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Old 05-02-2012, 07:08 AM   #1
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New Here and New to Fentanyl, though not new to Pain

Long story shortened: I have had severe pain off and on for 10 years, and off and on for 10 years, I was prescribed Lorcet, then Norco. For the last 3-4 years, back/leg/hip pain has been constant and with no relief even with 2 years of Norco and a year of Vicodin 10/660 TID and Flexeril.

I had heard of pain patches and finally broke down and asked my doctor if he thought I would benefit from them. He prescribed me one box of the 12's and gave me an rx for a full month of the 25's. (started my first single 25 patch today, 5/2/12, but starting Thursday of last week, took the 12's)

While, I am still taking some of my Vicodin and right now wow, I am sleeping some of the best sleep than I've done in years!! Though my back is still hurting

Does anyone here achieve pain management Fentatnyl 25mcg patches?

 
Old 05-02-2012, 05:05 PM   #2
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Re: New Here and New to Fentanyl, though not new to Pain

You went from one of the weakest meds for pain to one of the strongest, if not the strongest, med that Pain Docs can prescribe. So, the fact that your getting good results is not surprising. The problem with this is, you skipped many levels in between. The goal of Pain Management is not to end your pain, it's to get it to a level that can be tolerated and accepted. As I'm sure you know when you take these kinds of meds over a long period of time you build up tolerance to them, then they become not as effective, then your Dr. puts you on something stronger....well...you skipped from weakest to strongest...when you build up a tolerance to the Fent patches and they stop working, where will you go?

There's a reason Dr.'s don't prescribe the hardcore meds early on....Pain Management is a process with different stages and levels, when you skip from the bottom to the top and leave out the middle, your going to have trouble later when the patches stop working because all you can do at that time is go to the middle drugs which are weaker than Fent patches.

 
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Old 05-02-2012, 07:21 PM   #3
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Re: New Here and New to Fentanyl, though not new to Pain

Quote:
Originally Posted by katlin09 View Post
You went from one of the weakest meds for pain to one of the strongest, if not the strongest, med that Pain Docs can prescribe. p working, where will you go?
.
Thanks,
I had actually been tried on multiple different pain medications, before the last 3 years, when the pain meds were dominate. I had been given morphine, oxycodone, switched back to Vicodin. I don't tolerate morphine well. I was on Morphine PO for several months, Oxycodone for several months and then Vicodin for a total of about 3 years out of the last 6. For about a year, I was switched to Vicoprophen (spelling?) So, there were other medicines that were tried and attempted (some of them, multiple times) but Vicodin was the most used out of everything, and is now the breakthrough rx. Though it appears I am having a lot of break through pain.

Pain management physicians tried nerve root injections, spinal taps, blocks, etc... Before prescribing a wonderful transdermal cream that worked for short period of time (for small areas, closer to skin) that contained Voltaren and pain relievers, but the doctor that ordered it for me, left the state, and no physician here deals with compound pharmacies, so I can't get it, any longer.
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Old 05-02-2012, 09:13 PM   #4
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Re: New Here and New to Fentanyl, though not new to Pain

So you are saying that although you are sleeping well, your pain is not controlled as well as when on the the Vicodin? It is too soon to tell with the 25s...Fentanyl patches take days to reach steady state in the system. I'd say by your second or third patch at this dose you will have a better idea how you are doing. Also, some respond better to certain meds, even at an "equivalent" dose. My best advice to you is to read the entire prescribing info for this and all medications. That tells you how long it takes for its full effect, what to do and not to do (avoid heating pads and long hot showers), etc.

I agree that I think it was ill advised for your doctor to move you from Vicodin to Fentanyl. Although you tried morphine and oxycodone, it sounds like it was short lived and they weren't the long acting ones? The manufacturer chart doesn't even give a conversion from Hydrocodone to Fentanyl. That said, I have been reading more and more about doctors making this same exact switch and patients doing well on it (but they may also do well on other meds). I worry that you will become tolerant quickly. Fentanyl is actually known to increase tolerance quicker. One of the reasons they started making the 12s (used to only have 25s) is for patients that aren't very opiate tolerant (and for tapering). I would be very cautious of overdose as the 25 kicks in.

