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Old 11-18-2012, 07:58 AM   #1
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Fentanyl Patches - Pros and Cons

Hi,
I was hoping on getting some advise on Fentanyl Patches. For those who are or have used them. Both the good and the bad. I think this may be my next step. I had Radio frequency Ablation done a month ago and so for no results. Still hoping it may work, but I am starting to think of what the next step would be. My pain management team did mention patches when I was first evaluated as something we may look into. Right now nothing is working. The meds I am on a barely helping, so if the RFA doesn't help I really need to find something to help make things more tolerable.

Thanks for any and all advise.

 
Old 11-18-2012, 09:16 AM   #2
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Re: Fentanyl Patches - Pros and Cons

Quote:
Originally Posted by cspineguy View Post
Hi,
I was hoping on getting some advise on Fentanyl Patches. For those who are or have used them. Both the good and the bad. I think this may be my next step. I had Radio frequency Ablation done a month ago and so for no results. Still hoping it may work, but I am starting to think of what the next step would be. My pain management team did mention patches when I was first evaluated as something we may look into. Right now nothing is working. The meds I am on a barely helping, so if the RFA doesn't help I really need to find something to help make things more tolerable.

Thanks for any and all advise.
Hi cspineguy, Funny, you should post now. Im condidering RFA of the S1 nerve root? I have also been on fentanyl patches for >12yrs. There is a sticky note all about uses& applications of f patch @ the top of the pain mgmt board. Ok. I see your in the coersive trap of we say we will get you out of pain even using schedule two narcotics on 1st visit, then you have to fill our cash register with epi steroid inj's etc, then maybe we will or wont give you the meds we discussed on first visit? PM/anes dr right? Urrgh. So, f patched are given in 25mcg increments, or it was on me as all this info is from what happened to me personally. So, 25mcg patch first, but, recently heard of 12.5mcg. Then, raise it as needed for mod/severe pain. Also, breakthru meds as needed. So one long acting, one short acting. F patches are changed every 3 days. But, b/c some people absorb differently it can be prescribed every other day. Miracle for me. Now cons. Once you start a med that cant be called in there are no refills. Every month you have to see dr & many times feel & see tension from the dr who fears the dea. Possibly urine tests monthly? Do you already have pain contract? Most wont prescribe soma or any benzodiazapenes. B/c f patch can affect breathing, esp mixed with valium, xanax, etc. There are meds that are lower on opioid scale that you might try first b/c resistance is a fight you must win everyday with chronic pain! So, oxycodone is first on the list as far as schedule 2 medicines go, But, i personally think oxycontin(long acting oxycodone)
would kick my rear.I do not like to feel medicine!! Thats why f patch is perfect for me. No more stupid. So, tell me your story. What causes your pain & what do you take for it currently/past?

Last edited by gmak; 11-18-2012 at 09:28 AM. Reason: typos

 
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Old 11-18-2012, 10:10 AM   #3
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Re: Fentanyl Patches - Pros and Cons

Thanks for your support Gmak. Right now I am on oxycondon during the day and oxicontin at night along with zanaflex. The oxycondon will help to take the edge off my pain, but not keeping it under control during the day. I still work, but this makes it difficult, and I spend most of my day in awful pain, but keep a smile on my face, as I had some issues with my bosses regarding my "productivity". The oxcontin I find the least effective and have pain all night long and wake up every night in pain. I have mentioned this and at my last visit they gave me MS Contin to try a few nights. I find that a little better, but still have problems with sleep. I do have a pain contract and have to go in once a month to get prescriptions and urine test, so that wouldn't be a change.
My condition is chronic pain following an anterior corpectomy and fussion. I have permanent nerve damage from the pressure that was on my spinal cord. Every day I am in pain in my neck, shoulders, and arms.
Still hoping the RFA does work, but as the weeks pass with no results I am not feeling as optimistic. Next month I have medication consultation and if nothing has changed then I'm going to ask what we do next. Glad the patches work well for you and sharing you experiences. This was mentioned before to me as an option so I wanted to get some user opinions on this, so if we go in this direction I will be better informed. The other thing that has been mentioned is a spinal stimulator, they even gave me a booklet and DVD. I am open to talk more to the doctors about this too, but need more research as it is something they implant into you.

