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Butrans Patch (20mcg) vs Fentenyl Patch

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Posted 5/30/2014 5:53 PM (GMT 0)
Hello All,

I am new to this forum so let me give you a quick background on myself. I am a 35 yo female, with 3 kids, daughter 17, daughter 16, and my 13 yo son has cerebral palsy. I have had chronic pain due to endometriosis, scar tissue, and just recently found out I have bulging discs in my back from lifting my son all these years. I have had a complete hysterectomy due to the endometriosis but it still keeps growing back and covering my abdominal wall. I have had over 10 surgeries, approx 5 of them to go in and cut out endometriosis. I have recently started seeing a pain doctor. The more surgeries I have the more pain I am in from scar tissue. I have tried norco, dilaudid, nucynta and am currently on percocet. I have asked my doctor if there is a patch I can try so I am not popping pills all day. I hate swallowing all the pills and feel it has a negative impact on my teenagers that popping pills all day is ok.

My doctor prescribed the Butrans patch. At first, my insurance did not cover it (medicare) and my insurance wanted me to try morphine or fentenyl patch instead. My doctor said he did not want me on the morphine or fentenyl patch because he felt it would sedate me too much and I would not be able to care for my disabled son. The nurse fought with my insurance for 2 weeks and finally got it approved. I have been on it for 2 weeks now and it really hasn't helped with the pain at all and it also seems to be preventing my percocet from working as well as it used too for breakthrough pain.

I have some questions...has anyone tried the fentenyl patch and if so what side affects have you experienced? Is is that sedating where I will be unable to function normally? And how do I tell my pain doc that this medicine he tried so hard to get my insurance to cover isn't working? Its actually causing a lot of skin irritation, headaches, and nausea....7 days is a long time to wear a patch especially when it doesn't work! Those of you who have tried the Burtans patch, have you had any success and have your breakthrough meds worked while wearing the patch?
Posted 5/30/2014 6:16 PM (GMT 0)
Hello Raidergirl & welcome to the forum. I can tell you Fentanyl is a good pain medication, very smooth & consistent. The patches start out at 12.5mcg & then 25mcg, from there on they increase by 25mcg. if you are pretty sensitive to pain meds I would start out on the 12.5. You must avoid hot showers, being out in the heat as the heat can cause it to release more medication that what is needed. In turn by day three you will have very little left on the patch & will be miserable possibly. Patches can be changed every 48 hrs or 72 hrs. Some people have to change them every 48 hrs because by day 3 they are in severe pain. Even with Fentanyl you will still need an oral med for BT pain.

Butrans is usually a hit or miss, I have seen more misses than hits. They have been discussed quite a bit here at the forum. You might want to use our search feature here at the forum & type in Butrans patches & read those posts.

Anyway, just wanted to say hi & welcome aboard.
Posted 5/30/2014 8:47 PM (GMT 0)
There are other moms here that either use the Fentanyl patch or even stronger things like the lolipop and I have not heard them complain that they couldnt function or they couldnt take care of their kids.

I take MS Contin 60mg total in 24hrs spread out in doses during the day and night. I do not have any impairment.

I hope you find a med that works for you whether it be pills or a patch. One thing though is that if your daughters or kids are aware of your surgeries and the pain you suffer from, then they should understand that you do need to take medication. 'Popping pills' is no different that 'wearing a patch'. The way I would look at it, is that its a great opportunity to educate them about that stuff and who knows maybe they would have more empathy of the situation and help out more than what you actually expect. ( hey a mom can wish right ;) )

Regardless I also wanted to welcome you and let you know that this a great place full of wonderful, caring people who give helpful, sound, logical advice and superior support. Someone here will pop on and be able to give you advice.
Posted 5/30/2014 10:45 PM (GMT 0)
Thank you both for you quick and informative response!

I wouldn't say I am sensitive to pain meds. I have been on them for a few years now. I started off on Norco, then went to Dilaudid, and am now on percocet along with the Burtrans patch. Although, since I started the Butrans, my percs don't seem to work nearly as well. I have gone and researched the older posts on Butrans and it was very informative. I know for a fact that I have built up a tolerance to meds. I recently went in for a gastric block and they only lightly sedate you with fentenyl and when they injected me, nothing felt different and I was totally awake for the entire procedure. The doc said the commonly happens in people with a tolerance.

Sophia, Thank you for you input. It is nice to know there are other mothers out there who are in a similar situation as I am. It makes me very hopeful that I can find a pain med that works without impairing my ability to be a good mom. I guess it's something I have on my conscience that needing pain meds makes me less of a mom. My children do know about all my surgeries and I feel guilty that there was a large period of their lives where I was in and out of the hospital so much.

There are more reasons I prefer a patch to pills and mostly being that I suffer from anxiety (I take 5 pills a day for that) and really acid refulx (4 pills a day for that) and IBS (2 pills a day for that) I am just all pilled out you can say....the less pills I have to swallow the better. And the patches are supposed to provide continuous relief with needing pills for BT pain only. I had no idea that the pain lollipops were more potent that the patches.

