Butrans patch vs. Duragesic patch

I know this has been posted before, but it's been years so I'm brining it up again in search of new answers. I have been on the butrans patch for 4 years. It doesn't relieve all my pain, but it helps, and I don't like taking several pills a day. I have had a problem in the past with overusing them. Several herniated discs at l1,2 and 3, I've done physical therapy, yoga, I work out 4-5/week, turmeric, multiple injections, chiropractic care, you name it I've tried it. Surgery is a 30/70 chance for me and I'm fairly young (mid 30's). The butrans patch was a godsend- because it took away just enough of my pain that I could function, gave me energy, and most of all I didn't have to mess with any pills. I decided last year that because of the cost ($480-600/box, one month supply on my high deductible plan), that butrans was no longer cost affordable for me. My doctor switched me to cymbalta 30mg/day, klonopin as needed, up to 3 times a day, and tramadol twice a day. The first few weeks went ok, I felt kinda crummy but the pills helped. But I work a lot, I have 5 kids, and I exercise a lot. I overused them, as usual. I'd like to go back to the patch. I wore the 10mcg patch for 5 days instead of 7, then changed it. Been working fine and steadily for 4 years with no need to up the dosage. So I'm reading about the duragesic (Fentanyl) patch. From my understanding it is much stronger but I was thinking I could try a low dose. This is purely because of cost. With Butrans being around $500/month out of pocket and the fentanyl patch is around $50. I'd like opinions on switching from butrans to fentanyl, in patch form only. The only drawbacks from the butrans have been a- cost, obviously, b- itchiness and rash at site, c- they seem to fall off quickly, especially during the summer when it's hot, and d- it's hard to find a spot to put them where they aren't visible, especially during summer. I feel terrible with the combo I'm on now and can hardly get out of bed, husband says just go back to what worked. Any help?? I'd like to talk to my doctor about this ASAP.

I have to think that a physician is NOT going to prescribe the fentanyl transdermal patch vs. your prior butran's patch due to financial considerations - the fentanyl patch being comparatively less expensive.

The current climate on narcotic/opiate prescribing is brutally restrictive.

The fentanyl patch is a potent narcotic. It is what I consider to be The Big Guns. I do not see that your situation is yet warranting for fentanyl.

I am on fentanyl. But my use of fentanyl came to be only when the status of the bone integrity of hips was truly shocking to see on a radio-isotope MRI study and it came only when my functional capabilities were genuinely close to bed bound/wheelchair bound.

I know the costs of purchasing medical insurance on the market exchange are high, especially for those who do not receive a federal subsidy. I am in this situation, myself. The additional cost of a Gold plan, over a lower price point silver plan with less comprehensive benefits, was $175 per month. For me, paying the additional $175 for the Gold plan was a no-brainer. I am a heavy user of health care services - everything from monthly ostomy pouching supplies, to prescription medications, to outpatient infusions, to PCP and specialist appointments.

The point being . . . I use more than the additional $175 in baseline health services each month. The Gold plan, although more expensive per month, is more cost effective for me in the long run than a lower priced plan with less comprehensive benefits.

If you are on a high deductible plan with lower monthly premium, you may save more in the long-run with a lower deductible plan with a higher monthly premium - if you are a moderate to high consumer of health care and health related services.

Back to your question of Butran's vs. Fentanyl patch, I think that you are over-reaching in posing this question to your physician from a cost saving perspective. Also, fentanyl is a potent narcotic. Its use must be taken with a high level of respect and responsibility.

Taking narcotics is not without its own downstream sequel. Opiate induced secondary adrenal insufficiency, for one (I have Addison's disease, which is primary adrenal insufficiency). Opiate induced constipation is another real and troubling side-effect of the stronger narcotics. Long-term opiate use also potentially increases one's overall pain experience by increasing inflammatory markers in the body (opiate induced inflammation).

I am on Fentanyl + dilaudid as I am on Palliative Care (a medical model focusing on care and comfort for individuals with serious, life-threatening chronic conditions). I am 56 years of age but with an internal body that is ailing beyond these 56 years. I do not think that I would be afforded a fentanyl + dilaudid narcotic cocktail if I were outside of the Palliative Care arena.

I am sorry that I have to be so dissuading in my opinion. I know that all that any of us wants (for the Holidays, for our birthday, for Mother's Day, for everyday) is a dose of pain relief.
- Karen -

When someone has chronci severe pain, they have to adjust their life style. You may need to cut back on your exercise or change the exercies you do. How old are your children ? It sounds like you may be overdoing it. Have you discussed this with your doctors ?

If the OP is under the care of a pain mgt dr, using Kratom could cause her to be fired by her dr & kicked to the curb. Once a patient gets fired by a PM dr it is very difficult to get another PM dr to take over the care.

Getting in a hot tub at 103 degrees can be dangerous to a person when you have no idea if they have underlying health issues.

I realize you are trying to help but please be careful with your recommendations.

I would agree that moving toward the Fentanyl patch requires thought and consideration as to the long-term effects.

I am in palliative care. Care and comfort.

I have been advised that I will never be able to titrate off of narcotics owing to the underlying nature of the avascular necrosis of my hips. But that is a concerning prospect in this environment of restrictive access to opiate medications. I cringe at the prospect that at some juncture in time some aspect of government oversight may limit my ability to have a basis of comfort even on palliative care.

I also have to be ever watchful not to run low on my prescription. Withdrawl symptoms are agonizing. I've been in withdrawal and it resulted in a hospital stay. It was that severe.

The decision of the fentanyl duragesic patch is a serious consideration, not to be taken lightheartedly.
- Karen -

Fentanyl is such a strong opioid & I have read many articles of Butrans being used with it to wean off of Fentanyl with the least amount of withdrawals. Going off with nothing is no way to go.

Vickie had very good results using Butrans to wean off of Methadone. She had a good knowledgeable dr that knew enough about Methadone to know that it is not as simple as lowering the dose. Methadone is the hardest one to get away from.