Welcome, Friend!

It looks like you're new here. If you want to get involved, click one of these buttons!

advertisement
advertisement
Veritas-Health LLC has recently released patient forums to our Arthritis-Health web site.

Please visit http://www.arthritis-health.com/forum

There are several patient story videos on Spine-Health that talk about Arthritis. Search on Patient stories
Protect anonymity
We strongly suggest that members do not include their email addresses. Once that is published , your email address is available to anyone on the internet , including hackers.

Notice
All discussions and comments that contain an external URL will be automatically moved to the spam queue. No external URL pointing to a medical web site is permitted. Forum rules also indicate that you need prior moderator approval. If you are going to post an external URL, contact one of the moderators to get their approval.
Attention New Members
Your initial discussion or comment automatically is sent to a moderator's approval queue before it can be published.
There are no medical professionals on this forum side of the site. Therefore, no one is capable or permitted to provide any type of medical advice.
This includes any analysis, interpretation, or advice based on any diagnostic test

Butrans pain patch---anyone?

ItsmemeIItsmeme Posts: 6
edited 06/11/2012 - 7:52 AM in Pain Medications
After being on Lortab 10/500 for nearly 15 months, recent microdiscectomy surgery in late February, pain is still persistent. My doctor suggested, and at my request to get off the lortab, I've been put on Butrans patch 10 mg. It is working wonders when I am somewhat inactive during the day, but with activity (at work, doing chores around the house etc), it's not helping with my pain whatsoever!! I've also been prescribed tramadol 50 mg for BT pain. I'm also having a heck of a time keeping these patches stuck to my skin!! Even have tried waterproof tape, around the edges of the patch with no luck?!

Dr said if the 10 mg wasn't working he'd switch me to the 20 mg, so I may call him this week to discuss. But I wanted to ask if any of you here have experience with this patch, any advice would be greatly appreciated!! I've looked online and through alot of the forums here with no luck...

Thank you!
advertisement

Comments

  • I haven't tried the patch (it's not available where I live, unfortunately) but I have been on the immediate-release version of the same medication (buprenorphine) for many years in the form of sublingual tablets. They are called Temgesic and come in 0.2mg and 0.4mg strengths. I usually need at least 0.8mg in the morning, sometimes up to 1.2mg. Personally I find they work better than the other meds I've tried (tramadol, dihydrocodeine, oxycodone, etc.), but like you, I find they only help up to a point.

    These tiny tablets that dissolve under the tongue often work wonders on the pain if I am fairly inactive or not doing anything too strenuous, but with activity (such as walking too long, lifting or carrying things, etc.) the pain quickly gets worse. I find that they work better combined with muscle relaxants and a neuropathic pain medication (mine is Neurontin).

