

Ok...I'm done...but will simplify. Can I just take off the patch and start back on MS Contin, until I can get to my doc office and we can figure out something else to do..which will likely be Wed...or do I have to wait to the Fent to clear out of my body some? When I started it, they never said anything about waiting between my regular does of MS Contin before putting on the patach. Do you think the fent is not working b/c she didn't prescribe equivilant dose for equiviliant dose?

Thanks so much for your help!
Shutter

 
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Old 05-02-2010, 12:44 PM   #2
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Re: Dr moved me from MS Contin to Fent Patch, I'm in horrible pain..need advice!

Gosh, I'm sorry about what you're going through. I would definitely call your Doctor's office first thing Monday and let them know about the level of pain you're experiencing. It really sounds like she doesn't have you on a high enough dosage of the patch. Like maybe a 100 mcg/per hour and 50 mcg/per hour would have been more appropriate. I think your Doctor really needs to re-evaluate your dosage and given that you had a change during the month, there shouldn't be an issue with you calling. Also, I would let them know that your noticed there was a "mistake" on the amount she prescribed for your breakthrough meds. It sounds to me like it was an error if your Doctor didn't discuss making a change beforehand.

I hope you get answers very soon. You're in my thoughts.

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Old 05-02-2010, 02:23 PM   #3
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Re: Dr moved me from MS Contin to Fent Patch, I'm in horrible pain..need advice!

Thanks for your reply...to my pitty party. I try not to do that, but I'm on my third patch...nine days of this increasing pain. (I'm prescribed to only change them every three days.) It feels like the lack of pain relief is cumlative.

I can honestly feel myself loosing it. When the pain starts to completely take over physically...then it starts messing around with the mental part. Know what I mean?

As far as the dr....I agree....I'm on the phone first thing Mon morning. I hope my dr can see me b4 wednesday. We are in a rural area and she works out of two offices....so I'm gonna keep my fingers crossed that I can get into the other office.

I have no idea what the conversion rate was/is between MS Contin and Fent Patch...that's why I asked. Honestly it feels like I'm getting half the medicine...don't know if that's actually true...just what it feels like. While I don't like wearing the patch, I have noticed that there is much less dry mouth and I don't feel so tired all the time...I keep thinking there has to be a comprimise but I can't quite seem to find one.

I finally let myself think about getting a pain pump and started looking up information on it over the past few weeks....but there are just as many doctor horror stories with pain pumps than there are with regular pain management drs. One thing I wish is they would teach these doctors is that RESPECT and TRUST go both ways.

But that's in the future...the only think I care about right now is being able to make it to the morning.

Thanks...

Shutter

 
Old 05-02-2010, 06:56 PM   #4
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Re: Dr moved me from MS Contin to Fent Patch, I'm in horrible pain..need advice!

Quote:
Originally Posted by Shutter View Post
I have been on MS Contin for several years, and Morphine Sulfate Instant Release for somewhere around 10-12 years...because of all the meds, the MSIR works the best.

The patches are not even close to relieving my pain. I can't sleep, my arm burns where the patch is, I can't hardly sleep due to pain and can't take MSIR for btrough..incase I run out.
Shutter
Which fentanyl patch are you using? The brand can make a world of difference. I went into withdrawal on the new Sandoz matrix patch - the old Sandoz gel patch worked great. I don't do well with matrix patches. Some people, on the other hand, do really well, and there are people who swear by the Mylan patch which many people hate - it puts them into wds. In addition, the generics can vary by up to 20% with the active ingredient. For generics, Sandoz and Watson (for gel users) used to be the best. Sandoz is a bust for me now, and I think that the brand name Sandoz might also be difficult for me. Watson is one of the few manufacturers still making the gel patch. the other is Activas, but the little information I was able to gather on it was mostly negative. Finally, it's possible that you just don't respond well to fentanyl. Everyone metabolizes the medication differently and some people simply don't do well on some meds.

I think (and don't quote me on this) is that the conversion is 100 mcg of fentanyl converts to 200-400 mg of morphine. The conversion varies more than most medications. Does any of your pain feel like withdrawal pain? [headaches, pain in places you usually don't have it, etc..] That might tell you more about whether or not the dose is too low. On the other hand, you don't have to be in wihdrawal to have your pain go way up. I am about to switch from the patch to MSC and am scared to death that my pain is going to shoot through the roof. The patch handles my pain, but I'm having too many problems and it's become too difficult to use.

