Discussions that mention duragesic

Pain Management board


I strongly agree with Marcia. To be very honest and candid, I don't think your Doc knows much about pain mgt. He is proposing that you go from a pistol to a rocket launcher....And skipping everything in between.

According to Janssen, the makers of the Duragesic patch, the lowest available patch is 12.5mcg (micrograms). It comes in micrograms instead of milligrams because it is so potent. Many will tell you that fentanyl (active ingredient) is the strongest pain med available.

The lowest level patch, 12.5mcg, is equivalent to 45mg of morphine. Oxycodone is twice as strong as morphine, so 45mg of morphine is equal to about roughly 22mg of Oxycodone...Daily. You are receiving 40 10mg Percs per month, or 1.33 per day, on average. Thus, the Doc is proposing at least to double your meds, which is unreasonable IMO. Furthermore, as Marcia says, he's proposing you switch from one med that's working to another chemical all together....For no real reason. This is all assuming he's going to put you on the 12.5 and not the 25 (most people start with the 25). The 25 is appropriate for those who are taking a range of 60-134mg of morphine (according to Jansssen). If he put you on the 25mcg, he would be increasing your med potency by 4X.

Thirdly, the patch is a 24 x 7 med because it dispenses a precise amt every hour all day/night...Meaning your tolerance and physical dependance will skyrocket. Why start with a 24/7 regimen when you don't have to? You'll be forever tied to pain meds @ that point...Much more so than you are now. I would try to avoid a 24/7 regimen as long as possible.

Personally, I would try to increase the # of tablets per month whereas you could still control the amt you take. I feel sure some days are better than others and you probably don't need much, if any. By skipping days, you can prevent physical dependence. One perc per day is nothing. If the Doc objects, then the only thing I would consider would be Oxycontin, which is the same active ingredient as Perc....10mg would give you 10mg spread out over 12 hours. You would probably start @ 10mg 2x day, or 20mg per day.....Still a significant increase for you for no reason all at once. I would wait to move to OC until I needed to....Usually when the # of short acting meds each day is equal...So, when you got to 2 10mg Percs per day, it would be time to switch.

The patch is a great med....I have found it to be the best of all pain meds. However, it's the "big gun" and should be reserved for such. Lastly, not sure of your "lifestyle", but the patch requires some changes in most cases because it's a patch....It's effected by sweat, heat, & etc. Do a search on the subject and you'll get lots of good threads on this site.

Good luck, and I hope this helps some.

Ex
Hi, I have some experience with the Duragesic patch. I have been on it for about 2 years now. It has helped me with pain so much. I was in so much pain before I was in the hospital for a week for just pain. BUT I had already tried everything else but it! I had left the hospital previously with the only thing that helped being morphine drip. When I was released they put me on liquid morphine to take at home. After about a week I was back in the hospital for the week I am talking about. Intraveniously it helped a lot but by liquid or pill it didn't. So they put me on everything I can think of to the highest possible dosage and then put me on dilaudid (IV). It was fabulous. But you can only take it in the hospital I guess. They finally put me on the patch to go home with and it has been great. First I was on 25mcg. then went to 50. Then to 75. I went back into the hospital for more surgery and the people there almost killed me by giving me xanax (so I wouldn't move in MRI machine) ontop of the patch and dilaudid and tramadol, and muscle relaxers. If my husband and daughter hadn't been there to see I wasn't breathing but 6 time a minute I would have died. Actually I told them to let me die. I was so comfortable finally. I didn't want them to bother me.

I tell you this so you will know how serious to take this med. I feel like I am normal in every way instead of dopey like the other meds. But I am really not. I do function better but I realize I do things I am not aware I have done later. I have a terrible memory. I don't drive because I can fall asleep instantly, even standing up. This is getting better now, but like I said I have been on it for 2 years. I had to drop from 75 back to 50 because I get real mean on 75. I was fighting with everyone in the hospital, and with family too. It helped the pain better but was ruining my life at the same time.

You can't just quit taking it. I went on a trip and the airlines lost my patch meds. I had to go into withdrawals for 3 days before I got home and it was terrible. NOOOO sleep for 3 days and terrible shivering and pain. Back to great with patch in about 6-8 hours. This med RX has to be hand delivered to the pharmacy. Just for a note: The Mylan brand of Fentanyl sticks better and is much smaller than other brands. The name brand is real big and won't stick as good. Funny huh?

