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[QUOTE=MESnap;5003425]I think it was withdrawal symptoms that had me so sick.

[COLOR="Purple"]Yes, it was withdrawals that was making you sick, the patch has to be completely adhesed to your skin for it to work like it's designed to.[/COLOR]

Question 1: Has anyone else had a problem like this? I keep reading that others use the nasal sprays with their patches so it obviously works for some people. It seemed to me like the patch got coated by the spray and it acted like a barrier. I'm afraid to try it again because I can't afford to waste another patch.

[COLOR="purple"]Either your Dr. will have to come up with another solution, or you can try another patch, I"ve used Watson, Sandoz, and Duragesic. You can also use Tegaderms over the patches to help them stick, some manufacturers give these out free to patch patients, if not you can get them at the pharmacy or online in bulk cheap.[/COLOR]

Question 2: I've read the mylan patches are a bit infamous regarding their sticking abilities. (I like them bc I can cut them creating two smaller patches that are more easily fitted to my arms.) If I wanted to try the gel type patch (that I know cannot be cut), could I just ask the pharmacist to supply that type in the future?

[COLOR="purple"]You can request that your Pharmacist order a different brand patch, they usually have a couple of choices, he may not be able to get the specific one you want.[/COLOR]

Question 3: Sometimes the fentanyl seems to REALLY help with the pain - actually break through the nerve pain [to yet another pain underneath, but a small miracle] which never happened for me before. Other times, however, I'm as miserable as I was before switching, and increasing, medications. (The switch ultimately included an increase in opiod quantity, btw. An equal switch was to 50 mcg of fentanyl - which began helping in that I stopped crying in my sleep.) Does anyone else have a topsy-turvy problem with pain aid from what should be a really steady relief?

[COLOR="purple"]Even Fent being a continuous BPL med can still not be able to handle pain flares at times. It's important to always change your patch at the same time. Alwasy wear your patch above your breastline. Stay out of hot baths, sauna's, jacuzzi's, not too long in a hot shower, stay out of the heat outdoors for very long. Any of these conditions can and do cause your body heat to rise which causes the patch to release the medication unevenly which will effect how long it lasts.[/COLOR]

Question 4: Has anyone else noticed a change in your reaction to other narcotic medications after switching to fentanyl? I've had both percocet and norco for breakthrough pain; neither of them help at all now. Dilaudid (an emergency BT med) used to make me feel horrid as it wore off (just irritable and aggravated so easily) prior to the switch, and I don't notice that at all now. Sometimes it helps, sometimes it doesn't. It's like the fentanyl is so strong, other narcotics are a non factor. Even though the fentanyl is a godsend, it scares me that my reaction to these other medications has changed so much. And also, I have little to help with BT pain, which is a problem re: question 3.

[COLOR="purple"]You hit the nail on the head...Fentayl is pretty much the strongest "use at home" pain med. Once your on it there's isn't anything stronger to go up to, so the weaker meds aren't going to do much for your pain. That's the risk patients take when they chose to go to a Fent patch.[/COLOR]

Thanks to any who feel like taking the time to respond to my ramblings and questions.

[Medical situation re: pain] I have an above knee amputation with chronic residual limb pain. The pain includes a neuroma that has recently become very aggravated. I also have SI joint pain, an L5-S1 and L4-L5 disc herniation on the right side (the same side as the amputation) and pain all along the nerve going down to my stump. In the past 6 months the neuroma has taken over my life. I take neurontin and several other medications.[/QUOTE]

[COLOR="purple"]I hope things stabilize for you and this works out. As you know Pain Management is not about relieving pain, but making it manageable so that we can live our lilves as we endure it. The Fent patches can work very well but there are a lot of variables to consider. If they don't seem to be lasting long enough or working well enough you can go to a 48 hr. dosing as opposed to the 72 hr., might be something to discuss with your Dr. on the next visit. Also when on Fent, most switch to a more powerful BT med like pure Oxycodone, the weaker ones are like taking baby aspirin at this point. Welcome to the Boards, hope we can be of some use and support to you. [/COLOR]

Kat
Thanks for the advice on longer drying time for Flonase--I too thought once it didn't feel wet it was "dry". I'm on 100+50+50 every two days. Once I got up to this, I started doing an alternating schedule, changing a 100 on alternating days from changing two 50s. I'll mention it to my doctor, but as its not a change in dose or frequency (I started it by keeping a patch on for 3 days so I didn't even use an extra), I don't see a problem.

