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Butrans Patch having little to no effect, any ideas?

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Posted 5/5/2013 1:07 AM (GMT 0)
Hello, I'm new to the boards. I've spent a good deal reading various posts in the past but just recently decided to ask my own questions.


I have been on Narcotic pain killers for roughly 7yrs. I suffer from a severe form of Urethral Stricture disease that developed when I was 6yrs old(I'm now 30). Over the years I have had countless surgeries to correct the stricture, I have even had 2 major surgeries that involved replacing my damaged urethra with new grafted tissue, both of which failed.

A lifetime of surgical procedures have left me with severe nerve damage aswell as a large build-up of scar tissue. In short, everytime I urinate I am treated to an extreme burning sensation that results in hours of discomfort.

about Since 2005, after my 1st failed Urethraplasty(sorry if spelt wrong), I was put on Hydrocodone 7.5's for the pain. I eventually got to a point where I was consuming 60+ pills every 5-7 days to cope with the pain. Obviously this was no way for me to live so my Urologist sent me to a pain management clinic for help. Since then I have been on MS Contin 30mg a day and Hydrocodone 7.5 3x daily. While this helped to control my pain it eventually lead to me becoming incredibly dependant on my medications. I could barely go 12hrs without entering into withdrawals if I didnt take my pills.

After living like that for so long I decided I didnt want to do it anymore, maybe my pain wasn't as bad as it used to be since it had been 6 or more years since I really had to deal with it. Not to mention I felt like I was a slave to my medication. Every moment of the day revolved around taking and thinking about taking my pills.

I decided to check myself into a medical detox facility and get off the pain med's altogether in order to get a better perspective on how my pain actually was. I was in the hospital on Methadone for 3 days to cover my withdrawal and was weened off before sent home.

After leaving the hospital I felt like a million bucks, unfortunately it didnt last long. A day or 2 after coming home my pain from urination gradually returned and I was once again miserable. I went back to my PM Dr. who perscribed me the Butrans 5mcg/hr patches.

After 2 days on the patch I felt no relief whatsoever, I also began to feel like I was going through withdrawals for med's I hadn't even been taking. I contacted my Dr. on-call over the weekend and he recommended applying a 2nd patch, uping my dosage to 10mcg/hr. If I dont receive any releif or continue to get sick then I'm to remove the patch and follow up with him as soon as possible. The Dr. believes that some of the previous narcotics were still present in my system since its only been 7 days since returning from the hospital, and as a result the medication is making me feel a slight withdrawal effect.

Sorry if this has been too drawn out, my question is: "Should I stick it out with the Butrans or take it off and wait to try something else? I've read many posts that say it takes several days for the Butrans to build up in your system before you feel any real relief. Is this true?

Any Help would be amazing, thank you all in advance smilewinkgrin

Posted 5/5/2013 2:12 AM (GMT 0)
If your pain is actually from nerve damage then any narcotic medication is not likely to work except in fairly high doses.

Medications such as Lyrica, Cymbalta, Neurontin and some antidepressants have a lot better history of managing pain due to nerve damage.

about the only exception I know to the narcotic rule in Nucyenta. It is the only FDA approved narcotic for nerve damage pain and it also help with other forms of pain too. Kinda of a kill two birds with one shot type of thing for those it does work for.
Posted 5/5/2013 2:17 PM (GMT 0)
First welcome to the forum as we are always glad to have new members we are sorry to see someone who has been in pain for so long.

I expect the on-call Dr was correct and add to the fact you did your wean on methadone and yes a week out even two there would be enough left to cause you problems.

I certainly understand your mindset when you decided to undertake a total move away from narcotics but had you came here 1st we would have told you many of us had been there and failed miserably.

How did you do with the methadone? Many of use it as our base Med as it has awesome pain relieving qualities and your not so tied to your Med bottle. I take the entire daily dose at onetime and use no b/t meds. I can take another 10mgs a day if I need to but rarely do I.

The butrans is used by some here and I'm sure they will respond but from listening here your correct they have to work with it and dosing to get it right.

Jim's correct in saying that even though the methadone takes care of my non-nerve pain I take lyrica to battle the sciatica.

Keep checking as weekends can be slow in getting responses but they will come.

Good luck
Posted 5/5/2013 2:27 PM (GMT 0)
im on the same patches for cp I started out on 5 mg a few months ago and my dosage is now up too 20mg and still not offering much in the way of pain relief. my dr is applying to the drugs of dependence authority here in south aust to up the dosage to 30 mg . im really hoping we can find a level that starts to kick in and offers some relief soon .

your only on a very low dose I would stick with it and ask your dr about a more suitable pain management for nerve damage there is better out there than what your on now .

good luck with it and I hope you find something soon that works for you cheers dean
Posted 5/5/2013 3:21 PM (GMT 0)
Hi Omagon and welcome.

I recently started using the Butrans patch. Prior to the change, I was taking oxycontin 10mg x2, Ultram ER 300mg plus about 15mg of oxycodone for BT.

I found that 5mcg/hr had no relevant effect. But 10mcg/hr has been modestly more beneficial.

The down side is that the dose isn't anywhere near constant over 7 days. In my experience, the first day is VERY strong, even too strong. Then the next 2-3 days are fine. After that, the patch is less effective and by the 6th day, it doesn't seem to do anything.

While you may still be dealing with withdrawal from your prior meds, keep the above in mind. Despite how it is marketed, I'm not sure it offers a steady dose.

