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    Old 04-08-2006, 09:53 AM   #1
    Amsterdam
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    Switching from fentanyl patch to...

    Currently I am on the 25mcg switching every 48h and I am just not getting enough relief. I also have been getting more frequent headaches and a "clouded head" feeling.

    I am seeing a great PM doc now, which I am very happy with... thanks to Mush and Mike J. I had my first appt last week, but will be going again next week to see how things are going. I can't thank you both enough for helping me find such a great PM.

    I am not really interested in going to the 50mcg patch because I doubt the side affects will get any better. I have heard good things about Meth and treating nerve pain. According to this chart at the bottom of the page.. [url]http://www.**************/fent.cgi[/url]

    Looks like the equivalent would be 15-44mg oral meth to a 25mcg fent patch.
    So does that mean that my starting dose on meth should be around 30-40mg daily? I don't want to start off too low, so what would be a good starting point without risking w/d symptoms. Thanks!

     
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    Old 04-09-2006, 10:34 PM   #2
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    Re: Switching from fentanyl patch to...

    Amsterdam,
    I'm so happy that you have tried the patch. I know Dr. Irving is an excellent physician. I had difficulty when I switched. He was so patient. I was with him about eight months. We tried several different medications.
    I also changed my breakthrough medication. I'm currently taking Dilaudid for breakthrough Pain medication.That made the biggest difference for me. Please let me know how you're doing. mike
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    Old 04-11-2006, 10:50 PM   #3
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    Re: Switching from fentanyl patch to...

    Mike, I have a follow-up coming up soon. I might ask for something other than the fentanyl because it doesn't seem to be working all that well. I was taking 10mg hydros TID for BT but they did nothing for me, so I told my previous doc to forget the norco. I know dilaudid worked well in the hospital, but I've never had it in pill form. I hate to request medication, but I am against hydro and oxy because I hate the rollercoaster effect. I don't know whether to ask for an increase on the fentanyl and add a BT, such as dilaudid or to ask to be switched from the fentanyl to something like meth or morphine. I'd rather the doc make the suggestions, but I like to go in with an idea of what might work since its no fun having minimal pain control. If I make a suggestion, say fentanyl 50mcg with a BT dilaudid (dose amount?) or go off fentanyl and over to meth 10mg TID or morphine (MS Contin) 30mg TID. I would be interested in changing from fentanyl because my body absorbs the fent quite fast and the initial 12hrs is OK, but the 24-48hr mark is marginal. On 72hr dosing, my body was going through w/ds on that third day. I'm now on 48hr schedule, but I think I would be able to manage a smoother and more continous dose with a pill. The toughest thing for me in this whole PM deal is how to get a steady level of meds. The oxys were absolutely torture, never going back there. The fentanyl still has a rollercoaster effect, although its easier to handle on 48hr dosing. Now I am ready to look for something that can smooth it out even more so I don't have to be so distracted by the ups and downs. Hopefully someone can give some advice here because I think I am getting really close after years of battling these meds to finally find an even ground.

     
    Old 04-12-2006, 04:00 AM   #4
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    Re: Switching from fentanyl patch to...

    I was on the fentanyl 25mcg patch for4 months, in addition to Percs for b/t pain and Valium for muscle spasms. I HATED the patch- couldn't sunbathe, have a long hot shower, get in the hot tub. I lost 15 lbs, and could no longer orgasm... I suspected it may be responsible for some of those side effects I was having. My doc took me off it, and upped the percs for a month, to see if the patch was actually doing any good. Turns out I'm in just as much pain without the patch. I had a little bit of withdrawl, but since I still have opiates and valium, it was very manageable. I see my doc in 3 weeks, and we will decide how to go about controlling the pain. I've also heard Methadone is excellent for pain relief from my doc. Hopefully you will find any answers you are looking for. I feel your frusteration!
    mrsaa

     
    Old 04-12-2006, 08:33 AM   #5
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    Re: Switching from fentanyl patch to...

    Amsterdam,
    I am concerned about what you said. Are you going to your regular physician who referred you to the pain clinic. I would make the appointment with him,I am concerned that you're having difficulty. I'm not trying to be negative towards you. Please let me know what's going on. I would suggest that you contact the referring doctor and make an appointment with that physician. I would have him give me an opinion how he feels about this medication. please remember he is a one that has to write off on the treatment plan. He will probably be the one writing out your medication. I would tread lightly with him or her. when I had difficulty this worked excellent for me. Let me know what's happening. mike,Shoreline any suggestions
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    Last edited by mike j; 04-12-2006 at 08:37 AM. Reason: grammar change

     
    Old 04-12-2006, 08:47 AM   #6
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    Re: Switching from fentanyl patch to...