    One thing I have noticed is that sometimes increasing the dose just a little bit (say, from 0.8mg to 1mg) can make a lot of difference in terms of pain relief. You may find that you need to try a slightly different strength. Obviously your situation is a bit different to mine, as you are taking the extended-release version while I'm on the immediate-release form. I hope it works out for you and you get some better pain relief.
  • wondering if anyone has had side-effects from the Butrans patch, especially nausea. My pain management doctor prescribed the 5 mcg patch and after 24 hours I discontinued it due to nausea.
    I read in the prescribing information that nausea is a fairly common side effect.
    Anyone have problems with nausea and any suggestions?
    Thanks.
  • Nausea is a common side effect with most opioids, especially the stronger ones, and especially when you first start taking them - it usually subsides as you become used to the medicine, within a week or two. This is a common effect of many drugs, actually. I remember when I first started on Neurontin it made me feel really strange, but now I'm completely used to it. Good luck with the Butrans!
  • Giving it another try. So far, so good, but I'm only about five hours into the new patch. My pain doctor recommended taking an antihistamine in case I get nausea again. We'll see.
    Thanks for the comments!
  • I started the patch. The first month was on 5mcg/hr with 7.5 lortab for breakthrough. Dr shifted me to 10mcg and have decreased breakthrough pills by half.
    I also take amrix which seems to counter the constipation side effects (even though it is listed for amrix as well)
    The patch stay on seem to pull pretty hard to get it off. Good luck with your second try.
    laminectomy c4/c5 2008, ACDF c4-c7 Jan 20 2014 sched
  • I know everyone's different, so not to be discouraging - the Butrans patch (from 5mg to 10mg) only seemed to help over the first three months. Placebo effect? Had trouble keeping them on and if they didn't fall off, I'd itch like I'd rolled in poison ivy. Looked like poison ivy reaction too.
    I, too, was prescribed lower doses of hydrocodone in an attempt to replace those opioids with the patch (antagonist). No pain control ultimately. I was doubling up on the pain meds and wondering why neither it nor the same dosage of hydrocodone was working anymore.
    Been on opioids of this low dose (anywhere from 7.5mg/325mg to 10mg/325mg) for about, oh, 7 years. Finally had the spinal cord stimulator implanted (again after a botched attempt by diff providers last year... they implanted a left a sponge in there, too.)
    Just not too sure about the Butrans patch as a pain management therapy. Maybe a replacement therapy... if you are NOT in pain. Just taking Butrans now and ... I don't notice a damn thing. Just notice same old irretractible pain with a patch-sized spot of red, blistering itching.
    L3 - S1 laminectomy/discectomy '97; L3-S1 fusion '05; medtronics spinal cord stim '10 w/ removal in '11. Boston Sci scs '11. Nerve damage, not sure of dx. Was failed back, but getting different opinions from current neurosurgeon. fusion looks fine to him. It's nerve damage and scar tissue at nerve roots and in spinal column he believes is the culprit, it seems.
    (Oh, PS to all the non-legit pain sufferers out there who acquire and sell pain killers illegally, not that any are reading this, - thanks for making pain managaement with pain medication near impossible in the United States. Our legislatures have made it criminal to prescribe medication that could help and are helping electronics companies make billions off these spinal cord stimulators. I don't think I have room in my dural space for this damn thing. I feel worse today than I felt last month.)
  • I started it 4 days ago (10mg) patch and suffer from back issues as well as fibromyalgia and raynards - which effect your extremities. Today, I have notice a drastic improvement with my extremities, my hands, feet and calves do feel a bit better. It's noticeable, however, I am not so sure that my back is feeling better at all, as a matter of fact, I know it is hurting much worse. I think it from the stimulator that the Dr gave me. It is supposed to send off electronic pulses to interrupt pain signals, which it feels "ok" when I use it but with out it, dear gosh. I can't wear it forever, afterawhile it starts to hurt me.
    I have been on Lortab for 3 years now and hate it, hate it hate it. First, it's not effective, secondly I hate to take pills all day long, I can't tell I'm taking it anymore but when I try to stop taking it I get very jittery and I know it's a form of withdrawl. I really had high hopes for this medication. I have only been on 10 mg and put it on Wed afternoon - it's now Sat. Should I call my Dr and request a higher dose? My biggest fear is that someone won't take me seriously. I have my MRI report stating the degenerative disk disease in L4-L5 and am set up for a nerve block appointment, but like the last post said, thanks to 'junkies' I feel like I am scared my Dr will think I am just trying to get more pain medicine since it has been only 4 days. I just keep thinking that, if it takes 3 days to get in to your system, I am looking at another few days of pain.
    FYI, as you can see - I am sensitive to what others think of me, I got it from overly aggressive parents....
    Can anyone give me any advice? I like the way this doesn't sedate me though, again, it is so much better than traditional meds like loratab. I too, have a sense of 'normal' Please advise.
  • I was on the Butrans patch from August until about one week ago. I was on the 5 mcg dose and just loved this medication. About a week ago, I became severely dizzy and lightheaded. I felt that maybe the patch was over-delivering but I wasn't sure. I also noticed that I was urinating a ton and perhaps my sodium got low and accounted for the symptoms. But anyway, I quit the patch and have been avoiding withdrawal by using a bit of Percocet. I did have to take a bit of anti-nausea medication with the patch at times. I found the most effective by far to be Zofrain. The patch also gave me great pain relief. Better than other meds including Percocet and Oxycotin. I hope to resume it in the future, however, I need to talk with my dr. first and find out what in the heck happened.
  • Lacansada, Thank you so very much for the reply. I have noticed that every now and then I will get a nausea feeling - its not the common but it can be aggravating. I am so far very impressed with it --I am still in pain but I am on the 10 mg and doubleing it seems kind of scary. I have had the best sleep of my life since, and its only been 5 days.
    Don't take this the wrong way , but I hope you just had a bug and maybe you can get back on it. I have been suffereing for 8 years and have been on every thing from Lyrica on. Those drugged me so much I couldn't function. Did you notice feeling drugged with the patch. I don't, it is amazing. also, the ups and downs that come with pills, along with constant ulcers aren't there - or at least my stomach has only had mild discomfort since, but again, it hasn't been that long.
    Again, Thank you for repling. It is hard to be stuck at home with a 3 yr old, that already makes me feel so very alone during this. 3yr olds don't care if mommy hurts and I try not to influence his childhood with moans and groans.
  • Dixie chick, you're most welcome. I also slept great on the patch and felt more normal in the head than I had with any other drug. It was amazing. I have a dr. appt in one week and I might ask about about the oral or sublingual form of the drug. I hate to give it up. It seemed to have an antidepressant effect on me and I was reading that this is common with this medication. Until I had the dizzy spell (it did last 3-4 days) I felt great. I hope it works as well for you!
  • I started on a 5mcg patch and was told that for the first time, it takes 2 to 3 days to reach a steady state in your system where it is dispensing the drug evenly. I was told that if after 48 hours it was not helping enough that I could put on a second patch which I did (actually after 72). At first, after the 2nd patch I felt so much more normal and more "me". Now, having just started patch 3, I hurt pretty badly. I don't know if it's from increased activity because it was feeling better or if my body just adjusted. The doctor said that if needed I can add back in Tramadol for extra pain management but because I reported that my head was "spinny" (yeah, pain meds and a consistent 4 to 5 hours of sleep are not really a good combo), he opted to not up the dose to 20. In the meantime, I am temporarily off my large Celebrex dose and am not allowed to take the Tramadol until after a test on Monday. Sigh.
  • I've been on the 5mcg/hour for maybe 6 months now. It was amazing how good I started feeling with my first patch. I'd say I feel normal on a regular basis. Previous to the butrans patch I was taking up to 6 500mg metaxalone (muscle relaxer) thru the day and 2 flexeril at night. I was only taking pain medication on a irregular basis b/c it was so inconvenient to go to the DR every month to get a refill. I have tramadol for my bad days. I don't like the tramadol at all. It makes me wiry and jittery - like I've had to much caffeine or I'm on allergy meds or something. If I don't take the tramadol before lunch - I just skip it regardless of how I feel - otherwise I'm awake all night. My days are motstly good.. Bad days are usually the result of sitting too much - ie being at a conference or riding in the car for a long time. I've also found that avoiding pushing really heavy grocery carts has helped too. A trip to Sams without help can throw me into a tailspin. I have found that it is a good idea to NOT drink alcohol while one the medication. I can have one drink or so in a social setting but I've found my tolerance to alcohol is way down. I don't mind this at all.

