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Old 12-05-2012, 10:16 PM   #1
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PATCH and PERCOCET

I just started on 25 mgs. of Fentynal patches, and 10/325 of Percocet for breakthrough pain. The patches work great, but are just not strong enough, so I have to take 1 Percocet every 4 hours to keep the pain away. I hate to ask my new Pain doctor to make changes after 2 days, but I know my system, and I'm thinking of calling him to suggest "doubling up" on the Fentynal patches, so I don't have to take the Percocet so often. I am not real happy with the Percocets, 'so I'm going to also suggest asking for a morphine pill for breakthrough. I like this new doctor, and I don't want to lose his trust in my judgement. So anyone think I'm asking too soon?. My doctors trust and respect is very important too me. It's not easy too find a pain doctor that believes in your opinion. Thank you, SA....

Last edited by stuarm2; 12-05-2012 at 10:22 PM. Reason: MY AGE IS 50, AND I'M ONLY NEW TO THE PERCS. i USED TO BE ON 100 MGS. OF FENT. PATCHES, WITHOUT B.H MEDS.

 
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Old 12-06-2012, 08:53 AM   #2
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Re: PATCH and PERCOCET

Stuarm,

Firstly, be sure to understand that you are not taking 25mg of Fentanyl; you are taking 25mcg of Fentanyl. Micrograms (mcg). Fentanyl titration adjustments are made slowly after many days, and yes, 2 days is way too soon. As for BT meds during this adjustment time, take what you need in order to take the edge off. It may need to be upgraded to every 2-3 hours.

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Old 12-06-2012, 11:18 AM   #3
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Re: PATCH and PERCOCET

Quote:
Originally Posted by stuarm2 View Post
I just started on 25 mgs. of Fentynal patches, and 10/325 of Percocet for breakthrough pain. The patches work great, but are just not strong enough, so I have to take 1 Percocet every 4 hours to keep the pain away. I hate to ask my new Pain doctor to make changes after 2 days, but I know my system, and I'm thinking of calling him to suggest "doubling up" on the Fentynal patches, so I don't have to take the Percocet so often. I am not real happy with the Percocets, 'so I'm going to also suggest asking for a morphine pill for breakthrough. I like this new doctor, and I don't want to lose his trust in my judgement. So anyone think I'm asking too soon?. My doctors trust and respect is very important too me. It's not easy too find a pain doctor that believes in your opinion. Thank you, SA....
Stuarm,
Being new to being on the fentanyl patches ( dosed in micrograms, not milligrams) , it takes at least a couple of patch changes ( usually done every 48-72 hours), to build up to a steady blood plasma level so that you can truly gauge how the fentanyl is going to work for you. If your skin is overly dry or you sweat a lot, it can be more difficult at first for you to notice the slow build up. Fentanyl is not like other opiates, in that you really most likely will not notice a feeling of onset like some do with other opiates, it is more that you notice that the pain levels are being managed more effectively.
How is the percocet prescribed to be taken? It is one thing during the transition to the fentanyl , with your doctors approval to use the percocet to ward off any conversion problems from one med to another, but be careful that you don't find yourself taking it regularly. All you suceed in doing by taking any breakthrough med regularly ( whether by the amount of times per day that you are allotted , or by using it in addition to your long acting med, is increasing your base medication blood plasma level, so when you do have increased pain levels, you are left with nothing effective to take.
I would hold off on contacting your doctor or making suggestions about what meds to increase or add to your regimine. Some doctors view that type of behavior as a red flag. If you are having more pain than the fentanyl can handle after being on the patches for at least 2-3 patch changes, then discuss that with your doctor at your next visit. Most PM's like to see a patient give a medication change or combination a month to see how well things are going or not.

 
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Old 12-06-2012, 06:44 PM   #4
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Re: PATCH and PERCOCET

Thank you. Very helpful. I'm taking 1 pill every 4-6 hours, and that's my concern. if i don't feel pain, i don't even think about the pills, but its rare that a noticeable is not bothering me. i will wait until I see him in 2 weeks to see what changes should be made again, thank you, Stu....

 
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Old 12-06-2012, 08:14 PM   #5
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Re: PATCH and PERCOCET

Agreed that you need to give this time, and its a very bad idea to suggest meds by name or specific doses. If in a period of weeks you still aren't meeting your pain relief goals (which shouldn't be 100%...50% may be reasonable, and its a good topic to discuss with your doctor), then I'd tell your doctor what level of pain you are still having and/or what percent relief you are getting, and see what they suggest from there.