    I'm glad you got in to see Dr. Irving.
    Personally I am not comfortable suggesting meds to my doctors. I don't know how Dr. I would respond to that. Might be a good thing...might not.

    I understand your desire to have a steady serum level. We all strive for that.
    If the patch isn't working for you maybe meth is the way to go. If you don't mind taking however many pills it would take to cover your day. Meth and the patch are the two things Dr I suggested to me if I grow tolerant of my current dose of Oxycontin. If you can get past the drowsiness of Meth I've heard that it is great for sustaining a serum level. No rollercoaster. I'm still trying to come to terms with the fact that I will be taking meds forever. Meth scares me because I've heard it's hard to come off of but...since I've been taking pain meds for three years I'd probably have a hard time anyway.

    Good luck with your quest and keep us posted. ~Mush

     
    Old 04-13-2006, 12:57 PM   #7
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    Re: Switching from fentanyl patch to...

    I appreciate the concern, and I don't see anything you wrote as being negative. I am scheduled to see a new primary care doc. I am getting more stable than when I was on OxyC, so its much easier to manage. Its nowhere near the ups and downs I used to have, so I can't complain too much. I think I'm at a fairly low dose, so there is probably room for improvement. I have been able to manage very easily and with 48hr dosing, I don't have to suffer on the 3rd day. I think I just have a fast metabolism or something. I would imagine a BT would be beneficial but I don't have any interest in hydro or oxy, so it would need to be something else. With being grossly undermedicated for over 3 years, I am just trying to get to a comfortable level of relief and not be sedated either. I surprised the nurse at the office because they couldn't believe how long the doc spent with me. I guess I got special treatment. I don't want to suggest meds because I believe in this doc and just want to tell him my symptoms and make a decision based on his knowledge. I'm no longer suffering from severe w/d on a monthly basis so the balance of meds is going to be much less desperate than its been in the past.

    I really appreciate the advice and concern expressed on this board, its given me a much more positive outlook when depression seems to be quite overwhelming while dealing with CP.

     
    Old 04-14-2006, 08:48 AM   #8
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    Re: Switching from fentanyl patch to...

    I am on methadone and it has worked quite well for me. I don't have nerve pain though. But I had tried pretty much all of the other pain meds out there over the past 7 years. Some worked but had side effectst aht didn't work for me, etc.... I like the methadone because it does not make me mentally feel any different. I get no buzz from it. I know some people do...but most that i know that are on it do not. Taht is my personal experience with methadone. The drowsiness was a problem for me at first but that side effect wore off within the first two months for me. I know it persists for longer periods for others. The only time it hits me now is if I have been missing a lot of sleep. That is my main side effect from methadone, that it keeps me up at night. But I have ALWAYS had insomnia so that probably has something to do with that. But otherwise it has worked better on my pain then any other drug I have tried. That is my opinion. I hope you end up with one that works well for you!

     
    Old 04-16-2006, 07:03 AM   #9
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    Re: Switching from fentanyl patch to...

    Well,amster,nice to know your still out there,lol.i was wondering how things were going.sounds like you now at least have a good PM to work with you,and that really IS the most important part of PM,just having a doc that cares and wants to try and help us.

    you mentioned the Dilaudid as a possible BT med,just wanted to tell you that it may be a good choice but the only real drawback in using it orally is that it does not seem to work quite as well as the IV stuff.at least that has been my experience with it.i respond really well to dilaudid and its saved my sorry butt from really having to deal with ungodly levels of pain when I had that spinal cord surgery,but when I was Rxed the oral stuff after I had my aneurysm coiled for those lovely post coiling headaches,i found that it worked well for my headaches but not quite as good for my other pain as when I had it in the hospital in my PCA.it could have very well just been a dosage thing but it just didn't seem to be quite as effective orally as it was when given IV.It also seems to have a much shorter duration of effectiveness than with other BT meds I have tried.but just to 'hit' the BT type pain,it could be very effective there,since most bt pain when hit right away and with the right meds will usually subside much quicker than the "normal" heights of pain that you deal with on a daily basis.do you know what I mean or am I just confusing you more,lol.i am like that sometimes.

    I do suggest certain meds to my NP when we are thinking of doing any changes.i just research all of my meds and any other possibilities just to discuss them with her from time to time,and she knows that.this is how I knew that I was being lied to by a different NP one day about the ceiling effect of oxy,and the fact that it does not have one.she disagreed.researching any possible meds to try is just something every patient should do,ya know?i mean this is what we do here on this board on a daily basis.I am going to be trying lyrica and getting off the gabitril just based on the info that I have obtained on this board.my NP wanted to wait until my surgerys were over and things were a bit more stable before tapering me off the gabitril and onto lyrica.

