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Fentanyl Patch!! Advice please!

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Posted 1/26/2011 7:08 AM (GMT 0)
Hi everyone, I am looking for some help. I recently got switched from Oxycontin 60mg 3 times a day, down to 25 mg Fentanyl patch for 2 weeks. I am going nuts....I had been on the Oxy's for about a year, and they just werent touching the pain any longer, so they wanted to try the patch, but didnt want to start me out too strong, saying it can make some people very sick to their stomach? Then I go to 50mg Fentanyl patch the last 2 weeks, then see the Pain Doc again to re-evaluate to see if its working. My question is......when does this medicine work? I have been on the patch since last Thursday, and I am in just as much pain as before. I do take Percocet for BT 4 times daily, as needed, which I do take. Is this going to get any easier? They are now talking about a pain pump if they cant find an oral medication that will work for me. Does anyone have one of those? If so, how do you like it? RIght now, I jsut want my life back, and most importantly, just want some pain to go away. I know it isnt going to completely go away, but, it would be nice to have a little relief. THis patch is definitely not cutting it.

Any feedback would be greatly appreciated.

Thanks everyone. Take care.

Posted 1/26/2011 7:24 AM (GMT 0)
Hi mary!
And welcome to the CP Family!
I take oxycodone products for pain and it works as well as can be expected for me so I don't have experience with patches or pumps. But we have many members who are very knowledgeable about both. I'm sure tomorrow they will be stopping by to give you some help. I just wanted to know that I'm thinking about you tonight and will keep you in my thoughts and prayers.
Warm hugs,
Chutzie
Posted 1/26/2011 3:03 PM (GMT 0)
Thank you so very much!!! I really do appreciate your response. Yes, I do hope I can get some feedback.....this is the first time I have ever written on one of these, I am just tired of feeling alone in this struggle. Maybe if I could have someone that is going through , or went through something similar, it would make me not pick up the phone and call the dr. I will just get through it. Again, I really appreciate it. Have a blessed day.
Posted 1/26/2011 4:59 PM (GMT 0)
You are on the 2nd lowest dose of fentanyl and it may take a few more days before it gets to the blood plasma level that you start to see the benefits. Sometimes, it can even be effected if your skin is dry. Don't apply lotion before applying the patch though or it won't stick well.

When a doctor changes you from one medication to another, they take your current dose of in your case, oxycodone and convert it to the new medication and then usually reduce the new medication dosage by around 10% for cross tolerance. This gives you a chance to get your body acclimated to the new medication and to see what , if any side effects you may experience. Those usually subside in a week or two.

Fentanyl is a very potent pain reliever so it will most likely start to provide better pain relief once your blood plasma level is built up a bit more. It can take up to a week before someone feels the benefit of the new medication.

You said that you are going up to 50 mcg. in two weeks, correct? You will most likely see the pain relief when you get up to that dose if you don't see it with the current one.

Your PM doctor is being very smart in titrating you up slowly and giving your body a chance to adjust to the new medication. wink Hang in there,
Sandi

