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Fentanyl Patches the best place to put them?

AnonymousUserAAnonymousUser Posts: 49,900
edited 06/11/2012 - 8:24 AM in Pain Medications
My question is where is the best place to put them. I've had good luck with putting them right on the spine and the higher the better, it seems like they don't work as well when placed low on the back also if they get wet when I shower they don't work as well. Any suggestions?


  • I found my 'four best spots', and rotated them each time I would change the patch. I used the insides of my thighs, halfway up, and also about 3-4 inches above each nipple on my chest, just a bit below my collar bone. (not sure why above post says 'Never put a patch on the chest.'; it makes no difference in the delivery and effectiveness of the patch, just as putting it by the spine does not increase pain relief to that area). I chose my 2 spots due to the fact that there was minimal body hair, it was smooth even skin, and those locations did not move very much even when I was moving around. As for getting them wet (assuming warm/hot shower), the heat can cause the medicine to transfer to your body too fast, which is unsafe and potentially very dangerous(i.e. fatal), but also leaves the patch mostly on empty, which is why it doesn't work afterwards.

    As for it falling off from the water, Charry mentioned the plastic bag; just tape it on with medical/waterproof tape right before your shower, and take off after you are done drying. Make sure the plastic is bigger than the patch, so the patch is undisturbed. I think Johnson and johnson has some sort of 'patch covers' that are breathable and help them stay on, so that you can leave them on 24/7, shower with it, and just remove it each 2nd or 3rd day with the patch.

    Those patches were so much more work than I ever thought they would be, and the things mentioned above HAD to be done if I wanted to get at least 2 days out of one, and be able to shower. Other people have had much better luck; I hope you are one of them!

    (ps- no baths, or hot tubs when using the patch; just in case nobody warned you..)
  • I also wear mine on my chest area, just below my collar bone. I alternate from right side to left side. One of my reasons is the same as JWM - it's an area of my skin that stays flat and doesn't move. The second reason is that my physician said that hot tub sessions as part of my physical therapy were fine, as long as the patch wasn't submerged. Putting it on my upper chest keeps it out of the water.

    As far as the patches falling off, I think I must have special skin or something. I spend ~8 hours a week exercising (submersed up to my neck) in a heated pool as part of my therapy, and after each pool session I spend 15 minutes in the hot tub (submerged to my bra line). I've never had a patch fall off or needed tape to hold it in place correctly. I guess it's just willing to stick with me through anything. =))

  • j.howiejj.howie Brentwood, Ca., USAPosts: 1,736
    Hi,and welcome to S.H. The doc. said the best place for absorption was a fatty area. the problem with that is most fatty areas either stretch, and the patch won't stretch with you. Or the fold or crease and that loosens the patch also. I used the patch for about 2 years and put them on my shoulders alternating the shoulder and the shoulder height. I never had one come off.
    Good luck, Jim
    Click my name to see my Medical history
    You get what you get, not what you deserve......I stole that from Susan (rip)
    Today is yours to embrace........ for tomorrow, who knows what might be starring you in the face!
  • Thank You, my DO told me not to put them above my heart for some reason, any thoughts?
  • Does anyone else have trouble with them not lasting the full two days? Or working really well for one day and then the next time you put one on it doesn't work quit as well and there is a lot of B/T pain?
  • I think how long they last depends in part on how they fit in your overall pain management regemin. I change my patch every 3 days and I don't normally have problems with them losing effectiveness. However, I have noticed the effect wanes and I require much more breakthrough medication when I'm not eating properly and/or when I take days off from my therapy/exercise routine.
  • I was just prescribed Duragesic 25mcg/hr patch, I bought the generic (I dont know if that makes any difference) And I am supposed to change it every 72 hours. Prior to this, I was taking 20mg of percocet every 4 hours(while awake). I still have the percocet for breakthrough pain. I put that patch on as instructed by the paper that came with them. its been 3 days, I have used two patches (not at the same time ofcourse) and I have felt withdrawal symptoms even while taking my percocet for breakthrough pain. I dont know if this is the right thread to discuss this in, but has anyone else had this problem? I called my doc, and he said that it can take up to a week for it to start working.. How could that be possible with a medication so strong?
  • It sounds like you are doing the right thing putting them high on back or shoulder back. You could tape plastic bag over the patch to keep it dry. Take care. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • Fentanyl withdrawal is the worst thing I have experienced in my entire life, without a doubt.
  • I agree on he withdrawals. It is horrible. I just switched from 50mg to 25mg and i am having difficulties. Im not sure if its because the weather is so hot and the patch is wearing out quickly, or if im having withdrawal from cutting my dose in half, or what the problem is. things worked really well at 50 mg. 25 not so much. and considering how much the meds cost, i cant really afford to try much else. so i guess im not really helping with this thread. I usually wear my patches on my ribs. no one said anything to me about where i should wear them. i probably should have asked. maybe ill try a new spot and see if it works better.
  • I have been using the patch for about 3 years I and put them on my stomach. It works great for me. Also, my doc told me I could use tagaderm patches over the patch to keep them on. They are basically a clear bandage cover. They can be purchased the CVS locations with the expanded home health section, or any place that sells medical supplies. A little pricey but I live in Fl and tend to sweat in the 200 degree heat :).
  • We place my mothers patches on her front thigh above her knee and it seems to be the best place for her. She has very dry skin and they didn't stay stuck on anywhere else. She's in the hospital this week and they've got it on her upper arm and have taped it around the edges. She has been prescribed 100's to be changed every 3 days (72 hours) and a 25 to be placed on the 3rd day as the 100's weren't always doing the trick.

