Tramadol vs Fenanyl

In 1996 I was involved in a high speed collision with a semi-trailer, the impact was hard enough to break my seatbelt and I was thrown out through the closed drivers window and into the truck. This resulted in a broken cervical and thoracic spine a broken head and a brain injury, and has left me with chronic neurogenic and neuropathic pain. I have tried strong opiates such as Endone and Oxycodone which while working well to reduce the pain cause severe itching and copious vomiting, anticonvulsants such as Tegretol, Epilim and Sumatriptan all of which made me desperately ill, and have had very good results with 200mg of slow release Tramadol twice daily for many years. I attend a large practice that has combined services, pathology, nursing etc and my previous GP has retired and the new one I have "inherited" doesn't believe, despite evidence to the contrary, that Tramadol works for nerve pain even though it is an SNRI and SSRI, and wants to change me to Fentanyl. What I would like to know is if anyone else, perhaps with a similar condition, can tell me if Fentanyl might be more efficacious.
Regards,
Mick

Hi Mick, welcome to the board. Under the circumstances (chronic pain which is never a treat for anyone) you have come to the best place I've found o line for support. I don't have much advice on your question, but I'm sure someone will be along later tonight or tomorrow (when everyone wakes up) that can be of better assistance. I sis Google search and I found a calculator but I'm not exactly sure I know what I'm doing so I'll post the webpage here:

http://agencymeddirectors.wa.gov

I hope you get the answers you're looking for but I will say, it seems like going from Tramadol to Fentanyl is quite a jump! I hope you find relief soon. Welcome again!

Linds

Hey Mick and welcome to CP. Sorry to see you've had such a time of things but joining HW can offer you some great support and understanding ppl who know what lliving with CP is about.

I must say I'm a bit confused as to why any Dr would want to go from tramadol, that's working, to fentenyl? Thats like comparing a semi to a pick-up. Your not on even a extremely high dose of tramadol at that.

Fentenyl is a great med for severe chronic uncontrollable pain. Its a patch changed every 2-3 days so you get what's ordered whether you need it or not. Its a much stronger med so if you had problems with the other class II meds you'll likely have the same issues.

I also want to add that over years of using these meds we tend to build tolerance issues and the longer you can put off starting them the better.

If I were still having some pain issues on the tram I would first look into upping that but let me add we are never without some pain no matter the meds and its important to find alternative modalities to help our meds.

I've been on tramadol for a few years, 50mg 3 times a day for fibromyalgia, and never needed to raise the dose. After surgery (a whole bunch of them) I usually get something stronger for a while but go back to my tramadol and never have withdrawal.

I've had Fentanyl during surgery and for procedures. It doesn't help me with pain and always leaves me vomiting for at least 8 hours. Zofran helps but doesn't last as long as the nausea.

Star Lover - If you have surgery scheduled, definitely call your pain doc to get approval for a narcotic which you will need. She can kick you out if you don't get approval! I've had knee surgery too. Get a walker to go home with you. Sometimes you can find one in a thrift store, or maybe there's a loan program. You won't need it long. Crutches don't do the job as well.

Firstly, thank you to everyone for taking the time to respond to my question. Part of the problem with pain management here in Australia is the Victorian era attitudes in a lot of the medical community, I have had several GPs tell me that in their opinion there is no such thing as chronic pain and that everyone claiming to suffer from the condition is just a drug addict exhibiting drug seeking behaviour. Here is an example of the way things work here, as opposed to Europe where you have been able to buy Tramadol over the counter for 20 yrs and the max dose is 1600 mg daily, I had to be referred by a GP to a Pain Management Specialist, the specialist had to give me an approval certification which I then had to take back to my GP, who then has to ring the government authority centre to be given an approval number to be able to prescribe Tramadol with repeats at a max dose of 400 mg daily, and if you have breakthrough pain and exceed your dosage and come up a day short the next time the GP rings for permission to re-prescribe they are likely to refuse.
To make it all the more ridiculous and frustrating, this current GP says she is worried that I am dependent and abusing the Tramadol, which clinical studies have shown has no recreational potential, and now wants to give me Fentanyl (known colloquially in Australia as Hillbilly Heroin because it is so easily abused) even though there is an ongoing concern in Australia about the number of accidental overdose deaths. To make things just a little more frustrating, because every visit is now added to a computerised database if I go to see another GP with the hope of finding someone a little more enlightened, I get listed as a "doctor shopper".
Having lived with this condition for 17 yrs now and done a great deal of research and trial and error it is also very frustrating to be dependent on the whims of a GP half my age who knows less about pain management than I do, and needs to resort to the calculator on her smartphone to work out what 6 times 15 comes to because she didn't even believe me when I told her how long my scripts are supposed to last.