They weren't lasting 48 hours so I'm hoping it helps. Still waiting for the increase from 150 to 200 to kick in. Seems to be 3-4 days for me. When changing my 100 yesterday I decided not to risk the Flonase again until I got further advice (I couldn't tell if it affected absorption on my 50s as I'm doing pretty bad lately, but I wouldn't be surprised).

>>Anyone else absorb this med so fast they don't even last 48 hours? I get increased pain and even some withdrawal at 40-44 hours, and I change them at night so this is during the evening, where I usually have the least pain.

For me the welts seem to have a lot to do with location. I seem to have figured out that although the leg is really good (doesn't bug me so much, and lots of area for rotating locations & for multiple patches), too high on my leg isn't good--there is too much bend/movement. I got the worst welts on the hip and very top of the leg. Also, with me wearing multiple patches, overlapping the edges of the Tegaderm covers all on one leg seems to be better. That way I only get welts on an edge on its own. With my rotation I will have to cut away the stuck together Tegaderms though to only replace half the dose every day.

I sit a lot (like most folks) and I've also realized that even with covers, many spots of the skin will have the patch crinkle up when you are sitting...that has got to effect it some as you aren't getting that full contact.

I agree with those who have said patches for ambulatory patients can be tough. Thankfully I've been no where near OD though...I think I'm still having some withdrawal in fact. I haven't gone out in high heat (mild summer here), but I haven't noticed any problems with hot showers or using covers. Something to definitely keep an eye on.

ttomassini-So will you now run out very early if you can't get your doctor to do something? Sounds like you've used up quite a few patches these last couple days. I just haven't had that option, but really hope I can get some extras going forward. It can be a bad idea to increase your dose on your own, even in situations like yours (assuming your doctor didn't give you this option to go from 50 to 62.5). The conversion chart I looked at said a 12 mcg/hr patch is like 15-30 mg of oxycodone a day, so I'd be surprised if adding the extra small patch helped much...plus patch dose increases often take 12-72+ hours to kick in.

At my current dose & schedule if I was on two 100s every two days (instead of 100+50+50) it would be 30 a month. Getting 30 patches in 28 days would be a good start for me, and seems pretty reasonable. I hate having no extras, especially as these as so easy to mess up. Usually I would have waited longer to switch to the patch to use up my bit of extra meds so then I'd have the extras of the new med, but I only do full med changes on weekends, and I couldn't wait until the next weekend.

>>Does anyone have some data on how much of a difference various locations make?

My best spots seem to be lower abdomen and the side of my upper leg for comfort & less welts. I wonder if I get better patch contact on the leg, or if that is outweighed by it being even further from my heart. My doctor said it worked best on the chest, but I could use it any number of places such as everywhere the manufacturer listed, plus the abdomen and upper leg.

She didn't elaborate on how much of a difference it makes, nor can I find anything on that or why its best on the chest (per some info...other info says it doesn't make a difference, and neither does the amount of fat). I'm guessing there is a different type of tissue there that stores/releases the med better. Some claim the patches don't work on frail/skinny people as the med needs the fat. I don't have that issue though. I've even heard claims that placement on the abdomen will increase the release rate of the med. Can't find reliable data though (this is mostly from forum discussions).

Curious how much of a difference this is. This could help me justify to myself that a dose increase is ok. Per the equivalency chart, I am well above what I was on previously, yet with less relief. I know charts are just a guide, but I'm curious if I'm not getting all the medicine or if this medication just isn't a good choice. I get the best bang for my buck on methadone, but it doesn't last long enough so I wake up in too much pain and play catch up all day. I just may have to go back to it though.

When I started at this doctor I chose to try switching meds before just increasing the methadone dose as I was frustrated after being on it for years without my doctor allowing any changes. Also wondering if brand will make a difference for me. I have Watson and Apotex right now, but am trying to get my pharmacy to order Sandoz.