  • Please, no one put regular surgical or other tape over the patch. I didn't know and I couldn't figure out why my heart was racing, missing beats, and I could not sleep. It was awful.
    I realize now how dangerous what I did was and I warn you others not to do it, I honestly had no idea what I did was causing my problems.
    I was glad not to have to call one of the PA's again. How much do you want to bet they wouldn't have picked up on this? I'd like to pull the hair of the last one 10 days ago who literally burst out laughing when I told her the patch hadn't relieved my pain after 24 hrs. If I ever see her again, she will be told that a person seeking pain relief lives life a minute at a time and struggling for relief. I learned a lot and am older and wiser!
  • Anonymous said:
    My question is where is the best place to put them. I've had good luck with putting them right on the spine and the higher the better, it seems like they don't work as well when placed low on the back also if they get wet when I shower they don't work as well. Any suggestions?
    I have been using the patch for several years now and for a while I had the same problem as you. The patches don't stick and then they seem to end up becoming less effective and my pain came back. I was told by a friend who also uses the patch to try XXX tegaderm film dressings which are a transparent tape that goes over the patch to keep it from falling off. It works great I can now go take showers and not have to worry about the patch falling off and suddenly feeling like a drill is going through my back.

    URL removed by Cindy (neck of steel). Posting violation. 02-22-11
  • Everyone is different. I am prescribed 100mcg patches with Morphine Sulfate 15MG's for severe back and leg pain. Pain to the point that without meds, I would be unable to put any pressure on my leg.

    I have tried my "love handle" area and suffered severe withdrawal and was taking much more Morphine than intended to make up the difference. I then tried my upper arms with moderate success but my pectoral area has been the best spot for me. I rotate between my left arm, right pec, right arm left pec and have been experiencing great relief.

    Other people say those area's don't work.

    I also use the tagaderm because without it, I would never be able to wear them. The Tagaderm patches are a life saver for wearing a patch.

    P.S. Not that the way I rotate them has any viable effect on relief. I just do it this way. I bit of OCD I guess. :)
  • The instructions say not to put it on a bony area and not to use alcohol. Alcohol is what a lot of surgeons use to make the strips stick. It removes the oils from your skin so adhesives stick better, but also leaves a residue that can conflict with the medication.

    Moving to AZ brought new issues with keeping the patches on for even 10 hours. So using my RN knowledge, I clean a fairly good size area well with alcohol, then clean with warm water to remove the residue and then dry well. Place the patch and cover with the Tegaderm. No more problems. The Tegaderm even removes the dirt line that can show up.

