Quick question about pain patches

I can't take many oral narcotics because they make me nauseous or vomit and they lower my bp (my bp is normally low anyway). IV pain meds I don't have much of an issue with other than it still lowers my bp a bit but no vomiting or nausea. I am going in for a bunionectomy on the 23rd and I have been afraid of what sort of pain meds they are going to prescribe. So my question is: If you have an issue with narcotic pain meds ingested orally, do pain patches do the same or are they better?

No, I'm not seeing a PM doc at the moment. I was seeing one a few years ago but he sort of gave up on me. I have bad reactions to pain meds and I don't think he knew what to do with me. I'm not actually allergic to codeine...more of a major intolerance to any codeine derivative. The main problem I have with them is that they lower my bp - sometimes dangerously low but they also make me get that tunnel vision, like if I'm going to pass out (perhaps from the lowered bp) and I end up vomiting.

The only pain meds I have tried are Vicodin, Tramadol, Tylonel #3 and Darvocet (when it was on the market) - these meds make me experience what I stated above. If I end up in the ER, they give me IV morphine but I have no issue with this. I'm just wondering if perhaps oral causes me more issues than IV or even the patch because of my gut issues (stomach ulcer, Ulcerative colitis, Diverticular Disease and IBS). I pretty much try to stay away from narcotics (and my GI wants to me to stay way from them as well) because they are contradictory to IBD - they can cause severe constipation in IBD'ers that it can lead to a deadly condition called Toxic Megacolon.

But the podiatrist is putting me in a twilight sleep, but numbing my foot. I haven't really discussed pain management with him but if I can't get the patch, I was going to ask him for an anti-nausea med just in case I have an issue with whatever he gives me.

Hi Sherry,

Good question! I'm not a doc, but am in veterinary school & majored in biochemistry, so I understand the pharmacology of these meds pretty well, & I think I can be of some help to you:

Unfortunately, potential side effects of any opioids include nausea, but the medication in the patches is absorbed through an entirely different mechanism than the same medication in pill form, and completely bypasses the stomach/gut, so they have been known to be gentler on the GI tract (although due to the receptors that bind opioid medications, they will still cause slowing of the GI flow/constipation, regardless of the mechanism of absorption).

The patches deliver the medication from your skin directly into your bloodstream, whereas medication in pill form must first be broken down and absorbed through the lining of the stomach or intestine before it can reach the bloodstream. In either case, once the medication reaches the bloodstream, it is then metabolized by the liver, and the resulting metabolites are delivered via the bloodstream to their site of action (in the case of opioids, the mu-opioid receptors in the brain & the intestines).

As for which will work best for you -- definitely something to speak to your doc about, but with your GI issues, I'm thinking that the patches may be the way to go if you need to be on regular pain control. Honestly, it may end up coming down to trial and error. I know that docs are technically not supposed to prescribe fentanyl patches (don't know about butrans) to opioid naive patients (patients who were not previously on round-the-clock oral pain control), although we do in the veterinary world -- obviously we just start our patients on a very low dose. Anyways, I think that this would most definitely be worth talking to your doc about. You may want to talk to both the GI & the surgeon/anesthesiologist (a few days or more prior to surgery is probably best, if possible, especially since when you first start out on a patch, it can take up to 72 hrs to get the meds into your system & notice any benefit, so if they want you to use a patch for post-op pain control, they may actually want you to get started on them before the surgery). Good luck! Let us know what happens! I'm curious to hear what works best for you!

Skeye

Post Edited (skeye) : 1/9/2013 10:09:14 PM (GMT-7)

Welcome to the forums! I am currently on pain patches along with percocet 5mg for BT pain and the only thing I can tell you is that if you get nausea from oral pain meds then you will probably get the same result from the patches. This also goes the same for your BP. Fentanyl patches are very strong and from my experience they can definitely lower your BP even if you are opioid tolerant. I had one experience a couple of months ago when I put my new patch on for the new month and got really sick from the patch, to the point where I was borderline OD'ing from it. I don't know exactly why it happened as I have been using them for a while now but I have only had this problem once and only from the patch.

I would highly recommend talking to your doctor about the pros/cons of the patch. I was lucky enough (or unlucky depending on how you look at it) to be in the hospital at the time when my doctor wanted me to try the patch instead of oral meds and I was under 24/7 care and watch while I was first trying the patch. This was good because I was worried about the side effects and if something happened that was bad at least I was at the hospital already.

I think the patches work great for the pain. and along with the SA meds for BT pain they work even better. Good luck.