I have the same question. How do I do the switch it since it takes 17 hours for the first 50% of the patch to leave your body. If you look at the insert in the package, it looks like most of the fentanyl is gone within a few days. But I recall needing to adjust the dose a week to 10 days after going off fentanyl - thats how long it took to leave my body! I agree that you should call your doctor to find out how to do it. Unfortunately, I don't think my doctor knows. He doesn't know that heat and the patches don't mix, for example. This is pretty basic stuff...

Some people love the patches and some people hate them. Is Oxycontin an option for you or is the heat around oxy too strong? You could still reduce your dose by rotating meds.

If your dr. gives you a schedule for going back on MsContin (or any med), would you mind posting it? I need help w/ this too!

Sorry it hasn't been working out for you - do post the kind of patch you're using tho since this can make a big difference.

--Best, Krit

Last edited by krit; 05-02-2010 at 07:13 PM.

 
Old 05-02-2010, 07:31 PM   #5
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Re: Dr moved me from MS Contin to Fent Patch, I'm in horrible pain..need advice!

Thanks so much for your info. I'm on Sandoz fentanyl 100mcg.

It didn't feel like a withdrawal feeling. Actually it felt like it took away some of the achy pain that the MS Contin didn't touch...it is the stabbing hot knife, buckle until you fall over pain that it's not touching.

I can't live like this. How long do you think I can start taking pills after I take off the patch? Cause I'm seriously considering taking off the patch and take one of the 100 mg MS Contin pills, so I can actually sleep for a few hours tonight. FWI...I wouldn't think my tolerance to MS Contin is lowered because it's onlyu been 9 days, since I was taking 3 of those pills a day.

Let me know what you think.

shutter

 
Old 05-02-2010, 07:43 PM   #6
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Re: Dr moved me from MS Contin to Fent Patch, I'm in horrible pain..need advice!

Like I said it's been years since I've been on the patch..so sorry when I don't know what you mean when you say Matrix patch. The Sandoz patch label doesn't say anything about being matrix. As far as the patch...you can see a little bit of get squishing around inside of it. If squishing is a word.

I know my pain quite well by now...and it doesn't have anything to do with withdrawal causing it to get worse....cause this is exactly how I feel whenever I've run out....because dr was gone...or when they've tried to change me over. It's always the same mind numbing pain.

I think what's happening is, that I'm just not getting enough meds, or like you said I metabolize the meds differently than the other stuff. So it just doesn't work as well.

Thanks

Shutter

 
Old 05-03-2010, 05:13 PM   #7
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Re: Dr moved me from MS Contin to Fent Patch, I'm in horrible pain..need advice!

Quote:
Originally Posted by Shutter View Post
The Sandoz patch label doesn't say anything about being matrix. As far as the patch...you can see a little bit of get squishing around inside of it. If squishing is a word .Shutter
One thing I forgot - how long have you been on the patch? It takes time to build up in your system, and your dr. should have given you MORE short acting medication to use while the patch was getting into your body. It can take 5-7 days for it to even out and give you a steady amount of medication.

A problem w/ the patches is that there is a lot of variability in how well people absorb the medication from the patch. The Sandoz gel [the one you can get squishing with and are using now [was the best patch for me and is generally regarded as one of the best, if not THE best generic patch, at least for people who do well with the gel patches (squishy ones where you can see the medication). I'm surprised you were able to get it since they aren't making them any more and none of the pharmacies here have them. I was unable to get 75 mcg patches in the gel last month and can't get any this month- they only had the new generic patches, which are completely flat (you canít see the medicine) and put me into withdrawal and a lot of pain - you can't see any of the medication inside on the matrix patches.

It's possible that you aren't absorbing the fentanyl very well and that another type would work better for you. It's also possible you haven't waited long enough for the patch to "kick in." I assume you are putting them on your upper arms, chest - breasts for women, & sometimes upper back or stomach and making sure that none of the ends come up, even a little, since they won't work correctly if the ends are coming up.

You might need a higher dose - you could still be getting less and not be in withdrawal. But it's possible that fentanyl just doesn't work for you - it acts on different receptors than oxycontin and morphine, which is why it's a good medication for rotation when you're trying to reduce your tolerance. But it also means that it might not be right for you - sometimes a medication just doesn't work for some people - they don't respond well to it.

Doctors sometimes want their patients to wait at least 2 weeks before deciding a medication isn't working. Obviously, they don't see it from your perspective! I would certainly call your dr. and tell her how much pain you're in and how it's affecting your life. If she insists you give the patch more time, ask for a higher dose (25 mcg more perhaps) and/or more short-acting MS-IR to help w/ the pain while you're waiting. See if you can make an appt. w/ her in a week or two weeks from the date your changed -it's not uncommon to see your dr. again in the middle of a change in medications.