I am hopeful that the fentenyl patch wouldn't give me that 'out of it' feeling because I have been opiates for some time. I also feel guilty that my doctors nurse fought so hard to get the butrans patch approved and it didn't even work. I feel like by telling them I got no relief will disappoint them.
Posted 5/31/2014 3:48 AM (GMT 0)
Welcome Raidergirl to the CP forum. I actually have used butrans patch for a few months while trying to wean off 13 years of methadone so we could reevaluate my pain and give something else a better chance of working at a much lower dose then going from methadone to whatever we decided on. The conversion methadone to any of the other narcotics is really high.

The butrans did nothing for my pain and the symptoms your describing are actually the one's that occur most often when the base med in the butrans reacts to the base opiate in your b/t med. I also experienced them while taking lortab on butrans. Its the way the meds designed as well as the med in the butrans being a partial opiate antagonist.

DR's prescribing butrans have no idea the effects it can cause in the majority of people.

Fentynal is a strong narcotic but if your started correctly and titrated appropriately to the lowest therapeutic dose it shouldn't have enough sedating effects to hinder your sons care.

It sounds more like your Dr just doesn't want to use it. Note that some people are suddenly having trouble getting their insurance company and even medicare part D to pay for it and its extremely expensive, more so then butrans. I would be sure and check it out first.
Posted 5/31/2014 4:27 AM (GMT 0)
Hi raidergirl and Welcome to HW/CP! But...sorry that you had a reason to seek us out. There are a bunch of knowledgeable, caring people here who have 'been there/done that'. You will definitely find lots of support here.

Imho, with your medical history and the fact that you are opioid-tolerant, the Fentanyl patch would probably work well for you. And from what I've seen/heard, probably a better choice than the Butrans patch. I just haven't heard a lot of good reviews of the Butrans. And as Susie (Straydog) pointed out, the Fentanyl patch starts at 12.5mcg and goes up to 100mcg - so there's quite a bit of room to titrate to your needed dosage. The only concern I have is that you said you've been experiencing a lot of skin irritation with the Butrans - you would likely have the same issue with the Fentanyl patch - but then again, maybe not. I was on Fentanyl many years ago. When I first started using it, I did have some issues with sleepiness - but it wasn't that bad and it didn't last very long. I think it was my third patch and I had no more problem with that. I had a full-time job, took care of two little ones at home, and I was just fine with all of it. In fact, I slept better at night - I was no longer waking up in the middle of the night in pain and having to take a pill. (Oh I miss those days!)

I understand how you feel you about 'disappointing' those who worked so hard to get you the Butrans - but you need to let that go. The fact that they went the 'extra mile' to help you is wonderful but truth is, it's part of their job - to help their patients. Unfortunately, not all go that extra mile, but they should. And since they obviously do care so much for their patients, I don't think they'd want you to suffer because you didn't want to hurt their feelings. Does that make sense? Lol Just be honest and tell them the Butrans is not helping you and you'd like to try the Fentanyl. I wouldn't normally suggest asking for a different medication by name, but since it's already been discussed I see no issue with that. I sort of understand your doctor's concern about the Fentanyl, but then again I don't. 12.5mcg is not a huge amount for someone who is opioid-tolerant and I honestly don't think there would be any more chance of a sedation issue than with the Butrans. I don't know what mcg your Butrans is but depending on the conversion, you may even need a higher starting dose than 12.5mcg.

One more thing, I have A.R.D. (adhesion-related disorder) so I am totally empathetic with what you are going through with your abdominal issues - the word 'pain' doesn't even begin to describe the feeling some days! Well again - Welcome! And I hope you hang around, this really is a great place for support and info.

Oops, almost forgot something and it's kind of important. Oxycodone (Percocet) is contraindicated with Butrans (buprenorphine). Buprenorphine is a partial agonist - it blocks the effects of other opioids. That is why your Percocet is not working anymore.

Have a peaceful day. :-)

Post Edited (Splashdancer) : 5/30/2014 10:50:50 PM (GMT-6)

Posted 6/3/2014 6:38 PM (GMT 0)
Thank you everyone for taking the time to share your opinions and experiences. I have decided to stop the Butrans patch. I started having problems urinating, I had the same issue while taking nucynta, I don't know if the two meds have any common ingredients that could cause this issue but I am not willing to live with that side effect. I will be seeing my doctor this Friday, I am having a B/L Facet L3-S1 and will tell him my decision then when I see him.

With yet another failing medicine, I am losing hope that I will find a medicine that controls my pain successfully. It is truly disappointing. I do feel that my doctor may not want to prescribe anything stronger and I understand his hesitation but I just want to be able to live my life as normal as possible in the least amount of pain possible. Being only 35 and having so many issues with so much pain is just plain out depressing. I know many of you have probably felt the way I am feeling right now. How did you go about finding the right meds for you?
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