I asked them to get me 6 boxes of 100s next week since they don't seem to stock 100s and even the other local pharmacies don't keep that amount in stock. They said they could order, but they didn't guarantee a brand at the time (I said if they couldn't get Sandoz I'd take anything but Watson...they are driving me nuts due to the crinkly noise and you feel the more on your skin). Thanks! Best wishes.
MESnap-My 100s are Watson brand and my 50s are Apotex. I don't have any means for comparison as I was only on 25s in addition to my other meds before. Trying to get Sandoz next week, but we'll see. I'm happy to be able to have my script filled on the same day, as it seems like 100s are tough to find?

I unfortunately only get 15 doses of bt meds every 4 weeks. Lately I've been taking a dose a day, sometimes two. Almost more for the withdrawal than the pain. I've been quite stuck--seen my doctor three times in four weeks, but they will only increase doses so fast. I've also tried methadone and morphine for long acting. I've been on pain meds for 6 years, about 3 of which have been LA. I was on methadone until recently. I was seeing a doctor who wasn't comfortable doing any med increases or changes, so I finally found a pain doctor.

Haven't tried Oxycontin since I think my oxycodone tolerance is too high and haven't heard much good about the new formula (I take 60mg for bt and isn't hasn't been helping as much lately). Haven't tried LA Opana since I think my tolerance is too high (I was taking 60mg at a time for bt lol...later realized that is ridiculous high). Haven't tried Exalgo since IR Dilaudid made me nauseous (hoping to retry that though).

So, I've been on every med but not in every form. So far, I really do much better on methadone and am expecting to need to go back to it. More pain relief per equivalent dose and less side effects. Only issue is it lasts me about 5 hours. So, I would wake up in a lot of pain and it took most of the day for my doses to catch up. Maybe a higher dose would help though (my old doctor wouldn't). I long ago gave up on going to the ER since the trip/wait made my pain even worse, and they couldn't do much of anything (or if it didn't it wouldn't last long). Plus, the expense. If I get that bad and none of the pills are helping (I have a few different things to try in addition to the bt meds), I'll just take something to help me sleep. Its a good idea to have a rescue pain med to take if the typical dose doesn't work, but not too many folks seem to get those.

ttomassini-I agree you don't want to be taking bt meds around the clock...then they are just part of your regime and won't help when you need them. You either need a higher long acting dose, or you are trying to maintain an unsustainable pain level. 50% relief is apparently a good goal. If you and your doctor were trying to take away much more than that, you will be chasing the original relief and be building very fast tolerance.

I'm shocked your doctor was giving you more bt meds than your LA dose for the oxycontin. Even now they are about equivalent (a 50 mcg/hr patch is about 68-112mg of oxycodone), and 5-6 of the 15mg is 75-90mg. 2-3 times a day for bt meds would be great for me. I think that is average, but high average? Best wishes.
[QUOTE=tortoisegirl;5031533]I too am completely fed up. I'm still in withdrawal. Its worse than what I had before going up to 200, so its either the flonase I used under half of my dose for two days last week, or I've been taking too much oxycodone for bt (I usually only take a few doses a week, but I've been averaging one a day lately). I'm sure it gets much worse than this, but I can barely function, even allowing myself to take the oxycodone once a day. Anxiety, shaking, chills, nausea, stomach issues, emotional wreck, etc.

Until today I was planning to ask to try the patch for a couple more weeks with a dose increase, but now, I'm ready to go back on the methadone, especially considering we have a big vacation in a month. My appointment is tomorrow at least.

I was only on 70mg/day of methadone before...apparently 200 on the patches is more like 210-268 mg of methadone? I'm not even doing as well as I was on the 70mg of methadone, but I was only taking it twice a day, not four times a day like I'd need. Even considering that, seems like that is the better med for me.

I'm pretty sure now that my skin irritation from these is from my skin literally tearing at the edges since the covers are so big, and my skin doesn't have the space. My skin is crazy sensitive...I often scratch wrong and bleed. At least its not allergic? That would be easier to deal with however.

I now agree that folks either love or hate these things. If I was getting good relief I think I could put up with it, but I just can't hold in that long! I can say though that I haven't had a single issue with any part of it peeling up on the three brands I've tried, since I've used a Tegaderm or similar cover/s on every patch. On the two I missed a small part of the patch with covers, they definitely weren't sticking. Between those and the flonase ones, it would have been easier to have extras.

