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Fentanyl patch? Need advice. Apptmnt tomorrow 2/18/09

AnonymousUserAAnonymousUser Posts: 49,670
edited 06/11/2012 - 8:28 AM in Pain Medications
I have had three ACDF surgeries however, I have never had shoulder and back pain like I am experiencing after my most recent surgery on 12/16/08. I see a pain management doctor tomorrow for the first time and I am hoping some of you could give me some input on what might help. Right now I am taking Esgig (Fiorocet) and Soma together which only dulls the pain for about 3 hrs at a time. I try to only take it 3 times a day along with a Valium before bed. These are definitely not doing the trick and I may have to return to work on Monday as they have given me an ultimatum(This stress didn't help either). I can not take the really strong things like Vicodin or Percocet as they make me sick and don't even seem to help this pain. I was given Fentanyl through an IV after an extremely painful discogram in December and it seems to work really well but very short term. I understand this does not come in pill form and my OS does not prescribe this but says the Pain Management doctor does. Any suggestions would be greatly appreciated.




  • I've been on Fentanyl patches for over a year now and have tolerated it really well. The lowest dose you can start on is 12.5 mcg. It is 80 times stronger than morphine but break through pain can occur and that is why I need Norco every 4 hours. You change the patch every 3 days, but doctor have the option of doing the 2 day schedule which works best for me. Sometimes the patch won't last 3 days and the pain will go up. The best place to apply the patch is the stomach because Fentanyl works best where there is more fat distribution. I wore it on my upper chest and suffered side effects like nausea, vomiting, headaches, and dizziness. When I switched locations all the side effects went away. I didn't have any when my dose was increased also. You have to be careful not to get overheated and not apply heat directly on the patch like from heating pads or heated waterbeds. You can use medical tape if the patch doesn't stick well and it can be worn in the shower or while swimming.

    I feel comfortable on this medication and I don't experience euphoria or feel spaced out. Driving hasn't been a problem while on it either, but I always keep in mind to be extra careful since I'm on narcotic pain medicine. I hope your appt goes well tomorrow and they find an appropriate medication for you. Take care
  • Hi Laurie,

    The fentanyl patch does provide relief, but you will need something for the breakthrough pain. The meds you are on now do nothing for real pain. You might also want to discuss the fentanyl lozenge, it's like a lollipop that is short-acting but great for breakthrough pain.
  • I heard they are wonderful for break through pain but terrible on the wallet :jawdrop:
  • Thanks socamon. I have never heard of the lozenge. You are SO right about the meds I am on now. All they do is dull the pain a little for a really short time and to think, my OS though I was taking too much medicine. What I am taking is nothing compared to the Percocet or the xtra strength Vicodin he gave me that I don't take at all. I hope I will be glad that he referred me to the pain management doctor.

  • Paul, do you think Fentanyl is stronger than Oxycodone? Has anyone tried both medications and think one is better than the other? Any opinions on this would make interesting reading.

    Laurie, I had 5 epidural injections and it didn't work for me. All they do is numb the pain and doctors hope it's effects will last for months. Some people get relief for 2 weeks, 3-6 months, or even 1 year. It all depends on the person. I can't tell you what will guarantee you getting back to work the soonest. Some people think it's surgery and others injections. Only your doctor can determine what is right for your case. They really need to find a mix of medication that you can tolerate to get you back on your feet for now. I don't think you're on too much medication, it's all about finding the right one. I wish you had longer than next Monday to figure this out. Please let us know how your appt. goes. Paul is right about how to approach the subject of meds with pain mgt. Just tell them you had IV Fentanyl and it was helpful when they talk to you about the discogram. This way the subject is naturally introduced in this conversation. Take care
  • Thanks very much for responding. I am so stressed over today's appointment and knowing that I need to find something so fast due to the ultimatum my work gave me. I guess the worst thing that can happen is my work lets me go and I return to (or stay on) disability for the remaining 4 months. This pain in my back is so much more severe and constant than the neck pain ever seemed to be.