Quote:
Originally Posted by Shutter View Post
I know my pain quite well by now...and it doesn't have anything to do with withdrawal causing it to get worse....cause this is exactly how I feel whenever I've run out....because Dr was gone...or when they've tried to change me over. It's always the same mind numbing pain. Shutter
When you run out, you do go into withdrawal, and your normal pain gets much worse. Sometimes you have pain in other areas of your body as well though. And you might shake or tremble, feel more anxious than usual, have nausea or stomach cramping, leg muscle cramps & headaches, etc.

If that's the case, then you either need enough B/T medicine to get you through the first week while you're stabilizing on the patch. Or, if you've already been on the patch for at least 5 days (are you changing it every 48 or every 72 hrs? Most people can't make it 72 hrs - the patches rarely last longer than 60 hours, and many people have to change at 48 hrs.) and you're experiencing the symptoms you described above, with sound like mild w/ds to me, you may just need a higher dose. But while you're trying to figure out if this is the right medication or dose, you should really have short-acting meds to use.

I would def. call your dr. If you go back to morphine and she tells you how, please let me know! I'm afraid I'm going to be under-dosed on morphine even though my dr. used the same conversion ratio on me as he used on you. I'm waiting for him to call me now.

Hope that wasn't too confusing - I'm not feeling very well.

Krit

OH = p.s. A formula I found for switching back to MS Contin or another oral med from the patch follows - but your doc will have to give you plenty of MSIR, and really, it's her formula you have to follow.

1. Remove the patch. For the first 24 hours take short acting MS-IR every two hours as needed.
2. After 12 hours, take half of the new dose.
3. After 24 hours, take the full dose.

 
Old 05-04-2010, 12:23 PM   #8
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Re: Dr moved me from MS Contin to Fent Patch, I'm in horrible pain..need advice!

The Patch has a tenancy to run down on the last day for me so that could accumulate. I only am on 2 X 50 patches changed at 32 hours apart every 72 hours though. My level stays fairly constant but I also use BT meds though not as strong as yours. I am sorry you are in so much pain. I so hope things are sorted out a little for you today.
Allan
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Old 02-10-2011, 12:24 PM   #9
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Re: Dr moved me from MS Contin to Fent Patch, I'm in horrible pain..need advice!

I am sure you made the switch already. I just switch to Fentanyl 25mg a week ago. I was taking 140mg of oxycontin daily. During the first 3 day of the switch I have been taking up to 3 Hydromorphone 2mg and the remainder of my oxycontin about 40mg per day for the first three days. No problems now. I feel good. I was very scared to switch. All is well

 
Old 02-11-2011, 08:59 AM   #10
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Re: Dr moved me from MS Contin to Fent Patch, I'm in horrible pain..need advice!

I was on Kadian and changed to fent patch......on the 4 th hour i was freakin out and wanted that sucker off...so I called doc right away and she started me back on kadian..without ever a thought took patch off and took a kadian like an hour later. Then kadian stopped working and was put on methadone and oxycodone. I understand about the numbness and the not being able to join in the family life....that is why I made a change and got off all meds...not to say I am dying in pain but coping ok...at least I am laughing and spending time with kids and husband. before I was secluding myself and wouldnt talk about the news. I need to feel alive and I was dead....

call your doc right away.....have you tried kadian? it worked for a long time...theres dilaudid which i thought was like tylenol...did nothing for mee.


Kim

 
Old 02-11-2011, 12:53 PM   #11
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Re: Dr moved me from MS Contin to Fent Patch, I'm in horrible pain..need advice!

I was using two 50 patch's but now 11 weeks out from surgery I am down to a single 25 patch. 25 is only a low dose and but is enough for me now. It has given me a lot more freedom and less side effects than before. I hope some time next month I will half that. Also I stopped the valium, endone, celebrex and only that the occasianal parecetamol. I am very happy about the results and have no leg symptoms now either. I hope the patch is working ok for you. Though you may need a stronger patch.
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Old 02-12-2011, 01:02 AM   #12
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Re: Dr moved me from MS Contin to Fent Patch, I'm in horrible pain..need advice!

Maybe I'm clueless here but why can't you just keep the patch on, slowly add in your IR Morphine until you feel reasonably comfortable? Are there some dangers in using both together?

Also, since you were hammering away at a particular set of receptors with the Morphine, why not switch to another Opiate? Or, considering your dose of Morphine was bringing on so many side effects why don't you choose a stronger Narcotic; Hydromorphone, Oxymorphone, or Levorphanol?

~

 
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