Posted 1/26/2011 6:25 PM (GMT 0)
Hi Mary and welcome to Healing Well's chronic pain forum. So glad that you found us but sorry that you have to be here. By coming here you will see that you are not alone in your battle with CP, all of us here at this forum are right there with you. Every person that comes here has a story to tell as to what lead them down the CP road and what brought them here. No two stories are alike either.
I too was on Fentanyl at one time. I was started out on the 25mcg and felt relief fairly soon, but I was not on something as strong as you were either. Like you in another two weeks I was then increased to the 50mcg and those worked well for a bit. Then we tried the 75mcg and I was having major problems urinating which is a side effect and had to come off of them. That was about the time my PM dr approached me about the pain pump. I dug my heels in and refused to even think about it. Somehow, in my mind I felt like I was too young (52)for such a drastic step and surely there was another pain medication he could try me on. I had been through so many and I either had full blown allergic reactions or the side effects got me really bad. My body is just not wired right with medications of any kind and it makes it a challenge for drs to treat me with any kind of medicines. My dr sent me on my way and said in three months you will be back in here begging me to have the pump put in. He was right, it was less than three months and I was back and we did the trial and I had the pump implanted June 2005.
I am going to ask you to use the search here at the top of the page on the right side. Type in pain pumps and you will be able to pull up all sorts of info about the pumps. We have discussed the pump a lot here and some of it has been written by me. After reading some of it, and you need more info if you will post your questions here, I will do my best to help you out in any way that I can.
The pump is something that can give you your life back in many ways if you have a very good dr that knows them inside and out. The dr must really know about the medications used in them and know how to mix the medications and not be afraid of titrating dosages up in the pump. Some drs say they know all about them when they don't have a clue. My first PM dr was one of those and my pump was not an effective tool in controlling my pain and I really thought I had made a big mistake by having the pump put in. Even with meds for BT pain my pain was not in control at all. That dr stopped practicing pain mgt and referred his pump patients out to another dr . This dr has over a decade of experience with pump, she is a retired neurosurgeon and prior to retiring from surgery she did her own implants. She knows compounds so she mixes her own meds there in the office for the pumps, no waiting on a pharmacy to deliver them. She is wonderful and I am so thankful she is my dr. For the first time in the past two years I have been her patient my pain is under much better control. I currently have a Medtronics pain pump in and when it is time for a battery change, I will need a new pump too. We will be putting in a pump made by Codman that does not run on batteries. It is run by a gas that is in the pump itself and you never have to go through having the pump changed out again, unless of course if it were to fail. I am very excited about the Codman pump and not having to go thru anymore surgeries after it. I may have another 12 months left with the current pump and then will be getting the Codman put in. The pumps last normally around 7 years or so. Anyway, read up here what you can and then come back with any questions you may have.
Again, welcome aboard and keep us posted on how you are coming along.
Posted 1/26/2011 6:29 PM (GMT 0)
I imagine the fentanyl is not at the dose you need. I had a 100mcg patch for about 3 years, and was taking so much breakthrough meds as I was not getting relief. The dr I had at the time refused to let me wear more than one patch at a time, even though I had had patients in nursing homes that wore 3 at a time, and changed one everyday.(each patch every three days, but one new one each day). I changed drs. and was advised to take methadone. She started me on 50mg of methadone, which proved to be too sedating. I was eventually taking 30-40 mg of methadone, and then she left town and the dr she left patients with did not use methadone. SO oxycontin, and now ,after menths of going down on methadone and up on oxy, am on 40 mg of oxycontin every 8 hours (as it did not last 12 hours for me) It does not cut the pain for me, and am still taking the breakthrough meds everyday, also. I plan to go back to fentanyl, esp, if oxyontin becomes unavailable in generic here. But plan to do down on oxyontin, as I go up on fentanyl. Fentanyl should actually probably be as effective as that dose will be in a week, or after applying 3 patches. Most people will notice a difference in their pain control, by day 3, if it is effective. Are you still taking some oxycontin, as you change meds. ? That may be the problem, as the dose of fentanyl is not as high as the dose of oxycontin you were taking. Switching meds sometimes does allow you to go down on the dose of the new one, but a month at a time, is far between, esp as you will double the dose. Perhaps you could call, and say it has been two weeks, and the pain is not controlled, and ask to go up now, on the fentanyl.  It is always a chance they will say yes. I though I could not make the switch from methadone to oxycontin, as I do not like oxy as it gives me a constant headache, and was not nearly as effective as the metadone, plus I could take the methadone all at one time, once a day, and not have to take meds three times a day.  IT is different for everyone, but it is worth a call to the provider, to tell them you are miserable.
Posted 1/26/2011 7:01 PM (GMT 0)
Hello,



I'm on the patch too. Yeah, they are just doing their job starting you out at the lower dosage. I started there, then went to 50, now I am at 75 and have just been given a new script for the "brand" name to see if it is a difference, my doctor feels it is and wants me to try so I will.

