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wolfmarket 01-12-2006 11:56 PM

Dave, Fentanyl question
 
I currently am on the 100 mcg patch with 30mg Roxi for BT. I really am finding little relief from this dosage (change every 72 hours). I'm wondering if I would be way out of line to ask about doubling up to 200 mcg.

Also, why can't LT meds like MS Contin be taken at the same time you on the fentanyl patch.

I went from 100 mg MS CONTIN BID (with the 30 mg Roxi for BT) to the 100 mcg patch with the ROXIS for BT and then back to the MS CONTIN and then back to the patch.

I am really in a lot of pain and my PM Doc will not RX OxyContin, Dilaudid or anything other than MS CONTIN, MSIR, OXYCODONE and FENTANYL PATCH.

Thanks in advance!

Alan

Drewtn 01-13-2006 05:57 AM

Re: Dave, Fentanyl question
 
I know you asked Dave this but . . .

Do you get any relief at all from the patch?? Would it help to change it every 48 hrs instead of 72? I know it made a tremendous difference for me. Just a thought.

I take Dilaudid for breakthrough. I am surprised they won’t let you take it because it is short acting.

Good luck,
Drew

Shoreline 01-13-2006 06:31 AM

Re: Dave, Fentanyl question
 
Hey Alllan, There really is no reason someone can't be treated with multiple long acting opiates. I know one guy that uses several 100ugh patches, Kadian and meth as his LA meds and uses short acting for BT. It just depends on need, your condition, and your docs comfort level in prescribing.

The guy that uses the 3 med combo was compltely bed ridden prior to the intruduction of multiple opiates that all bind slightly to different receptors and sub receptors.The benefit was seen imdiately when he was abl to spend the majority of the day out of bed and trying to be productive around the house. It's juts a matter of is it neccesarry in this docs eyes to use a treatment plan that agresive. However there is no law that says you can only use one LA med at a time.

As far as asking to double the patch, that's a pretty hefty request, why double it if addng a 50 ugh patch would do the trick. Just like any titration, they are looking for max benefit from the least amount of opiates, doubling may be where you end up but skipping the steps in between would be hard to justify. Shooting for unrealistic goals and using whopping doses and agressive stratagies like mixing opiates is based on need for pain cntrol to function, not need to be able to continue working. There may not be a dose of meds that will allow a disabled person to return to work, despite doses and combinatinons I hit the same brick wall every time as far as standing lmitations and sitting limts despite the dose or md used.

I don't mean to imply that if your working your not in pain, but disability isn't a choice , you either can or your can't work, despite the measures they use. When I read about someone giving up on their disability claim when turnd down and just going back to work because they are afraid of loosing their home, then obviously working is something they are capable of.

It doesn't work like that. The questions are very clear on the disability apication.You can eiter work or you can't, the balance in someones checking acount has nothing to do with someones ability to work. Despite all measures tried, despite any accomadations made, and despite their fincial situation, someone truly disabled doesn't have the luxery of saying, OK, I'll go back to work. If that was the case, and working was a choice, they were never elligable to begin with. If smeone believes it's a choice, how are they any dfferent than the doc that says just suck it up and go back to work, you cawalked in here withut opiates , why can't you walk out withut opiates? Sme thngs can't be sucked up despite intestinal fortitude or guts or fiancial responsability.

Anyway, doubling dose and skippng what lies in between doesn't make good medical sense, but mixing opiates has solid measurable benefits, it makes sense in treatng pain that's been unresponsive to single med therapies, but at 100ugh, you can't say you need to mix opiates t function when there is so much room unlss side effects are preventing an increase. It is an option if nothing else works. But at 100ugh you certainly have room to adust the dose.

If your present doc isn't willing, you may have to find a new PM doc if that's what it's going to take to drop your level of pain enough to allow you to function.

That golden 50% relief that docs shoot for has differnt meanings to every patient, just like rating pain on a scale of 1-10. To some folks 50% relief means they can continue to work and be relatively comfortable, to others 50% relief means they can walk without help and walking to the mail box is a significant acomplishment if you couldn't previously stand in the shower without someones support.

I would absolutely discuss adjusting your dose, Obviously the largest patch is 100mcg, but that doesn't mean that's the largest dose anyone should ever use. But a 100% increase over night is a bit much to ask for. Increasing your BT meds untill you find a working dose of duragesic isn't an outragous request and success can be measured in needing less and less BT medication as they adjust the Duragesic dose. You do have plenty of room to tinker with things, combining opiates just depends on your doc, your condition, your prognosis, how well you ttolerate mcds and ability to function.

If you are presently working at the dose your on, It's kind of hard to make a doc understand when you say you can't continue to work like this, But if you're asking him to take you out of work untill they get you pain under control, he /she will get a better idea of just just how impairing your pain is.