    Also, note that different brands are much better than others. My favorite is Fentanyl by Mylan. WalMart sells a very funky type that is a large bubble with gel in it. It's awful, but Mylan are MUCH smaller, easier to handle and work much better. I tried putting one on my thigh yesterday and it isn't working. The soft area of your back between the shoulder blades work well but can show depending on the style of top. Good luck all. It beats continually popping pills!
  • I use my back, right under my shoulder blades, i switch sides obviously, but tonight I think I may have put my patch on the same side as last time?? Are there any risks involved with using the same side again, or am I ok?
  • I have been wearing Fentanyl for a little over 4 years, 50 mcg patch every 2 days. I take Vicodin 10/325 for breakthrough, neurotin, tizanidine, topomax and lidoderm patches to manage pain, in addition to non-medicinal efforts (acupuncture, salt water swimming, etc.) I have degenerative disc disease & used to do extremely high impact sports - sky diving, bungee jumping, and more which I will NEVER allow my kids to do!!!!
    I normally wear my Fentanyl on my upper arms, rotating with each patch (I'm a girl, chest is NOT a good option!) but in the last 2 months I've developed some sort of rash from the various covers I use. Because of showering, sweating in Dallas in the summer, swimming, etc, I typically cover my patch (that, and I'm really conservative about anyone knowing what type of patch I'm wearing). I use Bandaids, Tegaderm or other coverage "stuff" that is ripping my skin, causing a rash, and/or causing dry patches on my skin.
    I obviously can't use 3M barrier spray because it would interfere with uptake of the medicine. Any suggestions on places I can put my patches, or how to save my skin?
    I'm also a mum so I have to have the patch where I can see it so my 2 small kids don't accidentally have any transfer (I worry!!!) and I'm putting them on myself so recommendations for my back won't be a super help. Any thoughts? Anyone else have this happen to them just out of the blue like this?
    Thanks for any suggestions!!!!

    - C2-C7 fusions with titanium plate; L1-L5 ruptures, implanted neurostimulator, rhizotomy, tremors from spinal cord injury
  • I put them on the upper arm/outer bicep, with a micropore dressing film covering them to help them stay in place and hold.

    I sometimes shave the hair off that part of my arm a day or two before I use it, as I don't need to feel like I'm getting waxed at the same time.

    I clean the skin with rubbing alcohol first, and dry it thoroughly with fresh paper, to remove any oils/soaps/etc that may interfere with transfer.

    Primarily I take 100mcg every 2 days, and by day 2, I desperately need it.
    Plain old Codiene and Endone (oxycontin) for breakthough, which doesn't really work any more.
  • I have been on patches for over four years. I have been on everything from 12 to 125. I put them on my stomache, under ribcage on the fleshy part. I cover them with tegaderm, as it is the only thing that my body will allow. I buy them on Ebay alot cheaper. I get the 4X6 size and cut them in half, depending on the size of patch. I do this before I take them out of wrapper and they go twice as far. I only found they effected the patches with excess heat from my hard shell brace and I absorb the medicine alot faster. The fattier the placement of patch, the better it works. I have to change mine every 4 hours. Hope this helps. The tegaderm will ensure you dont loose it around the kids too. :)
  • Can someone tell me where on the back you put them? Higher the better I see in comments but what does that mean? High middle of back? Shoulder blades? Just under the shoulder blades?

    Any help would be appreciated as I have lost the ability to wear them on my arms. I put them on my arms my last change and I ended up in severe WD 6 hours later. I was getting almost NO medication from the patches. I am not talking about slight discomfort either. Freezing cold wrapped in a blanket, but sweating, runny nose, every inch of my body felt like it was being hit with something. Yeah, nice huh? What we put ourselves through for pain relief is crazy.

    Anyway, so yes, more info on back placement would help me a great deal.
  • This site has been extremely helpful already. I am 34 years old and have been through struggles with all my neck and shoulder pain for years (off &on) and the past 3 years being the worst, getting worse day by day.
    I have been on 5/325 percocet, 10 mg oxycontin, 600 ibuprophen, 300mg nuerontin for the past 2 years.
    This "cocktail" isn't always effective at relieving my pain but is helpful in comparison to nothing at all!
    A friend of mine recently told me about the fentanyl patches and how they are very effective for him, but his issues are different than mine (he also said he was using them to be weened completely off of opiate treatment) to me this didn't make since? but maybe..?
    I have cervical DDD, Spondylosis, stenosis, Bone spurs, and a fusion surgery has been highly recommended in my problem areas of c4,c5,c6,c7 by my nuerosurgeon. I am scared of the surgery after hearing all the possible risk and time frame I'd be down and out, with restrictions..being I am a single Mom of two teenagers and having to maintain my household, bills, running kids around primarily myself/alone. This has been the biggest issue about just jumping into this surgery and seeing what happens and keeping fingers crossed, that it will solve all my pain issues and lead me into a better life.
    Has anyone had this surgery that can tell me how long their recovery was? driving? kids? other helpful info?
    I'd also like to know what people do if the meds aren't working? what meds they have experienced work the best to manage all this pain & function?