Thanks again!

 
Old 11-18-2012, 12:00 PM   #4
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Re: Fentanyl Patches - Pros and Cons

I used them for 1.5 years. Had to switch every 48 hours. Good relief but ended up too high, 175mcg/48 hours. June had peripheral STS and weaned down. My biggest complaint is that I felt I had no control over how much I used or even how much. Now on nucynta while I wait for battery to be replaced. Very happy with nucynta, btw.

 
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Old 11-18-2012, 01:08 PM   #5
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Re: Fentanyl Patches - Pros and Cons

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Originally Posted by cspineguy View Post
Thanks for your support Gmak. Right now I am on oxycondon during the day and oxicontin at night along with zanaflex. The oxycondon will help to take the edge off my pain, but not keeping it under control during the day. I still work, but this makes it difficult, and I spend most of my day in awful pain, but keep a smile on my face, as I had some issues with my bosses regarding my "productivity". The oxcontin I find the least effective and have pain all night long and wake up every night in pain. I have mentioned this and at my last visit they gave me MS Contin to try a few nights. I find that a little better, but still have problems with sleep. I do have a pain contract and have to go in once a month to get prescriptions and urine test, so that wouldn't be a change.
My condition is chronic pain following an anterior corpectomy and fussion. I have permanent nerve damage from the pressure that was on my spinal cord. Every day I am in pain in my neck, shoulders, and arms.
Still hoping the RFA does work, but as the weeks pass with no results I am not feeling as optimistic. Next month I have medication consultation and if nothing has changed then I'm going to ask what we do next. Glad the patches work well for you and sharing you experiences. This was mentioned before to me as an option so I wanted to get some user opinions on this, so if we go in this direction I will be better informed. The other thing that has been mentioned is a spinal stimulator, they even gave me a booklet and DVD. I am open to talk more to the doctors about this too, but need more research as it is something they implant into you.

Thanks again!



Hey cspineguy, i thought i remembered hou from that post. One thing, the patches will totally be great for work if you respond like i did. With the patch, it takes awhile to get the dose high enough,ni think it was 25mcg a week for me but with the traveling pm/anes that go from one office to another it may be month by month but dont give up. As you see with me, its worth the wait, 12yrs & counting. Scs,spin cord stim. Is REAL back surgery. 3" incision in the back, 3" incision for unit. Real back surgery & a 50% reduction in narcotics
Is a no for me. Good thread on scs, moldova started it titled Spinal cord stimulators in nack or pain mgmt board, late oct- early nov 2012. Probably @ least 6 more if you search on back or pain mgmt board. Thanks, cspine: please keep posting your choice & if you need anything i will help as much as i can.Thanks, gmak

 
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Old 11-18-2012, 01:50 PM   #6
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Re: Fentanyl Patches - Pros and Cons

I wasn't on fentanyl patches very long as I wasn't getting relief from them and I was having problems with the patch delivery method, but I thought I've give some of my pros and cons. Its quite individual, so if they are offered, I'd give them a try and see how it goes for you. If you do try this or any new med, I'd be very careful for the first week or so after any dose change for driving and working...that is when any affect such as feeling loopy or drowsy is likely to be the worst. My view is likely skewed as I had a tough time with them, but I know many folks swear by this med. Best wishes.

Pros:
- Constant effect for 48-72 hours (no pills).
- Strong pain relief.
- Lots of dosing options with the different strengths (you can wear multiple patches).