I believe a conversion for the 25 is about 70 mg of Hydrocodone day. How much were you taking? Either way, this should be a bump up as you aren't tolerant to Fentanyl. Give it time and be careful. The sedating effect of the Fentanyl could decrease over time. Other side effects could also kick in. Sedation can also be a sign of overdose FYI. I'd look up the signs of overdose so you can be aware. I'd sure hope your doctor knew what they were doing with the conversion. If it were me I would hold off on the Vicodin if at all possible until I knew the Fentanyl was at its max.

Also, I agree the goal of this should be to manage the pain...your back will still be hurting even on an idea Fentanyl patch dose. A reasonable goal is 50% relief. At that most patients have a lot of improved functionality, whether that means they can continue working or just be able to get out of bed. Ask again if there is a similar cream which doesn't need to be compounded. Anything you can do to minimize your need for narcotics is good. I'm shocked a pain clinic won't write a compounding prescription for a cream, as they often do need to write compounding prescriptions for some patients. Best wishes.

 
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Old 05-02-2012, 10:45 PM   #5
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Re: New Here and New to Fentanyl, though not new to Pain

Thank you,
No, I didn't have relief from the Vicodin, either. My physician consulted with my specialist and came up that at this time, the best course was me to use the patch. I did start with the 12's, then applied two, then changed two twice, then went to the 25's (if that made sense?)
I was taking 6 Vic 10/660 per day along with some other medicines (toradol, etc)

In November, I was put in the hospital for a week and given my own little pain pump (as a trial) of Morphine 1mg per hour plus .1 each 10 min available. I do not like morphine, this did not last the full week. this lasted about 4 days.

I am disabled, my goal is to be able to stand or sit for more than 10 minutes. Hopefully, go to the park with my children? My muscles have failed and other muscles surrounding those are working harder (and suffering) causing pain and much inflammation. My doctor got the "ok" from me asking him, when he consulted my Mito doctor/specialist.

I have read the OD symptoms and signs, and so has my husband. My respirations and pulse had remained completely normal, I just got to sleep, which was much needed!!

I am enjoying reading everyone's comments and experiences on here, I hope to be able to contribute, in the future.
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Old 05-02-2012, 11:46 PM   #6
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Re: New Here and New to Fentanyl, though not new to Pain

There is a topical called Voltaren Gel, it's prescription, my doc gives it to me for my knees and ankles, it helps some. you might want to give it a try.

The thing is you've only ever been on short acting meds, which for your level of pain/injury is kind of weird. It's just a big jump from short acting Vicodin to Fentanyl.

I'm going to toss out a couple of things about Fentanyl that you may know, but some Dr.'s don't tell their patients. Always put your patch above your breast line, the patch works in conjunction with body heat. Placements on certain parts of the body produce to much heat and it can cause the medicine in the patch to release to quickly. No soaking in hot baths or hot tubs/sauna's with the fent patch, once again because of the heat. Most folks have trouble with the patch sticking after awhile, that was my biggest gripe with them. At every pharmacy they sell Tegaderm covers, it's like a clear thin bandaid that you put on over the patch, keeps out moisture and keeps the patch on for the length of time prescribed. When you change your patch move it around, don't keep putting it in the same place, the glue on the back can irritate your skin if you keep it in the same place over and over again.

The other thing you might check with your doc about, since your pain is largely muscular, is a muscle relaxer and an anti-inflammatory, they might benefit you more than break-thru meds.

And to reiterate, pain management is about keeping the pain under control not eliminating it. My regime is Morphine 150mgs/day, Oxycodone 60mgs/day, Ibuprofen 1600mgs./day, Voltaren Gel and Soma 350mgs./PRN with that I can walk and keep my pain level at a 4 or 5. So, you and your Dr. need to discuss what a realistic goal for you is and then strive to meet that level of pain.