Good luck, Dave

wolfmarket 01-13-2006 08:41 AM

Re: Dave, Fentanyl question
 
Thanks for the reply. The reason I was thinking about doubling was that this way I could just call them to approve it without having to get a new script. But you are absolutely right that 150 would be the next step. I probably will have to wait until monthly appointment.

I do work-I write 2 stock market newsletters-and the problem is that I cannot sit in front of the computer for the time I need to everyday. But you know what? Maybe I am at the 50% pain reduction and I'm being selfish or unrealistic. It is just that I am hurting so much, especially now on the right side.

But my days are fairly active due to the meds. I mean, I do run errands, shop, take my son to music lessons, even carry the keyboard, bass or guitar that he plays although my son is beginning to more of the heavy lifting now.

So, I can get around. But it is just so tiresome everyday to fight the pain everyday as all of you know!

Alan

conductor 01-14-2006 03:21 PM

Re: Dave, Fentanyl question
 
First, In response to Drewtn's response:

I use a 75 mcg patch that I change every 48 hours. ***I used to change it every 72 hours, and a received [SIZE=5]very little[/SIZE] help from it! But, when they changed the instructions to change it every two days, the dosing was much more consistent. As well, I use Dilaudid 8 mg for BT pain, and I use Actiq 800 mcg for BT pain. This has helped me tremendously.

Now, to Alan:

Dave is absolutely correct when he says that it's asking a great deal from a doctor to double the amount of fentanyl by 100 mcg. I understand that you were trying to save a step by avoiding the hassle of obtaining a new Rx (even though you would have to get a new Rx earlier since you would use the ones you already have more quickly): that would require you going by the office to pick it up and driving all the way to your pharmacy, etc. For some of us, that can be a long trip!

I really don't understand why your doctor won't prescribe the medications you mentioned because they can all be very beneficial to a wide variety of people. It's a shame that this doctor seems to flatly deny patients the benefits that these drugs offer!

Furthermore, we all understand that you are currently in pain and are looking for a way to feel better. I hope you and your doctor can find the best set of medications and other possible modalities to ease your burden.

Sincerely,
Jon (Conductor)

catnap 01-15-2006 08:30 AM

Re: Dave, Fentanyl question
 
[QUOTE=wolfmarket]Thanks for the reply. The reason I was thinking about doubling was that this way I could just call them to approve it without having to get a new script. But you are absolutely right that 150 would be the next step. Alan[/QUOTE]


Alan,

Your next step would actually be 125 mcq. The patches come 25, 50, 75, 100. Your doctor might give you more, but a 25% increase is usually normal in titrating the patches. Try to get him to prescribe it q48 hrs. That is the dose most of us have to use. It did not last 72 hrs. for me. I also needed a breakthrough med while taking it.

Carol

ruko4 01-16-2006 02:40 PM

Re: Dave, Fentanyl question
 
when i was on the patch i also started on every 72hrs. then changed to every 48hrs which made all the difference in the world. are the patches working at all? or are they working just not getting 72hrs out of them? or both. not working for you, and also not getting 72hrs, in that case you may need an increase and a patch change every 48hrs. also when i was using duregesic patch i used 2mg dilaudid for bt pain with minimal relief, but everbody is different. all in all most people i know and have talked to about the duregesic patch need to change it every 48hrs. same goes for oxycontin which i am on now, i started out on 12 hr dosing only to find that it works much better every 8hrs!! that also goes for ms contin when i was prescribed it at 12hr dosing found it better at 8hr dosing.

hypeadoo 01-27-2008 07:58 PM

Re: Dave, Fentanyl question
 
[QUOTE=ruko4;2146360]when i was on the patch i also started on every 72hrs. then changed to every 48hrs which made all the difference in the world. are the patches working at all? or are they working just not getting 72hrs out of them? or both. not working for you, and also not getting 72hrs, in that case you may need an increase and a patch change every 48hrs. also when i was using duregesic patch i used 2mg dilaudid for bt pain with minimal relief, but everbody is different. all in all most people i know and have talked to about the duregesic patch need to change it every 48hrs. same goes for oxycontin which i am on now, i started out on 12 hr dosing only to find that it works much better every 8hrs!! that also goes for ms contin when i was prescribed it at 12hr dosing found it better at 8hr dosing.[/QUOTE]

Dave, and others,I will give you a quick summary of my condition. In 1983 I had an industrial accident when I fell from above and hit my back on a Forklift below! My back has never been the same. In that same year I had what was know then as a Kayripapain injection (to dissolve the material between my budging discs) It did not work and has not been used since (Ginnepig)! Like many others with back pain I have tried everything known to doctors. My problems came from my sattic nerve, and lower 4 & 5 sl1 lower back, it was about 60% sattic, 100% lower back pain, if that makes sense? In May 2006 I finally was talked into a "FUSION"of the lower back, at that point in time all was tried and with pain at every step I took there was no alternative. I had a very great surgeon, and he did a wonderful job! The sattic pain is gone, the lower back pain is still lingering, but is somewhat tolerable, as long as I stay away from the activities that will upset it, such as cleaning the house etc.. I am going through PT 3 days a week, and will continue PT until I need it no longer.