Sad to say, this time frame is no fun. The waiting to get to the right mix. Hang in there and I hope it gets better for you soon.

And welcome!!
Posted 1/26/2011 9:54 PM (GMT 0)
Oh my goodness...Thank you, thank you, thank you!!!! I have tears in my eyes, just to hear that people responded to my questions is such a relief. I really do appreciate it. I actually did call the PM doc today, they told me to go ahead and wear 2 of the 25 mg until I could get the 50 mg filled next week. I put the second one on about 45 minutes ago, so we will see if there is any relief. I pray so. I have a great doctor, who listens, and he is trying to do everything he can to help ME! I , too, am saying , NO, to a pain pump, and he is trying different meds to see if anything is going to work for me, but, he knows, and its up to me to make the decision of surrendering and trying the trial out. I tried the Neurostimulator out, the trial, and that failed, and I honestly just dont want to fail again. I am 36 years old and I just want something to work. I have heard that pain pumps are great and can give your life back, and straydog, I so appreicate your feedback with the info. and will look int o that on this website. I am learning my way around here, and its so nice to have found this site and meet others with similar pains. I had a fusion on my L4-L5 , and it didnt go like I wanted it to....somehow, I continued to have pain and now I am left with Failed Back Syndrome, Permanent nerve damage in my legs and back, and 3 more discs herniated, but, they cannot do anymore surgery to repair. Thank GOd I found a wonderful Pain Management Doctor. He really is great in the sense of, listening, and as much as I want instant gratification, it cant be done. I am going to check more things out around here.
I will let you all know if this gets any better.......Again, I so appreciate your feedback. This comforts me so very much!!!
Posted 1/27/2011 12:03 AM (GMT 0)
sorry, I hit it twice....woops!!!

Hey Mary, no problem, I fixed it for you, lol. It happens to us all, lol.

Post Edited By Moderator (straydog) : 1/27/2011 10:26:04 AM (GMT-7)

Posted 1/27/2011 5:12 PM (GMT 0)
Okay, THIS TRULY STINKS!! I put the two patches on yesterday, per dr. instructions....so that is 50 mg. and there is still NO relief! I will still give this 2 more days to be fair to the dr.orders, but, I dont even think I will get the other prescription filled. Also, my husband and I are noticing that when I am taking the Percocet for BT, I am starting, and have been, but, just now figuring out the connection, that my chest fills like its closing up. It goes away after awhile, but, it is bothersome. Any one else had these issues? Just curious....anyways, there is my update with the 2 patches....not so good! I am just smiling through it though.....all you can do.
Posted 1/27/2011 5:32 PM (GMT 0)
Mary when you say it feels like your chest is closing up do you mean short of breath. Did this happen since adding the 2nd patch or what. Please call your dr ASAP. These meds like Fentanyl can cause decreased breathing and that is very serious. Or is it the percocet causing this, either way call your dr.

Please keep in mind these patches are for 72 hours only, and you will have to change them every 72 hours. Hopefully you will get more relief soon. Please do call your dr though about this chest situation and let us know what he/she thinks.
Posted 1/27/2011 6:05 PM (GMT 0)
Straydog has written such important advice. That can be dangerous, Mary! Please call your doctor! Anytime you have shortness of breath, you should call--especially since you just had a med. change!