Kat

 
Old 05-03-2012, 07:54 PM   #7
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Re: New Here and New to Fentanyl, though not new to Pain

I still use Voltaren gel, but see no change, by itself. I am on muscle relaxers and antiinflammatories, While I believe much of my pain is muscle, they say it is skeletal, from SJD, different length of bones throughout my body and the truncal support system that is in place. Thank you, we are trying to get me to a pain level of 5 (which would be big improvement) so, I could sit up, even in my electric chair for more than a few minutes.
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Old 05-09-2012, 08:39 PM   #8
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Re: New Here and New to Fentanyl, though not new to Pain

i too am getting good relief from the patches. you must talk to your doctor about if your relief is adequate, like, are you getting at least 40-50% relief? if not you may need some titrating-but typically you will be started at a low dose; remember medications effect everyone differently. What might be to low for one may be to high for another and viceversa.
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Old 05-11-2012, 05:02 AM   #9
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Re: New Here and New to Fentanyl, though not new to Pain

I have been on the Fentanyl matrix style patch for the last 3 years. I was initially started on the 12.5 mcg patch and that didn't do much for the pain. My PM Doctor than prescribed a higher dose of 25 mcg., which I have tolerated very well. I have heard of a lot of cases where people have had to go to higher and and higher doses of the patch, but I have always stayed at the dose. However, about a year ago, she did switch me from a 3 day change schedule to a two day schedule and I have to say that really helped. I was finding that after two days I was experiencing a return of of the pain. So, rather than higher the dosage of the patch or increasing my breakthrough medication, that going to a 2 day option was a preferable option - since I am getting relief for two days with minimal need for breakthrough meds.

I love the idea of the patch, I can put it on and basically forget about it, until it is time to change it and it reduces the number of pills I have to take. I have also found it has done a great job managing pain. I recently had knee surgery, so between my pain management doctor and orthopedic surgeon, changes were made to my current pain regimen. (They have had communication and worked as a team on the pain management issues related to my post-operative care). But, once I'm through the surgical related pain. I will return to my old pain management regimen.

Good luck to you and I hope this helps. Keep us posted on how it's going!

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Last edited by Fiona_Jo; 05-11-2012 at 05:03 AM.

 
Old 05-13-2012, 03:36 PM   #10
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Re: New Here and New to Fentanyl, though not new to Pain

Re: Fentanyl patches, I had been in PM for nearly 4-5 years before my dr. put me on it. It was "scary" sedating in the beginning in that I would literally pass out over my dinner plate! However, enjoy it, as it (like all the meds) won't last.

But I must say, I was on it for 3 years which is a really long time.

I would be very careful with anything at all you take with that drug due to its potency/toxicity.

Although my body eventually rid itself of the side effects and it controlled the pain well, it has a long half life and is active longer than you realize.

Of all the opiods I've taken (I think I've taken them all), the most unpleasant side effects were with Fentanyl, Methadone, and Nucynta-ER (tapentadol). The extreme sweating with those made me crazy. The Fentanyl was sporadic but it was almost constant with the other two (and the pain relief was minimal besides!). Good luck and take it slow, Divaj

 
Old 05-13-2012, 04:31 PM   #11
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Re: New Here and New to Fentanyl, though not new to Pain

I had same location of pain, with Dilaudid and Methadone prior to the Fentanyl patch. I, too. was given 25mcg patches, which didn't work. My PM doctor then went to 75 mcg patches, which worked quite well for awhile. With all of the pain meds out there, I see this happening alot, with decreased effect after using the med for extended periods...we develop tolerance.
I got a TENS unit while on the Fentanyl patch, and it worked wonders. Never acheived total relief, but know not to expect that. I have since moved up to an intrathecal pain pump...works good, but will likely always need pain meds for breakthrough.
Good luck with getting some relief. Main thing is to not get discouraged, it is hard, I know. If you have a good doctor who understands the legit need for opioid pain meds and treats you appropriatly, you are on the way.

 
Old 05-14-2012, 02:37 PM   #12
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Re: New Here and New to Fentanyl, though not new to Pain

Hey Missippigypsi,

I am going to disagree with a few here. I too went from hydrocodone to the patch. 12.5was not available so I started at 25mcg. Very quickly titrated to 50mcg then after awhile changed every 48 hours instead of the 72 hours and was on that same dose over 5 years without an increase. Yes fentanyl is strong which is why it is given in micrograms rather than milligrams. I think people tend to get a little freaked about how strong fent is, which it is but that is why it is prescribed in micrograms. So it still has equalanalgesic properties.