Dave and others,
Here is my question to you all?

Dave I've been on the Duregisc patch for 3 years the last 2 years 100mg every 48 hours, the patch was the only relief I had for the pain. I was actually bent over my bed in pain, and couldn't get no relief, with any kind of meds before the patches. I really believe I need the patch to tolerate the pain in my upper back, the doctors point out that there are no nerves or disc‘s where my pain is isolated (upper back, from shoulder to shoulder). At this time in my life I would like to start weaning off of the patch , I have been addicted to drugs in the past so I have a high tolerance to addicting drugs. Now at the same time, of course I am afraid that the pain will return, and the weaning would be for not! My question to you Dave , and the others on his site would be” Is going through the pain worth having pain without any relief? Hope that makes sense?

hypeadoo 01-27-2008 08:06 PM

Re: Dave, Fentanyl question
 
[QUOTE=conductor;2143219]First, In response to Drewtn's response:

I use a 75 mcg patch that I change every 48 hours. ***I used to change it every 72 hours, and a received [SIZE=5]very little[/SIZE] help from it! But, when they changed the instructions to change it every two days, the dosing was much more consistent. As well, I use Dilaudid 8 mg for BT pain, and I use Actiq 800 mcg for BT pain. This has helped me tremendously.

Now, to Alan:

Dave is absolutely correct when he says that it's asking a great deal from a doctor to double the amount of fentanyl by 100 mcg. I understand that you were trying to save a step by avoiding the hassle of obtaining a new Rx (even though you would have to get a new Rx earlier since you would use the ones you already have more quickly): that would require you going by the office to pick it up and driving all the way to your pharmacy, etc. For some of us, that can be a long trip!

I really don't understand why your doctor won't prescribe the medications you mentioned because they can all be very beneficial to a wide variety of people. It's a shame that this doctor seems to flatly deny patients the benefits that these drugs offer!

Furthermore, we all understand that you are currently in pain and are looking for a way to feel better. I hope you and your doctor can find the best set of medications and other possible modalities to ease your burden.

Sincerely,
Jon (Conductor)[/QUOTE]

I thought this might help, remember that this does not work in all cases, and in all people, because we all know everyone is different. I have tried both fentanyl and the brand name Duragesic patches. I can tell you when "I" used the Fentanyl versus the Duragesic there was no comparison, the Brand name wins out once again. Maybe you can ask for the brand name? Hope this helps?
Mark

brianpain33 01-28-2008 01:33 PM

Re: Dave, Fentanyl question
 
Hypeadoo:
Welcome to the boards and I just want to say that Dave and John provided quite a few useful suggestions. Good job guys as always. Which brand of the patch do you currently use? If you are using the [SIZE="3"][B]Mylan brand [/B][/SIZE]you should [B]SERIOUSLY[/B] consider going to the generic brand [B][SIZE="3"]SANDOZ[/SIZE] [/B]or the name brand [B][SIZE="3"]DURAGESIC[/SIZE][/B]. The Mylan brand has a notorious reputation for being not very effective.

Sedond I would suggest going up on the patch to 125mcg. If that helps but not enough then titrate up further. But do it slowly and allow a week on the same dose before changing. It does take that long for the level in your bloodstream to get steady from the change.

Third, you said that you have an addictive personality which really means you are an addict and hopefully a recovering addict and not using at all. I am also a recovering addict so don't be ashamed about admitting it. I have been on the patch for a couple of months now and it helps immensly. It really started working better when I went for every 72h to every 48h. For me my goal is to get my LA medication (the fentanyl patch) at a level where my breakthrough meds are kept at a minimum which I am finally at. Also, you have to get to a point where the side effects are at a tolerable level. You dont' want to be in bed sleeping 20 hours a day and not able to function even though you might not hardly have any pain. It is a delicate balance plus being an addict creates other issues. You [B][SIZE="3"]NEVER EVER [/SIZE][/B]want to get on a dose that makes ALL OF THE PAIN go away because at that very point you will probabaly experience a high. So you always want to have some pain even if your pain level gets down to a 1.

Talk to your doctor and have realistic expectations. Keep us posted.

Brian


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