Please be careful if he just jumps to putting you on it. IT WILL MAKE YOU QUIT BREATHING IF YOU HAVEN'T BEEN BROUGHT SLOWLY INTO BEING ABLE TO HANDLE IT! I don't take all my other pain drugs anymore except in dire need. I can't tell that Tramadol helps at all anymore. Flexeril doesn't either. None of the pain meds ie: hydroco, oxyco, percocet, etc. I have to take Zanaflex 4mcg. 2 of those knock me out if I am real bad pain. PS I have Lupus and have some liver and kidney damage and my Dr. still has me on it. I don't think it hurts them at all, or he would be telling me to get off it.

I hope this helps. If you can think of anything I can help you with just ask. Good Luck! I know what you are going through!
[QUOTE=Executor;3637965]I was taken off the patch recently due to the heat of summer. I will go back on it in the late fall and wear through Spring again. Any type of sweating makes the patch peel up off your skin. Sure, you can tape it down, but that's a lot of hassle and effects performance some. Also, the "heat" in general causes the patch to dispense more med than normal. It's also effected by electric blankets, hot tubs, saunas, and if you have a fever. Being out in the hot temps isn't good either and falls in this same category as the previously mentioned situations. This time of year is NOT the time to be starting the patch.


Ex

Ex, don't you go through withdrawals when you go off the patch? What strength are you on? I don't think I will ever go off of it. Of course my situation is a lot different than most. Because of the Lupus I can't go out in the sun anyway. My whole life has had to be adjusted. I don't have a hottub and not a big loss compared to what I gain with the patch. Hate saunnas. Haven't been faced with a high fever yet! Just dont take real hot showers or use an electric blanket or anything hot over patch. I use the Mylan brand of the patch and it is very small and not full of liquid like the others. Some how it is in the glue. I just put two curad "fabric" bandaids over it and it never falls off. And boy do I sweat with all that I have wrong. I have been on it for 2 years now and it has always lasted the same amount of time and I live in Oklahoma where it gets to 10 below and 110 above.

I do agree to not take it lightly but if you are in a lot of pain always, and nothing is helping and the Dr. says it's ok (I know most Drs. don't like to prescribe it because it is watched so closely)...it was a great choice for me. I also agree with the big jump between a few low meds and the patch. I would think the Dr wouldn't do that if that is the case. Maybe the 12.5 would be ok. I never used it myself. So I don't know how strong it would be to me. Like I said before, it only took about 5 days to get me up to the Duragesic 50 in the hospital. I was only on tramadol and flexeril before that. Of course I had pain meds after all the surgeries but only for about 3-4 days. Hated all of them or was allergic to them.

Don't want to confuse Richard anymore. I just hope he trusts his Dr. and if he doesn't, he needs to get a new one. I trusted mine with my life many times. When I didn't like one of the Specialists he sent me to or what they wanted to do...I called and talked with my PCP before I did it.
Rich,
All I can tell you is my experience. I was in the hospital in so much pain, I needed to be knocked out for 3 days. During the 5 days I was there they went through a lot of different meds. I know one was morphine and I think methadone. Like I said I was out of it! They knocked me out with dilaudid. This was a fantastic drug. It took away all pain, but I was mostly knocked out or severely loopy. They finally put me on a 25mcg Duragesic Patch on about the 3rd day and I went home on the 5th day still in pain, but not anything like I was. I was having severe cramps and muscle aches in my legs. My back, neck, knees, and muscles hurt All the time, but with the patch I can deal and without the patch I am climbing the walls trying to get into a comfortable position to sleep or just sit. It takes about 3 days off the patch before the pain started creaping back in. I didn't go over that, because the Airline delivered my luggage and I quickly put one on. But it was still another 12 hours before I felt it kicking in and could sleep again. NO this medicine does not in any form make me feel like I am on anything. Maybe my resistance is up so high, I don't know. I do know that when I was taking the morphine, oxy's hydros's etc. I felt so doapy. I can't explain it. I do however agree with Ex., because of the experiences I have had when I didn't have the patch for 3 days. You know it is an eye opener deluxe when you are talking about Chronic Pain. When you hurt all the time, it affects not just your body but your mind. You get so sick of feeling pain. I think a lot of getting on is accepting the fact you will hurt. Chronic pain isn't like acute pain. It will go away when you get better. Chronic pain don't go away. At least not in my life. I hope you are different! Sorry I can't help anymore. Good Luck!