The best thing you can do is read as much about the med as possible and then it becomes somewhat of a trial and error, like where does it fit best on your body. I tried the upper body for a long time but for me it works best on my abdomen and I don't mean medication wise I mean it sticks and stays better for me there. A little tip if you hae issues with the adhesive or glue on the patch or cover like a rash or little red sores, get your doc to prescribe an allergy spray like flonase and then spray it on the skin where you are going to put the patch and then let it dry and apply patch. Also when you apply the patch, take your hand and hold it over the whole patch for 1 minute to allow the heat from your hand to help the glue adhere to your skin.

You absolutely need to be careful of heat near the patch. If I want to take a nice hot bath or go in our hot tub, I will wait until it's time to change the patch(or you can stick it back on after being taken off, you'll just have to hold it there a little longer for the glue to adhere. But many times when I have wanted a hot bath I'll remove the patch, take my bath, cool down a little then put it back on). If I remember correctly from the phamphlet inside the box, once you have the fent in your system it stays for like 17 hours so removing it for an hour or two for a bath is OK. Although once I forgot to put one back on and the next day I'm like why is my pain so bad. Then I noticed I was reaching for my SA more. It took me 4 days to realize I didn't have a patch on! I was also going through a crisis with one of my furbabies so I was distracted.

The key is to go slow and steady and it sounds like it seems to be helping and I am glad. have been on the patch now for about 10 years. I was raised to 75mcg about 5 or 6 years ago and have been going nice and steady. If you have any questions feel free to ask!

 
Old 05-15-2012, 12:35 AM   #13
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Re: New Here and New to Fentanyl, though not new to Pain

Indeed, it appears that those who land on the proper dose of Fentanyl for them, seem to be able to stay on it longer than any other opioid (see the 10 year person & I was on it for 3.5 which was amazing for me/at the end, I was @ 125mcg./48 hours, one 100 patch & one 25 patch).

The mode of application that worked best for me was to have my PM doctor write for a supply of Tegaderm Dressings (not prescription but that way, I could run it through Flexible Spending Account or write off on taxes). They are GREAT with the patches/waterproof so you can bathe/shower without worry.

If you get a large size, you can cut to fit and the best buys for those are on Ebay.

I agree about the heat as it accelerates the dispersion of the drug which, as I told my PM doctor, is fine if one wants to "check out" early, which I don't! :-)

As the previous poster said and others said/implied, take it slow (and pay attention to how your body is reacting for the first few months and under different circumstances. Not to scare you as all opiods are helpful for different patients when used properly but Fentanyl is a drug you cannot afford to make a mistake with due to its potency).

The only reason I had to go off it was that I needed to do the "rotation" thing.

But I can't say anything negative from a pain control standpoint about Fentanyl once I found the right dose & my body got used to the drug. But it does take time with this medication.

Hang in there and good luck,

Divaj

 
Old 05-15-2012, 12:46 AM   #14
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Re: New Here and New to Fentanyl, though not new to Pain

Indeed, it appears that those who land on the proper dose of Fentanyl for them, seem to be able to stay on it longer than any other opioid (see the 10 year person & I was on it for 3.5 which was amazing for me/at the end, I was @ 125mcg./48 hours, one 100 patch & one 25 patch).

The mode of application that worked best for me was to have my PM doctor write for a supply of Tegaderm Dressings (not prescription but that way, I could run it through Flexible Spending Account or write off on taxes). They are GREAT with the patches/waterproof so you can bathe/shower without worry.

If you get a large size, you can cut to fit and the best buys for those are on Ebay.

One other factor I found that influenced the overall "performance" of the Fentanyl patch was the manufacturer. The best manufacturer IMHO is Mylan (best sticky property & best consistency of "drug flow").

I agree about the heat as it accelerates the dispersion of the drug which, as I told my PM doctor, is fine if one wants to "check out" early, which I don't! :-)

As the previous poster said and others said/implied, take it slow (and pay attention to how your body is reacting for the first few months and under different circumstances. Not to scare you as all opiods are helpful for different patients when used properly but Fentanyl is a drug you cannot afford to make a mistake with due to its potency).

The only reason I had to go off it was that I needed to do the "rotation" thing.

But I can't say anything negative from a pain control standpoint about Fentanyl once I found the right dose & my body got used to the drug. But it does take time with this medication.

Hang in there and good luck,

Divaj

 
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