http://en.m.wikipedia.org/wiki/Tramadol

Here is the wikipedia page on Tramadal... There are a number of references listed at the bottom and I typically start there when doing my research. As you mentioned the daily recommended dose is 400mg not to exceed 600mg. The risk for seizures increases at 700 mg. Taking 1600 is four times the daily recommended amount. So please be careful if you take that high of a dose.

And since this website is not about abusing drugs, I won't post a link but I googled tramadol abuse and was astonished at the number of sites that came up. This drug can be used recreationally and has a high potential for abuse.

Well Gama its about the same here in the states. We dont have a government center per se but we have the DEA and FDA controlling the amount and types of meds available to us.

One specific difference I see is here you have to add in the pharmacist who can also control whether you get your meds and the Drs here are battling to remove that kind of authority that they've gained in recent years out of their hands.

Linds tramadol actually is now a schedule medication as of this past year. Its potential for abuse actually contributed to that reclassification.

Fentenyl use to be referred to as Drs heroin here in the medical profession as it was a drug obtained only in a hospital setting and contributed to a number of overdoses and physicians arrests.

They're were articles about people coming out of surgical sleep and recalling horrible pain and patients insisting they awoke somewhat during the actual surgery, come to find out the anesthesiologist was withholding small amounts off their fentenyl doses for his private use. Thank goodness there are now steps and methods to prevent such things.

My point is fentenyl has long been a med of abuse and still is today. These folks find ways to ingest this med even in patch form, by the way, I'm not discussing those ways due to an open forum where children of all ages can Google and read.

Its a lower class schedule due to its degree of abuse over say tramadol. The abuse potential for tramadol occurs when they take it in much higher doses then recommended.

If we run short or take more than ordered you better believe we're going to get booted from the Drs care!

Once that happens finding another Dr can be challenging.

What I find most interesting is why some parts of the world has to implement these kinds of regulations and laws due to high incidents of drug abuse, Dr shopping, and drug associated deaths while other parts of the Country have no such problems therefore have no need for tight control over these types of meds.

If every Country could figure out the differences and fix the problem that could change the way the system works, if only that were possible?

We certainly understand Drs without the proper knowledge of these meds and who have no clear understanding of chronic pain. We still get more who say its not a dx and believe we're drug seeking or weak.

I have no good advice to offer and although the US is similar when it comes to many things its not the same as having a clear working knowledge of how the wheels turn in Australia.

I would arm myself with as much knowledge as possible, whether a new younger Dr still full of themselves is going to listen is a long shot!

Good luck and the best thing I can think of here is the old saying of "why fix something not broken "?

I hate the word Fentanyl as many of us has either tried it or heard/read horror stories. My warning would be not to sweat with this patch on as it'll dump the entire dose. Many of us have almost OD'd on these patches. I feel they are inconsistent and I won't use them. Of course when they work, they work fabulously. I remember feeling invincible with the patches. However after the sweating incident I threw them all away. Just my two cents anyway.

Further to my above comments, I don't want to leave the impression that all doctors from these areas are somehow lacking in skills, by far the best doctor I have dealt with was a gentleman from Jordan and the pre-eminent OB-GYN specialist in this part of the state who enjoys wide renown is from Sri Lanka. It just seems that the younger trainees we are now getting are sent out with too little supervision too early.