Is it a time for a change from Butrans ?

Sorry for the long post, but here goes:

After three months on 20 mcg of Butrans, I have found that I never make it seven days on a patch. The last one or two days of the seven day cycle, I find my pain levels up (to non-functional, cannot stand long, trouble walking) and it isn't covered by my 10 mg oxy bt meds. Heck, I had one patch that died in only three days and I had full blown withdrawal.

I had asked my pm doc about prescribing some extra patches so I could change when I needed to. His response didn't make sense at the time. He asked me to call the Butrans consumer help line and discuss the problem with them and report back to him what they said. I thought the request was a bit strange but I've only been seeing him since July so I don't know him well enough to understand the reason for his request.

Well, that phone call was an education. Spoke to a Purdue pharmacist and the take-away is that the 20 mcg patch is not enough medication to cover my pain level. That is what running out early every week really means. She said to discuss with my doc the only two options available since I'm already at the max dose. 1) is to increase my ir meds to cover me during the last few days, or 2) change to a different drug altogether.

I then asked "why can't I just change the patch when needed". The reply was that the clinical trials were only done on the 7 day cycle and changing early would increase drug serum levels and it had not been studied. The concern in higher levels is respiratory depression and heart q-t interval issues so it is a definite no-no to change early.

I reported that back to my doc on my visit this past week. He response was that we can do either, he was okay with either fix. If I change my long acting drug, he would put me on the 25 mcg fentanyl patch. We didn't discuss it much further than that but he said whenever I want to change the monthly routine, let him know. Easy, right?

So, I've done some research and I'm unsure what to do. I don't have much in the way of side effects from the Butrans and my pain relief about half of the days in a week is decent. But, I think I need too many bt meds (I need one every day in the morning to walk without a limp due to the pain levels).

So, I'm hoping for some opinions from the experienced cp'ers out there. Should I make the jump to fentanyl? Or, should I stick it out with the Butrans?

Thanks for reading!