Hugs,

Flower
Posted 1/27/2011 6:18 PM (GMT 0)
I am on 100 mg fentenyl, have crohns among 6 surgeries, arthritis and fibromylgia and severe scoliosis. They did same thing, moving me up, Oxys, morphine,methadine, none worked. The fentynal is the strongest med you can get, not sure why not working. Great thing is it does not pass through digestive system so you get full effect.. Trust me pain Dr will keep moving you up until u are comfortable. It is true it will make you so sick until you get used to it. Just be patient... Again it is like 50 times stronger than Morphine, and it is for opiate tolorant people. Great thing is you do not get loopy on it either!
Posted 1/27/2011 9:41 PM (GMT 0)
Almost like I am having panic attacks? It is strange, and I havent had one in forever, but, once I wrote that, we sat down and talked (hubby and I) and maybe it isnt my chest closing up, but , that now my pain is so great because the Fentanyl is not working, that is causing me to have panic attacks....that may sound weird, I dont know how else to put it. I am just so hoping that this is going to kick in and give me some relief.
I am again, so happy that I found this forum to be able to have advice, support, encouragement, etc. others do not understand this world I now have to live in and its so nice to have found this site. I really do thank God that I googled and found this and had enough guts to post something. I appreciate the feedback ALOT!
ljb, I am glad that you have found that strength to help you. They talked about that strength for me, but, said that we would have to work our way up, its difficult to wait it out. I am praying once I do the 'waiting' that it is worth it at the end....we all want relief in some way. I pray for others that deal with this stuff just like myself, that we can just have some comfort through the day.
Straydog, going through the site has given me a lot of info. on the pain pump and has made me feel a lot better with coming to terms with possibly having to get one. I appreciate your help with that. Can I ask what meds you use in yours? DId you have to try out different meds before you found the right one.....thanks.
Posted 1/28/2011 3:36 AM (GMT 0)
Mary, actually, my prior PM dr forgot I cannot tolerate Morphine and that is exactly what he put in my pump. So, we had to take it out and he put a cocktail is what I call it of different meds, I currently have Dilaudid, Fentanyl, Bupivicaine and Clonodine. Dilaudid in a pump works very well for most people, it is an old, old drug but has fewer side effects than any. All of these meds are in different dosages too. The Bupivicaine is 7.3 mcg and should never go over that or else it can cause lots of problems with your feet and legs going numb and losing the use of them. Alot of PM drs have no clue about this drug and they put way too much in and the people have all sorts of problems with their feet & legs and causing a lot of pain with them. Then only purpose for putting it in a pump is to help the pain medication adhere to the pain receptors, thats it nothing more. Avery good friend of mine had something like 15mcg and she was losin much of her feeling in one leg and foot and after we talked she fnally got her dr to agree to reduce it to 7mcg and a few days letter she got her feeling back in her leg & foot. I also have oral Dilaudid for BT pain. Even with a pump you can still experience BT pain and a pump patient should be given meds for BT too.

I sure hope you can get some relief soon and watch this chest pain stuff.
Posted 1/28/2011 4:27 AM (GMT 0)
Mary,
Like I said the other day, fentanyl's delivery system is transdermal, which means that it is absorbed through the skin and into the tissues beneath. It can take up to 24-48 hours before it builds up enough in your system before you feel the benefit of the increased dosage. It is not hours, but rather days. With fentanyl, it is usually recommended that you go through a week's worth of patches before making the determination that it is or is not working well for you.
It may be that you need to go even higher in dosage since fentanyl is doses in micorgrams, not milligrams, but even if that is the case, you still need to give it some more time before deciding it isn't working.
If you are having panic attacks, it may be that you need to think about some medication to help them for now, until your pain is better controlled.
If you experience slowed respirations, or become overly sedated , then you will need to contact your PM and find out what he would like you to do from there.

I know that having to wait for a couple of days seems like forever and fentanyl does not work for everyone but it is one of the strongest pain medications out there today and usually works pretty well for most.
Hang in there and give it a few days before deciding it isn't working.
Posted 1/28/2011 12:44 PM (GMT 0)
I was on fentanyl back in 2010. I was started on 50mcg and then bumped up to 100mcg after a week and a half. My system did not respond well to the fentanyl. With the heat in Ohio summers, everytime I went outside I would over heat and the patch would let out too much medication and either make me sick or after going back inside it would not let out enough medicine and make me sick. I was on it from February through August. I ended up taking myself off of it without calling my pain doctor because I just knew that something was very wrong.