Hoping my appointment goes smoothly and its agreeable for me to go back to methadone, get my bt med filled early (and possibly switched), and have another follow up before my vacation. Hope everyone else is faring better. Best wishes.[/QUOTE]

I just wanted to wish you luck when you go to the doctor. You are right when it comes to people's opinions on the fentanyl patch. You either love it or hate it. It is all or nothing. I guess I am pretty lucky (even though I don't always feel lucky). I switched from oxycontin to the patch because I had been on it for years and my dose was really high and my doctor believe that it would work for me better. I had doubts because of the horror stories about it. Then I would hear about what a lifesaver the patch is for some people. Needless to say, After getting the proper dosage established, I have to say that I wish I would have switched to the patch a long time ago. I have had different types also and I have never had a problem with none of them. I have had the watson brand (with the gel) and they work great. Never had much of a problem with them. I also took the mylan brand of patches which does not have the gel inside. Never a issue of any of them coming off. I have put tape on them before. But I don't do it that often. I love the way it really keeps my pain at a certain level. I still have pain but it is a pain I can deal with. I have very sensitive skin and I am amazed at the fact that I have yet to break out or even get any rashes from the patch. I hate that you have to go through all this mess. Everyone is different. If the methadone works better for you, then that is what you should stick with. I hope that the doctor get this taken care of for you so that you can get some relief. Let us know what happens when you come back from your appointment. Wishing you many blessings. Muah!
Hope your pharmacist can switch them out...I've heard often not, even when unopened. Interesting Mallinkroft is better than Sandoz for you. Most say opposite, but I guess you are only talking about stickiness, not pain relief.

You might want to try Smith & Nephew OpSite Flexifix film. It comes on a 2 or 4 inch roll. Someone else posted it was much more cost effective than Tegaderms. I got some online for about $40 for a 4 inch wide 11 yard long roll, but didn't do the math to see what the cost/patch was. I assume that would make more than 33 (3*11) covers? Ebay has good prices on Tegaderms...I got some that were individually packaged, but were lacking the outer box, for a fraction of the cost. I was even needing two of the small Tegaderms on my Apotex 50s (they are almost as big as a Watson 100 for some reason).

Since my generic copay is only $5, I was paying way more for covers than the patches. Whatever works though. Definitely shop around to ensure you get the best price. If you are fairly sure you will be on these for awhile, there is a good discount for bulk. Even if not, it could be worth it.

I put two covers on some of my patches (had to move them right after application...that might have been another one of my problems) and didn't have a problem, but I thought I'd pass on the warning that some folks do...the more you have covering it, the more heat buildup. Mine always felt significantly warmer than my skin temp. I remember reading Mylan provides free covers, but not sure if any others do. However, the opinion on Mylan patches here is low (on another board, it was high...I assume its individual). I definiately had to change them every 2 not 3 days. Hope your doctor will allow that?

Withdrawal seems gone. Woke up in more pain since the methadone wears off overnight, but maybe the correct dose and schedule could help that. They actually did a supposedly straight switch since I was in withdrawal. They just had me take off the patches and take the methadone right away. Usually you'd want to wait a good bit between at least, or even taper down on the fentanyl first. I was actually a bit woosey last night.

I wouldn't recommend a switch like mine to others unless you have a well educated doctor and they think you can handle it! Apparently this is a type of situation where it is easy to OD, so I was a bit wary to go to sleep last night. I was surprised he was starting me back up on the methadone so high (30mg tid is the max recommended starting dose and we're doing 40mg tid, but I guess since I've been on it before?) and didn't require a break in between the last fentanyl "dose" and first methadone dose. Best wishes.
We all react differently to meds. Such as I went into full withdrawl when using watson one time. Worst experience ever.My moto is stick with what works, and god forbid you switch have backup with what works god forbid the new ones dont work. This goes to show how much "generic" meds flucuate in strength. Read up about the "hatch-waxman act of 1999" Its a law that allows generic meds to flucuate in strength plus or minus of 20% of the active ingredient. So with patients like all of us were tolerance is a huge factor when and if we get a med and its 10% less of the active ingredient "such as fentanyl" we are going to feel that loss of 10% of the med. This very same thing put my mom in the hospital years ago with a med and it was all due to a generic med the pharmacist filled because he was out of brand. She was on brand forever then when she took the generic her body flipped and got very very sick. Her doctor at the time said he sees this and his opinion is any med you take were tolerance is a issue if you start with brand stick with brand. You start with generic stick with that exact generic. its amazing to think they allow it. Take care and feel good..





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