    Thank you so much for any input and information.
  • HI Chris,

    First let me say welcome to spine-health. Have a look around, and the one thing you will find is all medications work differently on different people. Depending on the type and kind of pain depends on the medication you should be on. I myself found it most helpful with my neck in the beginning to use percocet and a muscle relaxer. As we worked through all the different brands of muscle relaxers I finally found comfort in soma, working the best. Currently I do use fentanyl, along with percocet for break through. I also have lyrica for the neuropathic pain, and then still using my soma. Like many here no one med has done the trick but rather a combination of meds. Like many I have more than one type of pain going, for instance both mechanical and neuropathic, along with spasms. Why it is so important to work with your doctor on finding a good match for your pain.

    AS far as the patches I had several different brand names and prefer the mylan brand the most. One they stick better and are smaller. I have had the most success placing them where my bra is on the side under my arm. I get a two fold effect that my bra holds them in place and two even though they leave behind some skin irritation, as I don't do well with adhesives, it is not seen by anyone. Also no one can see the patches on me, which I really like. I had been using my upper arm, but with summer I wear a lot of muscle shirts so the heat and sweat doesn't work to well with them. I am on a two day change, so I have like three areas I use to move them around in that same area. Now I might add i usually have a sports bra on so it is a larger area than a standard bra. Also using that area I have no worries of it coming off, and if it did it would be secure in my clothes. But so far it has not happened.
  • mrsdollfacemmrsdollface Posts: 1
    edited 06/28/2012 - 9:46 PM
    I wear fentanyl patches manufactured by Mylan..if you call the company that makes your patches they will send you a 30 day supply of 2x3 clear covers every month..these clear covers go over entire patch and work very well..it's a 2x3 clear sticky film that's thinner and better than tape..and no residue left behind when you take it off like you have when you remove the tape..trust me they won't come of till you take them off..i can sweat, shower, do whatever and they don't budge..the company sends the covers for FREE..no shipping cost or anything..
  • It is not recommended that you cover the patch as this causes overheating the patch and the controlled drug is then absorbed in to the system faster.
  • Here is the solution:

    Tegaderm HP - 9534HP

    These are waterproof and the perfect size to cover the Fentnyl patches. I play golf 3-4 times per week and can tell you they work.

    Good luck.
  • Usually my patch stays on but if it gets red at the site I take it off and put it on my side flank then have to put a tagaderm cover overtop of it. I find Fentanyl patch better pain relief than pills and find it works better on my fat belly on the side. For some reason doesn't work as well on my upper chest. I like to wear short sleeve in the summer so it now goes on my flank stomach area or my upper leg. I find the roll of tagaderm much cheaper than the individual patches but the drugstore was out and got a big roll for $39. and free shipping.
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • I never needed the covers. The trick I learned is to hold my hand over the patch for about 30-60 seconds after I applied it. Since I started doing that, I never had patch problems. It's something to do with heating up the patch glue to your body temp when you first apply it.
  • too happy with fentanyl. Gives me bad dreams but it does even out the pain so I don't experience the "spikes" that I used to just on hydrocodone. Having tried various placements including tummy, my best area is my chest and second best is my upper arm area. Hopefully the spinal cord implant I am getting will let me get off of fentanyl. I'm on 25 mcg every 3 days plus 30 to 40 mgs hydrocodone. And other stuff that is not narcotic.

    Just experiment. You'll find your best placement.
  • Chnop35CChnop35 Posts: 2
    edited 08/23/2012 - 1:07 AM
    Hi all. New here and to the patch. Just started on 12 mcg and first one was fine. Not near enough however so Doc changed me to 25. Well the second time I took a hot shower and was time to change it. So much pain. Got out of shower, dried off and slapped it on. WOW! Within 15 min must have let the med all out cause I was so out of it for a good hour. Now I put on in am. Just did for first time. We'll see. Its my first 25. I also live in hot Florida. Ive been taking 6 vicoprofen and 3 valium a day. Hope this patch works. Used my upper arm as Im only 5 ft 112.
    Tetster in pain
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