Cons:
- Some folks need to replace their patch even quicker than 48 hours. Sometimes insurance won't cover any more frequent than 72 hours. I metabolize quickly and I found it lasted me about 36 hours.
- I believe these can drive your tolerance up fastener than other meds.
- Can cause skin irritation...my skin was literally raw at the edges from the patches. I tried a steroid nose spray, but that interfered with the med being absorbed. I never solved this issue, but not everyone gets it, and of those which do, some can overcome it. I also had a tough time finding spots for them that were approved by the manufacturer, were covered by clothing, and that I hadn't used the last time (as you are supposed to rotate). I also found them uncomfortable.

In between:
- Some folks report a big difference between different brands. Its likely best to try to stay on the same one so you get a constant effect.
- They can easily start to peel off, and if this happens you don't get the meds. However, using a Tegaderm or similar cover works very well for most folks. These are an added cost though.
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Old 11-18-2012, 03:38 PM   #7
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Re: Fentanyl Patches - Pros and Cons

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Originally Posted by deanh View Post
I used them for 1.5 years. Had to switch every 48 hours. Good relief but ended up too high, 175mcg/48 hours. June had peripheral STS and weaned down. My biggest complaint is that I felt I had no control over how much I used or even how much. Now on nucynta while I wait for battery to be replaced. Very happy with nucynta, btw.
Hi deanh , i didnt see you there. I think your post popped up when i was writing mine! Will you tell about Nucynta, idk anything about it @ all& would be very interested. Doing fine on my meds, but info is always good, like i said i cant have anything near dura so i have to keep meds as low and as long as i can stand the pain!Thank you, gmak

 
Old 11-18-2012, 03:54 PM   #8
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Re: Fentanyl Patches - Pros and Cons

Hi ctspine again, yes, i forgot, thank you tgirl, i hated duragesic brand &
sandoz,the plastic is 2-ply & harder, they are big & only have glue around edges. I use mylan, plastic more pliable, the medicine is actually in the glue, if you hold it on for 1 minute, it stays the 2- 3 days, stuck. On the name brand & others mentioned it has a gel thru a membrane delivery system, & with the glue only on edges it creates space under it thats warm, wet & hurts the skin. Also, you get free overlays (plastic,sticky, like they put over an iv site in the hosp) from duragesic and mylan, not watson or sandoz. With mylan, you can more easily find places to put it b/c your skin @ least mine doesnt break, its 2" ◊ 1 1/4, way smaller, stays stuck so get medicine, free overlays,generic price,& if out of mylan askina overlays a pack of 8 @ drugstore is $8. Tegaderm is 16 or 18 b/c of bigger size, mylan size is $13. Thanks, gmak

Last edited by gmak; 11-18-2012 at 04:32 PM. Reason: typos

 
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Old 11-18-2012, 06:30 PM   #9
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Re: Fentanyl Patches - Pros and Cons

I have been using the fentanyl patch as my LA pain medication for three years now. It has been great! I like the idea of taking less oral medication and I just put on a patch and don't have to worry. It really works for me for continual pain management, I do take a medication for break-thru pain, but I have found the patch has really helped for continual pain relief. I find the Duragesic works best for me and the Mylan works pretty good as well.

If you have any questions please don't hesitate to ask.


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Old 11-18-2012, 06:44 PM   #10
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Re: Fentanyl Patches - Pros and Cons

Thanks Fiona Jo,

What do you take for break thu pain and how much. I guess what concerns me on the long lasting medication is that I haven't had any relief with oxicontin, even though the pain center tells me it should give me relief thru the night. If this becomes an option I hope it works better, as I really need long acting relief rather than taking something and getting a little relief and have to wait for the next dose.