    I am just sooo relieved to know that you finally have a good PM who is willing to actually work with you to try and get some good and very badly needed pain relief.i know you have had to deal with so much crap along the way.it does tend to make us a bit more thankful for having these types of docs who are willing and able to help us through all of the ongoing crappy pain and all that comes along with it tho doesn't it?when you finally find one of the "good' ones who just care.

    I hope you can find a good BT and LA combo that will give you some relief from your pain.you have definitely suffered way too long with this nasty crap and do deserve to finally get some sort of actual relief.

    I do wish you luck Amster,really,i know you have been thru alot hopefully now things will only get better from here.sometimes it pays to just hang in there.and you have been doin alot of hangin,lol.please keep us all posted on just how things are goin for you.we DO care about you here ya know that.nothing like a bit of hope to help lift some of that depression.good luck,marcia
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    Old 04-16-2006, 11:58 AM   #10
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    Re: Switching from fentanyl patch to...

    This is the best treatment I've ever received and for the first time I'm actually seeing some hope. I went to the appointment as was seen by the NP, who treated me very good. I decided, sort of spur of the moment, that I would voice my concerns about the dose and also the overall use of fentanyl. So we decided to give the fentanyl a fair try by going up to the 50mcg before trying something different. If the 50 doesn't work then we will probably try Kadian next or Meth.
    I'll do some searching on this board and see what people have said about Kadian and it's positives and negatives. So far there wasn't mention of using BT meds. If anyone has any experience using fentanyl and Kadian or Meth and wants to explain some of the differences in how they work or anything that was noted as being better for pain, etc. I just want to be sure that I won't experience withdrawls if we decide to switch. I just want to be free of the drugged feeling of these meds and just get clean pain control with the least clouded head symptoms.

    I also don't want to start increasing in dosage or get into a med that is very difficult to detox from because I have hope that I may be able to get off these meds in the future. The doc did an injection into my back with bupivicane and I noticed an interesting effect. The pain in my leg seemed to significantly change, it went down. This was the first time I'd ever had anything like this, and I'm going to go in for a series of 4 shots. I know I had some significant relief, but it only lasted about 2 hrs. This was the first time in about 4 years of terrible nerve pain that I noticed anything lower my pain like that did in a matter of minutes. I don't know what that means for my ability to recover, or ability to treat, but the relief was a great feeling. They said the series of shots have a possibility of giving longer term relief....I really hope thats true.

     
    Old 04-16-2006, 10:39 PM   #11
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    Smile Re: Switching from fentanyl patch to...

    Amsterdan,
    I am so glad to hear you're getting some good results. I can relate to your postings all too well. Dr. Irving really cares about his patients. The Swedish pain center is probably one of the best in the nation.

    When I had him. I switched medication 4 different times.I think you will get you on long acting medication and see how your reactions are going. Then he will give you breakthrough medication, if needed.

    I'm very fortunate to be able to control my pain with meditation and exercise to a certain extent. I tried those first to reduce my pain,If that does not work. I use my breakthrough medication.

    I'm sorry I did not get back to you,my computer was on the fritz.
    keep up the nice work. Please keep us posted.

    Have a Good week Mike
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    Old 04-17-2006, 12:21 AM   #12
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    Re: Switching from fentanyl patch to...

    I have had severe pain for over five years. Needless to say I have tried almost everything. My pain doc put me on the fentanyl lollipops instead of the patch. They help take the pain down almost immediately. You don't have to use the whole thing if your pain is down, just put it back in the package and take it out as needed. I use 2-3 a day. I have had no side effects. Good luck.

     
    Old 04-17-2006, 07:27 AM   #13
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    Re: Switching from fentanyl patch to...

    I feel extremely fortunate Mike, and if it wasn't for you and this board I would have never found this type of care and for that I am extremely grateful. I feel like you've saved my life! that is no joke.

    I have a positive outlook again and hope that this treatment will reduce my pain so I can get out and enjoy the outdoors. I can't wait to be able to walk the trails and not be limited to about 20 min on my feet.

     
    Old 04-17-2006, 10:48 PM   #14
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    Re: Switching from fentanyl patch to...

    Well I can't believe how terrible these 50's are making me feel. I have tried putting them on twice and both times I'm forced to take them off after about 12-14 hrs. Extreme headache, nausea, dizzyness, etc.

    Oh well, back to the drawing board...

     
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