The patch builds in your system such that you may actually want to avoid taking the Percocet on a schedule, to ensure that you don't all of a sudden have too much medication in your system. It can take weeks to reach steady state. Also keep in mind its imperative that it is completely stuck so that you get the medication...any little but of peeling up and you get air under it and it completely dries up.

Did your doctor give you enough Percocet to take 1 every 4-6 hours until your next appointment? That would be an unusually high amount. If you don't have enough (plus due to the potential med build up), I'd try very hard to only use them for breakthrough pain, not on a schedule. Unless you are in withdrawal, I wouldn't contact the doctor. Two weeks to wait for any increases is not at all unreasonable.

What were you taking immediately before this (ie. were you switched from something else)? I'm confused that you say you used to be on the 100 mcg/hr patch. What happened in between? I hope this new doctor is helpful. Be patient with the med changes/increases. Best wishes.
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Old 12-06-2012, 08:41 PM   #6
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Re: PATCH and PERCOCET

I was on kratim 3 times daily, but it just wasn't enough
It worked better than the norco the older doctors had Kevin. But my tolerance and some strange side effects, brought me back to the doctors, and stronger meds. I've pretty much stayed on the prescribed amounts, i just thought i would give some herbs a chance after my earlier experiences with fentynal.

 
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Old 12-16-2012, 10:54 AM   #7
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Re: PATCH and PERCOCET

Quote:
Originally Posted by stuarm2 View Post
I was on kratim 3 times daily, but it just wasn't enough
It worked better than the norco the older doctors had Kevin. But my tolerance and some strange side effects, brought me back to the doctors, and stronger meds. I've pretty much stayed on the prescribed amounts, i just thought i would give some herbs a chance after my earlier experiences with fentynal.
Dear stuarm,
From what you have said here, I think and i certainly could be mistaken, that when the dr made the next appt in 2 wks & gave you bt meds every 4-6 hrs that your dr is intending to raise your f patch in 25mcg increments every 2 weeks according to how much pain relief you get & by seeing a reduction in use of bt meds, imo.. If it were me, even though I once req'd 100mcg of f patch, I wouldnt want to go straight to the top dose but would really pay very close attention to how much pain relief I was getting on 50 or 75 mcg so that I would have somewhere to go in the future with the same medicine and hopefully i wouldnt have to start over on a new one. This pain relief, imo, would also be evident by needing less bt. Ive been on f patch >10yrs & while the bt meds have been changed ive been on same patch dosage. So, 2 weeks between appts has only happened for me when the f patch was initially titrated b/c usually my appt is once a month. I would be careful with herbs of all kinds b/c there are some that have similar CNS depressant effects like opioids & taken together with your meds can increase chance of respiratory depression. Did you mean that you were on lortab 3◊a day & it worked better than norco? And that b/c of strange side effects you had to return to PM to get stronger pain meds? If that is the case be patient with the f patch titrating, & t girl is right dont take the percocet routinely & be careful with the fentanyl dosing. In my opinion, you must not think that b/c you were on 100mcgs before that you can jump up to that level again quickly when right now your body is "fentanyl naive" or not used to fentanyl anymore. I would be patient & wait until next appt to talk to dr b/c it seems to me that the dr is trying to do what you have told him to do, what has worked in the past for your pain, and he has to build up the fentanyl slowly, I have heard of pm/anes drs that raise fentanyl patch once a month only & start @ 12.5mcgs per patch.

Last edited by gmak; 12-18-2012 at 05:55 AM. Reason: wording

 
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Old 12-16-2012, 06:20 PM   #8
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Re: PATCH and PERCOCET

Quote:
Originally Posted by stuarm2 View Post
I was on kratim 3 times daily, but it just wasn't enough
It worked better than the norco the older doctors had Kevin. But my tolerance and some strange side effects, brought me back to the doctors, and stronger meds. I've pretty much stayed on the prescribed amounts, i just thought i would give some herbs a chance after my earlier experiences with fentynal.
hi STU

you mention Kratim/Kevin what is that or what are you referring to?

