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Fentanyl (Duragesic) - i need your help, sisters! Fentanyl (Duragesic) - i need your help, sisters!

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Unread 12-05-2005, 09:10 AM
Fentanyl (Duragesic) - i need your help, sisters!

Just a little update,

It's now been 72 hours since I first posted, and I took off my first patch this morning and put on my second one. I'm doing absolutely great on this, so far. I have basically been feeling the same side effects that the Lorcet has on me, just intensified; for example, the sleepiness, the nausea after I smoke too much (weird, I know, but it always happens, and sometimes I even throw up!) and the now bizarre and even a little scary dreams. But I'm really tolerating it ell. I can deal with a few side effects--I'm so happy not to be in pain anymore!
The only thing I did notice is that this morning it felt like it "wore off", I felt my pain again, but now that I have the new patch on, it's better. Maybe that's whats ya'll meant when you were saying that for some of you it's only good for 48 instead of 72.
Anyway, thanks everyone so much for responding to this and giving me some perspective. I love you girls!
Thanks again,
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Unread 12-08-2005, 05:25 AM
Fentanyl (Duragesic) - i need your help, sisters!

hey christina, i too am on the patch i started off on 25mg. and now take 75mg. for a long time every three days worked for me, but it seemed i did great on the first day and part of the second but then i started to feel my pain start, the way my dr. explained this to me was the pills take about 30 min to really kick in they only last about 1hr and a half and then they start wearing off. with patch you get a steady dose of meds so you dont have to go thru the up and down motions. depending on your pain you may have to take your meds for break thru pain , it helps. i have been on the patch now 3years or more and i have some since of normal with the patch. there are good days and bad days but i manage a heck of alot better with my patch than with out. good luck and i hope it works for you as well as it has for me.
Unread 12-08-2005, 04:46 PM
Fentanyl (Duragesic) - i need your help, sisters!

I'm so happy to hear the patch is helping! When I first started using it I did find that the patch only lasted me 48 hours instead of the 72. My doctor than wrote the script to change every 48 hours. That worked out great for me.

However, about a year ago, my doc said she couldn't write the script that way anymore. So I'm back to every 72 hours. I seem to be doing okay, but I think I would do better changing it every 48 hours.

Keep us posted on how you're doing.
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Unread 12-12-2005, 11:22 AM
Fentanyl (Duragesic) - i need your help, sisters!

Hey ladies!
Thanks again for all of your replies. Thought I'd give you an update. I'm doing great on the patches--the only thing is I'm still having the weird dreams, which doesn't bother me that much, and I'm feeling that they wear off too soon also. However, rather than change them every 2 days instead of 3, I'm thinking of asking my doctor to put me up to 50 mgs (I'm currently on 25mgs)- maybe that would be better. I've just noticed that I'm taking more meds for "breakthrough" pain then he thought I would, so maybe my problem with the Fentanyl is the strength. I go back to see him on the 15th (this thursday) to see how things are going, so I'll talk to him about it then.
Ya'lls advice has been invaluable. Thanks again!
Love ya, Christina
Unread 12-13-2005, 10:41 AM
Fentanyl (Duragesic) - i need your help, sisters!

I have a quick question. Are you taking more of the breakthrough meds towards the end of the first night of the last 48 hour day and the entire last day 72 hour day? Please let us know. Your dr. needs to know this. I know you said you felt great on the patch and since you just started sometimes dr's want you to stay on the lower dose for awhile till they will increase the dosage.

As for me, I stayed on 25 mcg for about six months and then increased up to 50 mcg and then about seven months later increased up to 75 mcg and was on 75 mcg for my surgery in April of 2004 and just now got down to the 50 mcg patch. I originally hurt my neck in the fall of 2002.

I think if you go up to 50 mcg that would increase your drug tolerance and not much would help your pain if you would ever need further surgery to help your problem if it would be helpful. I'm sorry but I don't know why you are taking the medicine.