Thanks again

 
Old 11-18-2012, 06:53 PM   #11
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Re: Fentanyl Patches - Pros and Cons

Quote:
Originally Posted by gmak View Post
Hi deanh , i didnt see you there. I think your post popped up when i was writing mine! Will you tell about Nucynta, idk anything about it @ all& would be very interested. Doing fine on my meds, but info is always good, like i said i cant have anything near dura so i have to keep meds as low and as long as i can stand the pain!Thank you, gmak
Sure. Getting decent relief and not as much narcotics as others. I take the 200mg ER twice a day. Also no constipation! Only been taking it month and a half. I do feel that I am getting better relief than other pills. The biggest complaint with the patch was I think my body took far more than stated and weaning down was tough. Hoping to get lower after my STS is fixed. Not sure what else to say?

 
Old 11-18-2012, 07:55 PM   #12
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Re: Fentanyl Patches - Pros and Cons

cspineguy-In my opinion, in addition to the potential that the oxycontin is an inadequate dose, it likely isn't working as its meant to build up in the system (be taken continually). It won't work nearly as well when taken once a day. From my own experience, I had lower pain levels when taking an even dose throughout the day than taking a much higher long acting med dose when I had higher pain levels (middle of the day) than at other times.

My doctor didn't give me enough to take throughout the day, so I was just taking the methadone twice a day, instead of four times a day like I now know I need it. I think getting you on an even long acting dose throughout the day and then taking it from there could be beneficial. I don't think any doctor should tell you something should be working...its always a we'll see how your body responds to this. If it isn't helpful, you either adjust the dose, add something else, or switch it. Best wishes.
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Old 11-19-2012, 03:43 PM   #13
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Re: Fentanyl Patches - Pros and Cons

cspineguy, I am not surprised nothing works for neck pain. I told you that before.
It's a nightmare. They just don't have the technology to fix chronic neck pain.

First of all you are taking 20mg oxycontin for severe neck pain and it's not enough.
I was on 40mg oxycontin twice a day and it worked for a while and then stopped working due to high tolerance to narcotics. But maybe you won't have that problem.
I will definatelly give it a try.

For some people, not sure you know, oxycodone bothers sleep. So you should not take it before bed time cause anyway, the neck pain doesn't let us sleep. I told you, remember?

For sleep, it depends, if the pain wakes you up then you should go for clonazepam.
I also took it for a while....and it worked.....and I slept great.....and then it stopped working.....cause I have high tolerance to pain meds. But perhaps you dont' have that problem, you see what I mean.

So I suggest: Taking Oxycontin twice a day (if 20mg doesn't work than increase the dose) and at night clonazepam. It relaxes the muscles and allows sleep.

Again, so sorry you have to live this life of pain. Remember the days with no neck pain?
7 years passed and I still remember those days.

 
Old 11-19-2012, 03:43 PM   #14
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Re: Fentanyl Patches - Pros and Cons

Hi cspine, tgirl & deanh, i dont know what the name of the medicine is in nucynta, that is the active ingredient? Sorry. Really want to know. Is it like old nubain, oxycodone, morphine, a combo like suboxone, etc. Which opioid is in it? Thank you, gmak


Hi change, im so sorry that you are having severe neck pain,too. I have back pain, occ neck pain. It gives me the creeps. Maybe after 30 yrs i dont know life without back pain. Neck pain hurts so much for such a small body part.

Last edited by gmak; 11-19-2012 at 03:50 PM. Reason: ps

 
Old 11-19-2012, 05:20 PM   #15
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Re: Fentanyl Patches - Pros and Cons

Quote:
Originally Posted by gmak View Post
Hi cspine, tgirl & deanh, i dont know what the name of the medicine is in nucynta, that is the active ingredient? Sorry. Really want to know. Is it like old nubain, oxycodone, morphine, a combo like suboxone, etc. Which opioid is in it? Thank you, gmak


Hi change, im so sorry that you are having severe neck pain,too. I have back pain, occ neck pain. It gives me the creeps. Maybe after 30 yrs i dont know life without back pain. Neck pain hurts so much for such a small body part.
Nucynta is commonly known as tapentadol. I am taking the ER version. No generic yet, btw.

 
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