    Thanks again,

  • Well, I saw the Pain Management doctor today. Since it was my first visit, he asked me tons of questions, took notes, examined the pain in my back and even did the simple coordination tests. I didn't really get to say too much on my own. I was in such pain I was in tears hoping he could help. He rushed me out so fast I honestly didn't know what he thought was wrong with me. All I knew was he gave me a prescription for the Fentanyl patch (50 mg) and scheduled me for three procedures in a surgical center every other Tuesday starting next week. He said if I wanted to talk more to call him and he would call me back when he didn't have so many patients. My head was spinning. I did call and when he called me back this evening he said that he thinks I have "Post cervical Laminectomy Syndrome" or "Post cervical inflammation of the nerve root". He scheduled me for a " Left sided C4-C7 SNRB" (Selective Nerve Block?) and "Bilateral Cervical Trigger Point Injections". All he said is that I will be given a local anesthetic and then steroid injections (small amounts of cortisone). He said he wants to try and "cool off the irritation and break the wind up cycle". He also mentioned my Trapezius muscle. This is the first time that I, myself, have heard the words Laminectomy, Nerve Root and Trapezius.

    Can any of you please tell me if you have experience with what I will be having done? I am very nervous about having anything else done to my neck at this point. Can this make me worse?

    I appreciate the input!


  • From Fiorocet, Soma, and Valium to the 50mcg Fentanyl patch is quite a jump all at once. Be sure you're careful while doing anything potentially unsafe while you're body is adjusting to that change.

    Post laminectomy syndrome, failed back surgery syndrome, and all the phrases like that are just catch-alls that doctors use when they can't figure out a reason the pain didn't stop after all those lovely surgical interventions. ;)

  • a lot of insurance companies won't allow them..but they are sweeter than a cherry lifesaver
  • but after a while I needed to have them bumped up...and my pain management dr did not want to. For me, the morning after it was changed the evening before was the best time, pain relief wise for me. It was totally gone...but then after being up for a while it was back to normal. I do believe that if I would have had the 75mcg ones changed every 2 days with 2 or 3 oxycodones for breakthrough, then it would have been super relief.

    I think when people hear about how much "stronger" fentanyl is over morphine then it sets them back a little...but I think it's a little misleading in a way...but at what dosage is the comparison being made.Personally, I did not get any better relief from 50mcg changed every 2 days than I did with 30mg morphine ER 3 times/day
  • HI Scinmyheart, do you really experience times of no pain while on the patch? I never do, even at 75 mcg and Norco for BT pain.

    HI Laurie, I agree that 50 mcg of Fentanyl is a big jump from Fiorecet. Please be careful with it and call your doctor at once if you start having trouble breathing or can't stay awake. I think he should have started you lower and then titrated the dose after seeing if you can tolerate it.
  • the "total" pain relief" was only the morning after putting a new patch on the night before...but by after lunchtime I was back to the regular feelings...now that was about 4 years ago and I've advanced with my problems since then, so if I were to do it today, who knows...towards the end before switching to something else, I was trying to figure out a way to see if I could just drink it out of the patch (well, at least it felt that I wish I could) as it seemed my tolerance built up rather quickly to it as compared to other stuff I've tried
  • Well, too bad I never got to read all of your warnings before I ended up in the hospital for the last three days because of the Fentanyl patch. I put it on at 7:20 PM Wednesday night and was in the emergency room by 11:00 AM Thursday morning. I guess I am one of those people that can not tolerate opiates very well. The hospital even tried Morphine and then the Fentanyl 12.5 patch and those didn't work either. The Dilaudid in the IV every 3 hours did help a bit but that was about it. I am finally back home on my plain Fiorocets, Soma and Valium until I have my procedure done on Tuesday.

    Thanks again to everyone for your comments and concerns and I would still love to hear more of them.

  • You have one of the doctors that is causing the FDA to target these prescriptions. :(


    You aren't opiate tolerant, which is one of the requirements for the patch. In addition to that, your doctor prescribed a HUGE dose to start out with. If I were you, I'd be considering a new doctor, because that mistake could have been fatal. :S
  • We contacted my new PM doctor before and after I got to the hospital. He told us that none of his patients has ever had any reaction to the Fentanyl patch. I find that really hard to believe. His first response after I was in the hospital was "you didn't have to go to this extreme to get my attention". He did admit though that I did tell him I was extremely sensitive to the side effects of all medicines. He difinetely believes me now and says I should be fine in Tuesdays procedure since they are using only Lidocaine and Cortisone. I sure hope he is right about me feeling well enough on Wednesday to start back to work after being off since 6/2008.