When I was taking 75 mcg before my neck surgery (herniated disc that was leaking fluid into the spinal canal), my pain mgt dr. recommended a morphine pain pump of a certain amount. After surgery my pain was not very manageable at all and I was in a LOT of pain in recovery so they had to give me a lot of morphine because of my high tolerance to the pain meds I was already on probably due to the high amount of Duragesic dose I was on. I think if I remember correctly, I saw somewhere on the Internet that a 25mcg pain patch is equivalent to about 180 mg of morphine. I could be wrong about that but you may want to ask your dr. to see if he knows that. I had to get morphine shots in my bottom every three hours as it was more powerful than a morphine pump and also had to be on oxygen because the morphine made my oxygen levels decrease. The morphine didn't take the pain away all together. They just said it would make me more comfortable. That entire night was very rough with pain and I was pressing the nurse call button every three hours for my pain shot. The physician assistant walked in the next morning and was ready to discharge me and I said "No way" as I hadn't gotten off the morphine shots yet, oxygen, I had been nauseated and hadn't really eaten a meal yet, and I couldn't really empty my bladder well which was one of my biggest concerns. I didn't want to have to come back to the hospital for a catheter. She wanted to push me out of there because it was considered an outpatient procedure. She said she would try to write it up for the insurance to approve it. Thank goodness I persisted and I saw the dr. that same night. He said to me that I didn't have to be so anal about wearing the cervical collar to which all the nurses wanted me to wear and he told me to take it off and move my neck around some. I'm so glad he told me this because I'm sure if I hadn't stayed I probably would have gone home all misinformed and made my neck all stiff from the collar and probably would have worn it to my post op visit a few days later to get the dressing taken off by the assistant. When I asked her what was found in the O.R. she just said they found what they expected. That didn't answer my question. It wasn't until Dec of that same year that I actually saw my report and read that my disc was leaking the gel like substance. Thank God I stayed to meet my dr. in the hall when I took my a walk with my husband as he said when he went in there it was much worse than he expected. As for now, I may be facing another surgery since I've been experiencing numbness in the last three of my fingers on my left hand and the outside of my left hand and arm since last Thursday night. I had an MRI yesterday and will soon know the results and have an appointment with this same dr. on Friday this week. I may see a neurosurgeon. I'm still on 50 mcg and will stay on that dose and if I need surgery then I will think about talking to my pain mgt dr. about increasing to 75mcg the day of surgery because of what happened before as my pain level wasn't managed well due to my high tolerance to the Duragesic patch. Oh I so wish I hadn't increased but I hadn't any choice because I was in so much pain and it was unbearable and it was preventing me from doing simple things. Sorry to go on about this.

This is just my opinion but if it were me I'd stay on a lower dose of 25mcg and ask your dr. to see if you can take it every 48 hours. Also if you are increasing your breakthrough meds, maybe he can change you over to something else like roxicodone that doesn't have Tylenol in it. I had an increase in my liver enzymes and the dr's were very concerned and I noticed you said in your post that there was a concern with your liver. Roxicodone is available in strengths of 5mg, 10mg, 15mg, 30mg, and I'm not sure after that. I started out with 5 mg and then took two of those so he was prescribing about 180 per month so I could take two. Eventually I just asked if he could increase the strength on the roxicodone and instead of him increasing it to 10 mg (He knew I was taking two of the 5 mg tablets) he just increased it to 15 mg. tablets. The breakthrough medications are much easier to taper off of or wean off of then the Duragesic patch so a lower dose is preferable according to what my dr. said. He even told me that he preferred me to taper off the higher dose of roxicodone than to decrease the dose of my Duragesic patch when I asked him about weaning off. He simply said that the patch was more difficult to wean off of than breakthrough meds. He said to first wean off the breakthrough meds and then wean down to a lower dose patch. I was on 75 mcg patch and then I finally weaned down to 50 mcg pain patch after taking something called Lyrica that helps with neuropathic pain or sometimes chronic pain which is what my primary care dr. put me on. Sometimes the medication roxicodone has to be specially ordered and can take up to a week at our local pharmacy but an off chain pharmacy usually has it in stock. This is very important to think about even if you have a problem now that doesn't require surgery because you may never know if you may have another problem that may require surgery and they can't manage your pain successfully. Good luck to you.

