Tegaderm over Butrans

I use tegaderm over my weekly patch. I have a process of application (well actually it's applied by someone for me because it's put on my back where my skin tolerates it best). The area is sprayed with anti itch spray using a guide I made of the size of patch itself and allow that to dry, apply the patch itself and press as instructed, wipe around the patch with alcohol to remove any excess spray that may have strayed outside of the guide (I figure the spray prevents the tegaderm from adhering properly) then apply the tegaderm. Usually this lasts all week without fail but occasionally the edges peel up no matter how careful I am about putting clothes on. Then I have to put smaller pieces of tegaderm or tape to prevent it from peeling all the way off and end up with tape all around the patch (and feels like all over my back). Does anyone else have this issue? Is it something I am doing wrong? I'm new to this forum and ever posting to any online site (besides FB) but I think I'm supposed to say my diagnoses based on what I have read.
Rheumatoid Arthritis, migraines (patch is for the RA) starting to have back pain, neck issues from car accident last year

I am on the 20. I think I did 1 or 2 weeks without a tegaderm and quickly found out how miserable it is to get wet. I had a lot if itching and pain not to mention just the odd feeling of something feeling wet on your body you can't get dry. The tegaderm keeps it dry as long as it doesn't peel, but I feel like I'm constantly concerned about it peeling and either revealing the patch therefore risking it getting wet or just removing it altogether since it's so sticky. This time we tried (my mom helps thankfully) to put it a little lower to allow my skin to rest and heal and this spot is not doing well. Within one night it's peeled in 2 places. Usually I put it along the bra line for multiple reasons - keep it place using the bra (although have to be careful putting that on), the bra covers it for wearing tanks, the skin is less sensitive and doesn't seem to move as much in that area. I have never tried my arm. Are you ever tempted with it on your arm to itch it? I feel like mine is out of reach so I can't itch it and ruin edges. :) When you say back of shoulder blade do you mean directly? I've never put mine that high on my back...may be worth a try. Thanks. My doctor said my location was okay and at first suggested my arm, but then said my arms may be too thin since I am on the 20. Not sure if yours told you this, but mine said he doesn't like it on the hip (I asked- figured I could reach and it's a new site then again putting pants on and off may be wearing). Thank you for your reply. I feel more at ease that I'm not the only one. I have been searching this topic awhile with no results and I'm still kinda new to this patch so I was starting to think I was doing something wrong.

Yes, I meant the back of the shoulder and yes, you can reach it to scratch it if you dare.

I spoke with the help line at Purdue several times and I was told that the patch should never be applied below the heart. The reason is one of skin temperature and you do not want to risk overheating the patch as it will dump the entire weeks worth of drug quite rapidly. I had this happen once, due to exercising in extremely hot weather and it was quite unpleasant - severe headache and nausea. The next day, there was no pain relief whatsoever and I had to apply a new patch.

Ultimately, I was taken off Butrans due to the patch always running out early at day four or five. I learned from Purdue that this was indication that the dose was too low for my pain level. The 20 ug was the highest dose available and it had only been studied with a seven day replacement schedule which left no options other than to switch to a different drug. It was a shame since it controlled my pain quite well with only mild side effects.

I have heard of people with a 20 and a 10 patch used together. But, this would be considered off label use and certainly puts the doc at risk should anything happen to the patient.

What the Purdue pharmacist told me was that going past 20 ug or changing more frequently than 7 days will result in higher serum levels of the drug which will affect the heart qt intervals which ultimately can result in death.

After trying Exalgo and Nucynta with poor to horrible results, I was placed on a combo of oxycontin and oxycodone for breakthrough which I have been quite stable on for about eight months so far.

Thank you both for your quick and informative input. I'm glad to hear your pain is managed Litespeed97.