    Thanks again,

  • patch. I also dont think that they should be given out without totally explaining the effects of it. I was given 25 mg first and that was after oxycodone was not releaving my pain for more than 3 hours. I had tried morphine sulfate and it made me tired all the time. So then the patches. I felt very sleepy the day after I put on the patch. I dont think any Dr should rush you out of the office handing you a script for something that strong. Glad you are OK!
  • Thank you so much for making me feel that I was not crazy and over-reacting. I still feel like I am recooperating today and haven't been able to do too much.

  • If I am obviously not opiate tolerant then what in the world am I going to be able to take that will work on this kind of pain? I have to say that the Fentanyl patch did take away the pain for that one night that I had it on but the side effects nearly killed me. I will have to be able to hold down a job on whatever medicine I am on also. Does anyone have any ideas or thoughts?



  • Opiate tolerant doesn't mean you can't ever have opiates. Tolerance refers to your body's ability to process the drug. When you're not opiate tolerant, it means your body hasn't "learned" how to cope with the drugs at lower dosages and less potent opiates, like Vicodin, Lortab, or Percocet. As you develop a tolerance, the lower doses/less potent drugs become less effective and you either have to increase the dose or change to a more potent drug to control the pain.

    Fioricet is a barbiturate, soma is a muscle relaxer, and valium is a benzodiazapine, which means prior to starting that Fentanyl patch, you didn't have any opiates in your system.

    Fentanyl isn't a first-line drug. If you look at the insert that came with the patches, it clearly states the patches should only be used for opiate tolerant patients, and even gives specific examples of the level of tolerance they're referring to -

    DURAGESIC® should ONLY be used in patients who are already receiving opioid therapy, who have demonstrated opioid tolerance, and who require a total daily dose at
    least equivalent to DURAGESIC 25 mcg/h. Patients who are considered opioid-tolerant are those who have been taking, for a week or longer, at least 60 mg of morphine daily, or at least 30 mg of oral oxycodone daily, or at least 8 mg of oral hydromorphone daily or an equianalgesic dose of another opioid.
    If I were in our position, since the opiate route seemed to offer pain control right before it tried to kill you, I would talk to the doctor about a less potent opiate. Try something lighter, like hydrocodone or oxycodone, starting with a low dose and see what result you get. It's much easier to live through starting out on an opiate that's not potent enough or in too low of a dose than to do it the other way around. ;)
  • I have tried Vicodin 500, 750 and Percocet. Most of the time they both make me feel very out of it and sick. On top of that, they don't usually relieve the pain any more than what I am taking now. Vicodin also does not allow me to sleep. I guess what I wish they could do, while we wait to see if Tuesdays procedure does any good, is allow me to take my current medication every 3-4 hours instead of every 6. They usually start to wear off after 3 hrs but at this rate I am suffering more hours waiting for the right time to take them than I am being relieved. If I take them as I currently need them then I will not have enough to last for the 30 day prescription. I could also keep trying the Vicodon in small doses (500) during the day and see if maybe I can get more used to it. I'll see if I can talk to the PM doctor before or after the procedure on Tuesday and see what he says.

    I honestly appreciate everything you have told me.

  • With Vicodin, you need to look at the first number rather than the last to tell the strength of the opiate.