BTW, if you haven't tried Tramadol yet, that too may be something to consider. I found it very effective for about 5 years.
Posted 5/5/2013 8:51 PM (GMT 0)
Butrans is a difficult drug as it can precipitate withdrawl symptoms when you've been on different drugs. 5mg is the lowest dose and definitely the one to start on. I'd be surprised if you'd had any effect. The effect of each patch should be assessed after about 3 days. You can easily safely increase it every week, going 5, 10, 15, 20, 25(maybe skip), 30 and then moving onto transtec (buprenorphine still but higher dose) patches so you can move up rapidly. Other opiates can be mixed with the butrans but may be less effective due to the receptor blocking properties of the butrans.

Tramadol can be mixed with butrans patches and I'd certainly give it a crack. You can take up to 400mg a day assuming no other drugs which mix with it, but NO MORE. It's very dangerous to overdose on tramadol. The good thing about tramadol and butrans is that it has a very mild opiate effect but also acts on two other pathways, meaning only one out of three pathways of pain relief is affected by the butrans patch.

Butrans patches offer a steady dose for about five days but apparently it tends to dwindle for the last couple of days so many patients experience more pain towards the end of the patch.

There are many up sides to butrans patches over other opiates so I'd give them a try if you can stick it.
Posted 5/7/2013 3:15 AM (GMT 0)
Hi,
I understand what you are going through completely. I am 22 years old and have been on pain medicine for 6 years now, through 6 hip surgeries. I started off taking hydrocodone or oxycodone in low amounts, but after each surgery my tolerance got higher and higher, and now it takes ridiculous amounts of medicine to curb my pain. After my most recent surgery, in November, I was placed on OxyContin 20mg and Xanax every 3 hours, plus valium and antidepressants. My day revolved around when I could take my pills. With the help of a pain management doctor, I am now coming up on 48 hours without ANY medications. It was definitely not easy--- it took a lot of time, hard work, and encouragement from my husband and family, but I know it will be worth it in the end. Needless to say, weaning off of the medications has been a horrific process. Withdrawals---restless leg, weakness, lack of energy, headache, chills, shakes, pain. I started by taking one less pill a day, or lowering the dosage until eventually all I used was a 5mcg butrans patch. I used the patch for about 2 1/2 months. It was difficult because after I put the patch on, it would take at least a day to fully kick in, and would start wearing off by day 5. So every week would go from the
high to low, and back again. Now that I am completely off the meds, I worry if my pain will be controllable without it. The doctors say I have lots of scar tissue, some arthritis, and may need more surgery for my hip dysplasia.

Like you, I also desperately want to end this vicious cycle with
narcotics. My doctor said that opiates can actually cause increased pain sensation in long term users, and that it can take up to two weeks, medicine free for your body to reset and start fighting off pain again. I am hoping that is the case.

Whether you end up deciding to use the patch or some other form of pain medication, or quit altogether, be proud of yourself. You have already accomplished so much to get where you are today. I will keep you in my prayers. God bless!
Posted 6/10/2015 6:05 AM (GMT 0)
I'll be 50 tomorrow and on my 8th pain clinic. All was well with my 1st shoulder surgery in 2007. Then another rear end car accident put me under the knife again this Time the doctor put a Stryker pain pump in my joint the soft tissue. When PT was not going well he did a scope and put a second Stryker pain pump in the same place. One year later and several other options I opted for a Hemi. It easy placed to high in the socket. Pain was increasing I was on 7.5 MG or Percaset? I have 25 year's clean in AA and have always taken as little as possible and was ok. Then I moved 500 miles away from my home town twice in three years. Pain management PA's prescribing everything under the sun all of the above. My first 500 mile move I found an excellent Orthopedic Doctor and now had my Reverse Shoulder for three years. I over used it in the move to AZ and dislocated it twice. My new orthopedic doctor said that's not possible but I popped it back in two times in a week. Test after test this year Nerve, Bone, ect., ect, I run daily 3-8 miles keeping my shoulder tight at my side this is by far the best pain killer. Making a long story short I am tapering off 15mg ER Oxytocin 4 times a day with 50mg of oxycodone for brake through. To be honest no ER/Patch has ever made the cut. Now the new Pain Doctor has me on Butrans 10mg and 40mg oxycodone in less than a week I have minimal pain relief I called and told them I was taking 60mg oxycodone and would be out of meds before the two week followup I'm going in tomorrow and the Physician Assist said they are tapering me off oxycodone and will up the butrans to 20mg. I am sick and tired of being sick and tired. All my physical activities as a participant in Football, Baseball, and basketball are over. Running is all I have. My only pain relief is sleeping. Shoulders and backs are the worst. I'm ready for the cold turkey. Any thoughts on another WONDER patch??? Someone has the answer I keep going to God but nothing has been revealed as of yet. I'm an Engineer but cannot solve this Mathematical Equation? Any Mathematicians? God Loving Friends?
Posted 6/10/2015 5:04 PM (GMT 0)
Hello WeldDoctor & welcome to the forum. Unfortunately, you have posted on an older thread that has not had any activity in a while. We do ask all new members to make a separate intro post so that all members will see it. Posting on an older thread like this one, not many will see your post here. We do like to keep the older threads off of the main page.

If possible please copy & paste what you have written above it would make a perfect intro post. I will lock this thread & look for your post as I do have some ideas for you. Thanks,
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