Also, you mention several times about "having no pain", is this because your goal is to or you are under the impression you should have no pain if you are on the correct dose? Because, if you have true Chronic Pain; you should already know pain mangement is just that-not total elimination of your pain. CP cannot be totally relieved; yes you could be dosed so high that you would be in a constant drugged stupor-but you would still experience the pain at some level-but no scrupulous Specialist would allow that either. It is about having a quality of life that you don't have without medication; like being able to, get out of bed, sit thru a movie or go out to dinner-simple things most people take for granted that a person cannot do anymore due to the severe and constant pain;without the help of pain medication.
If 25mcg with 10/325 perc for BT completely eliminates your pain-
I would think you are not suffering from true Chronic Pain-because CP; the Specialist goal is to get you to 5-6 on the pain scale-that is truly successful pain management goal for a patient who is in terrible agony 24/7 without any medication. It is my experience that any pt who's pain is under 5 with what you are taking-your medication dose is more than adequate.

The other thing i was thinking is how important it is to first get your long actingmedication titrated to where your pain levels are manged at this tolerable level(5-6 is considered excellant)for a CP patient, then it is pretty normal to have a short acting med for BT pain-you know; when your pain spikes due to over activity or something-perc 10/325 is a good choice I think, better than msir because oxycodone has a much better bioavailability than morphine(i.e. more oxycodone reaches your cns-way more than msir)

This is only my opinion and my experience with fentynal mcg patches and percocet 10/325 for my Chronic Pain.

Good Luck.
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Last edited by BB07; 12-16-2012 at 06:38 PM. Reason: clarifications

 
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Old 12-23-2012, 05:52 PM   #9
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Re: PATCH and PERCOCET

Stu, how many years were you suffering from chronic pain?
and were is your pain located?

By the way, most men don't have high tolerance to narcotic pain medications. So that is really strange.

 
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Old 12-23-2012, 06:09 PM   #10
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Wink Re: PATCH and PERCOCET

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Originally Posted by nochange View Post
Stu, how many years were you suffering from chronic pain?
and were is your pain located?

By the way, most men don't have high tolerance to narcotic pain medications. So that is really strange.
First, thank you for taking your time to write. I've Been on pain medications (narcotics) for about 10 years. Iv'e never heard of men not having high tolerance to narcotic pain medication?

 
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Old 12-23-2012, 06:29 PM   #11
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Re: PATCH and PERCOCET

I've also never heard that about men not building as much tolerance to pain meds. Any citation for that? I have heard that tolerance usually builds quicker in younger patients though (and slower in older patients). Other than that, I'm not aware of any predictor. Best wishes.
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Old 12-24-2012, 03:47 AM   #12
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Re: PATCH and PERCOCET

What can be done against high tolerance to narcotic pain medications?
Is there certain food we can eat to slow down this high tolerance to those type of meds? Perhaps it's happening to me cause I just don't eat enough and my body recognizes it as food?

Some people can use 20mg oxycontin for years, and don't. I just don't get that.
Any of you using NMDA to deal with this?

 
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Old 12-24-2012, 12:45 PM   #13
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Re: PATCH and PERCOCET

There isn't much that can be done as far as I know. I wouldn't think food would have anything to do with tolerance. However, some meds will be absorbed quicker/slower with/without food. The main philosophies are to keep the dose as low as possible (ie. don't try to treat 100% of the pain...more like 50%) and to delay starting them as long as possible (try all other non-narcotic treatments first).

Yes there are some meds that can be taken, but I'm not hearing much of it in pain management. I think its a really good topic to explore. Asking about meds to reduce tolerance / potentiate the meds can be a red flag, depending on how you approach it and what type of relationship you have with your doctor.

I believe the main reason doctors would be wary to prescribe a secondary med for that (such DXM) is the lack of studies. You mostly hear of addicts adding meds to combat tolerance. Sometimes more by accident meds can be added which could help, such as Namenda (which would still be off label for pain). Long acting opiates and opiates for non-cancer and non-surgical pain really haven't been used that long (a little over 10 years?), so there will continue to be advances.

Also, some meds may be more or less likely to cause tolerance. Methadone (or even better, Suboxone) may be less likely. Fentanyl and Oxycodone may be more likely. That is a bit more anecdotal though. Its all about body chemistry as far as if you will require more frequent dose increases.

This topic is intriguing to me as tolerance is a big issue for me, since I've been on these meds in some amount for 6-7 years, starting at 19. A good doctor will know when to use opiates, and recognize that tolerance is to be expected (and therefore dose increases will be required), but to keep in mind that in many patients its expected they will need them indefinitely. So, sometimes we won't be able to reasonably maintain the lower level of pain we had at the beginning of treatment.

There is also a condition that some doctors believe in: opiate hyperalgesia. I think some doctors use it as an excuse to stop prescribing opiates, when its just plain tolerance. But I can see how sometimes it does occur (but should be able to be recognized, such as if an increased dose doesn't do anything for your pain). Best wishes.
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