    Vicodin is a mix of hydrocodone and Tylenol and it'll be labeled as 2.5/500 or 5/325 or some other such variation formatted as a smaller number, a slash, and a much larger number. The first number is the strength of the hydrocodone and the second is the strength of the Tylenol. Percocet is labeled the same way

    Do you remember what the first numbers were when you were taking the Vicodin and/or the Percocet? That might give you a starting place with your doctor.
  • If you need or want to talk to your doc about meds you may want to call the office today. In my PM clinic on treatment day it is a mill. It sucks too! You get brought in asked the standard questions of how your pain level is and do you understand what is going on. The nurses and assistants do all the prep, all of it. the doctor walks in says a few words while he is doing the treatment and is gone! If you are at all sidetracked by pain or the other proceedings you will not get to say much more than "boo" to him! I don't know how your clinic is, but if it is like where I go it can be very depressing to realize you won't get a chance to talk to him at all! when I asked afterwards I was already out in the clinic area recovering and I was told his schedule was too tight to allow consults on treatment days! I'd need to have an appt. When I asked for an appt, my followup day was closer!
    just trying to forwarn you. You may want to check on this.
  • Hi Wrambler,

    I left a message to try and get in to see the PM today. Hopefully he will call me back knowing that I am out of the hospital now. I don't know how I can promise to go back to work on Wednesday when I do not have any new pain meds and don't know how I will feel after Tuesdays procedure. The release I need is from my OS and not this doctor so it's getting very confusing.

    Hi Bionic,

    My Vicodin says 5-500 and 7.5-750. I have lots of them since I don't take them very often. Is that the info you were wondering about?


  • There's too much Tylenol in the Vicodin you have now to increase the dosage much. You want to stay below 4000mg Acetaminophen daily and then only for short term.
    The brand name for increasing the dose that is most commonly used is Norco and it is 10/325 and is what I take.
    Keep in mind I can't give any "real" medical advice here! Just what I have heard and read!
    You may want to express your worry at taking too much Tylenol and still being in pain. Hope you get some relief from the shot and you can get your work release straightened out to give you a few more days. I don't know your employer or specific info, but here where I work any doctor can extend a work release if needed. I might have to explain it later, but it would work for short term!
  • Kattoo beat me to the same question I was going to ask you B) . I have to say I was shocked to hear what happened to you and I still can't believe you were started on that dose. I started at 25 mcg, went on to 50 6 months later, and then to 75 mcg 6 months after that. Before Fentanyl I was just on Norco 10/325's but I took them for 8 months straight, and I have been on them on and off for years for different reasons. I can't tell you how relieved that you are okay, because it could have been a whole lot worse. It is just that serious. I hope someday your pain goes away so you won't have to play Russian roulet with different opoids you have trouble tolerating. Please tell any doctor you see about this problem you have so that this doesn't happen to you again. >:D<
  • Yeah, those were the numbers I was wondering about. That means the Vicodin has 5 and 7.5mg of hydrocodone mixed with 500 and 750mg of Tylenol, respectively. Those are right in the middle of Vicodin potency.
  • As I am sure you can all imagine, I am extremely depressed and confused. I just called the surgery center to find out how much it is going to cost for tomorrows procedure and found out $697.00 not including the portion of my deductible that is not covered yet. I am also supposed to have this done a total of three times which is really going to add up. My questions to all of you are:

    Would you trust the same doctor to do the procedure (" Left sided C4-C7 SNRB" (Selective Nerve Block?) and "Bilateral Cervical Trigger Point Injections".?

    Would you hold him in any way responsible for all of the hospital bills that will be coming soon for my three day stay (due to his prescription of the Fentanyl patch)?

    The billing department did say that I could talk to him about finances and a discounted rate but I am not sure how to approach this with him.

    Just curious on what you may all think.

    Thanks so much!

  • The doctor can't be held responsible unless you sue him, that's my guess. And about the injections, they are very expensive indeed. I had a total of 5 done, and the bilateral ESI's costed $800. My portion was 20%. Doctors make a lot of money performing those and some PM doctors quit prescribing meds just to do these types of procedures which are very lucrative. You can always ask about starting a payment plan and billing will usually work with you.
  • Hi Meydey,

    Thanks for replying. I am waiting for him to call me back now. My first procedure is tomorrow and I am scared to death especially after what just happened. I'll see what he has to say.

  • I would be looking for a new doctor, but that's just me. I think it was extremely irresponsible to start you on that 50mcg patch and he really should have known better. Ending up in the hospital as a direct result of a doctor's lack of attention or forethought is a deal breaker for me. :|

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