P.S. I wanted to add that the weird dreams will continue and seemed to worsen as I increased the dosage in my patch strength to have nightmares where I would wake up in night sweats and then have to have hubby reassure me that everything was ok. If you are doing great now on the patches and have drug insurance it won't change the cost of the patches on your co-pay. At least it didn't on mine. I had to pay the same amount for 10 patches or 15.
Also remember what healthmaven said, "The only caution I would offer is the profound opiate withdrawal I experienced when titrating from 50 mcg. to 25 mcg."
Unread 12-13-2005, 11:07 AM
Duragesic patch comes in Micrograms (mcg) not Milligrams (mg)

Sorry about this but I have to add one more thing. When referring to the dosage of the Duragesic patch, it is in micrograms mcg not milligrams mg. Just thought I'd add that in there so there wouldn't be any confusion. There is a big difference in the two. Hope all my info that I gave you helps you in some way. s
Unread 12-13-2005, 04:39 PM
Fentanyl (Duragesic) - i need your help, sisters!

I just want to add my two cents about the Duragesic patch making post-surgical pain relief difficult. I had the same problem after spinal surgery. After being on the 50mcg patch for a long time and norco every four hours for breakthru pain, my neurosurgeon knew that I would be a challenge with pain control. He had me put a patch on the morning of surgery. Before surgery he gave me two oxycontin tablets (not sure what strength). When I woke up, I also had a morphine pump and my pain was OUT OF CONTROL. They started putting dilaudid in my IV every hour. Still I was unable to get up and walk. Finally, someone gave me some valium and that did the trick. However, being discharged two days later with only lortab and valium for pain control was really rough. And the withdrawls from the fentanyl were a nightmare.
Unread 12-13-2005, 05:41 PM
Fentanyl (Duragesic) - i need your help, sisters!

I started on the 25mg patch, I was on that about a month. We than increased it to 50mg for another month, than I went to changing it every 48 hours and that is where I stayed for quite some time.

I've since had to go back to the 25 as I was having some dizziness and thought it may have been that the patch was too strong for me. I am very small framed and at the time was at one of my lowest weights. I'm still using the 25 and have been on it for a few years now.

According to my pain doc it is not unusual to have to titrate the dose up. The smallest dose does not work for everyone, but I think most pain docs will start you out there as they want you to be on the lowest dose possible to help with the pain.

P.S. I have had additional surgeries since being on the patch and pain control has not been a problem for me.
Unread 12-14-2005, 12:02 PM
follow-up appt tomorrow

Hi ladies!
Thanks again for all your help. The amount of info is overwhelming, but very helpful. I go back to see my PM doc tomorrow for a followup to talk about how this fentanyl is working--how should I approach this? Remember my last reply on this thread about taking my breakthru meds more, and the patches not lasting? I just want to know how to approach this subject, because at the appt where he prescribed the patches, he said "if this doens't work, we'll have to go to a morphine base". I'm hoping that we don't have to get quite that drastic, so what should i say/ask?
Thanks again, girls!
Love ya,
Unread 12-14-2005, 04:59 PM
Fentanyl (Duragesic) - i need your help, sisters!

The duragesic/fentanyl *is* morphine, so I'm not sure what your pm doc means by a morphine base.

It is not unusual to have to titrate up with any meds. Generally the doc will start you at the lowest dose and see how you do. If you feel some relief, but you're still having some pain, they will try another dose. At least that has been my experience. In my case, I also have nerve damage, so we were trying various nerve meds also.

IMHO I would tell him just what you've told us and go from there. It may be worthwhile to try changing every 48 hours or to try the 50mg. From what you've said here it's not like the patch isn't working at all, so I don't see why he wouldn't want to work with the patch a bit before switching you to something else.

My personal experience is that I went from the 25 to the 50 and than to changing every 48 hours and that was what worked for me. I did have some relief from the 25, but I still was having some pain. It was her suggestion to go the 50. I did much better on the 50 but noticed that on the 3rd day I was having alot more breakthru pain and that is when we went to changing every 48 hours.

It may be helpful to keep a pain journal. I think it helps to see the notes rather than try to go from memory. A journal can make the picture clearer for you and the doctor.

Do keep in mind that we are all different, so what someone elses experience has been with the patch may not be what yours is. I know it's alot of info to digest, especially when you have so many people weighing in, people who have had different experiences with this med and with pain.

Many s to you

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