When I sat down and explained all of the problems and how I felt when on the patch, the doctor said that I had done the right thing because it sounded like the patch was letting out too much medication when I was in the heat.

My body has had problems ever since I had a bone marrow transplant with getting over heated and not being able to cool down. The heat just takes my breath away and my face gets beet red and I do not sweat very much. Something about the chemo damaging my sweat glands.

Good luck! Fentanyl does not work for everyone, but for those that it does work for, it is a wonder drug!

Trudy in Ohio
Posted 1/28/2011 8:09 PM (GMT 0)
Mary,
I'm really worried about you. I've suffered from oversedation myself. It is all too easy to do with the patches. I actually blacked out in the shower with a 25mg patch on me. If your chest is bothering you like that, take the patches off, avoid sources of heat (hot showers, heating pads, etc) and call your doctor immediately. Withdrawal sucks, but it's better than dying from breathing problems. If you don't get a hold of your doctor's office, get to the hospital.

You could also ask your doctor if it's okay for you to drink caffeine (coffee, hot chocolate, Mountain Dew) to counteract the breathing issues. Sometimes it is -- I do that. Make sure you keep track of how much caffeine you have in case you need to go to the doctor or ER.

As for the effectiveness, fentanyl is very fast acting. It should start working within 15 minutes or so. It does build up in your system, but that takes time. You cannot just start out on a high dose of fentanyl as people have died from doing just that. You need to build up & should be on a set dose for at least a week before going up to the next dose -- unless your doctor says you have some special circumstance and can go faster.

Please get some medical attention & when you have a chance let us know you're okay.

peace,
frances
Posted 1/29/2011 4:35 AM (GMT 0)
I , again, appreciate you all commenting. Okay, talked to the dr.'s office today. I am going to stop the patches, the 2 together wasnt working, and I am not going to get the other prescription for Fentanyl filled. Through the weekend I will take my Oxy that I have left over, and see him next week. I have had the patches in my system now for 11 days, and I cant tell ANY difference....I cant wait around to find out if its going to work or not for me...I am in pain, bottom line!

I will let you know what happens at the appointment. Thanks for the concern and asking.
Posted 1/30/2011 12:43 AM (GMT 0)
glad to hear you're okay. sorry the patches didn't work out.

crossing my fingers that they find something else that works!
frances
Posted 2/1/2011 9:45 AM (GMT 0)
Going in on Thursday to talk all this over with the doctor. I will let you all know what they say. I am praying they are not going to switch me around to a different medication. I dont do well with change, it was a hard thing for me to 'go off of the Oxy' to the Fentanyl, in fear that it wouldnt work, which is what happened, even though the Oxy wasnt holding me through...so I suppose they will just keep me on the Oxy, and then we will discuss a pain pump, which we do every time I go in. :-(

They have also talked about Opana? I think that is what its called, has anyone tried that, or found that its worked well? I know nothing about that medication iether. Thanks again for the feedback.
Posted 2/1/2011 3:44 PM (GMT 0)
Opana has worked decently for me in the past. Its really expensive. its oxymorphone.
Posted 2/3/2011 2:21 PM (GMT 0)
Thanks for your post. I go in at 2 today. Will post later to let ya know what they say.....I will read up on Opana before I go in, they have talked about that drug several times, might want to have some knowledge on it.
Thanks again everyone.
Posted 2/3/2011 11:09 PM (GMT 0)
Well, if anyone reads this again...they have put me back on Oxycontin and bumped it up to 80 mg 2 x a day, and 60 mg 1 time a day if needed. along with my breakthrough meds. I go back in on the 18th of february to see how this works. and to talk about the pain pump, once again.
Posted 2/4/2011 12:02 AM (GMT 0)
Mary I hope this will give you some relief. Please keep us posted on how you are coming along with the medication.
Take care.
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