    For those that have a rash with the patch, I've only experienced a mild rash when the patch was exposed to sun. Apparently, the new machines at the airport also can pick up the patch. I wish it could be worn in more locations. After another round of physical therapy and 3 or 4 steriod epidural injections - my lower back, leg, sciatic pain is almost nonexistent. My neck and shoulder continue to flare up.
    Fusion at C6-C7 in 9/2010. Now problems with C5-C6
  • I've been on the 5mcg/hour for maybe 6 months now. It was amazing how good I started feeling with my first patch. I'd say I feel normal on a regular basis. Previous to the butrans patch I was taking up to 6 500mg metaxalone (muscle relaxer) thru the day and 2 flexeril at night. I was only taking pain medication on a irregular basis b/c it was so inconvenient to go to the DR every month to get a refill. I have tramadol for my bad days. I don't like the tramadol at all. It makes me wiry and jittery - like I've had to much caffeine or I'm on allergy meds or something. If I don't take the tramadol before lunch - I just skip it regardless of how I feel - otherwise I'm awake all night. My days are motstly good.. Bad days are usually the result of sitting too much - ie being at a conference or riding in the car for a long time. I've also found that avoiding pushing really heavy grocery carts has helped too. A trip to Sams without help can throw me into a tailspin. I have found that it is a good idea to NOT drink alcohol while one the medication. I can have one drink or so in a social setting but I've found my tolerance to alcohol is way down. I don't mind this at all.

    For those that have a rash with the patch, I've only experienced a mild rash when the patch was exposed to sun. Apparently, the new machines at the airport also can pick up the patch. I wish it could be worn in more locations. After another round of physical therapy and 3 or 4 steriod epidural injections - my lower back, leg, sciatic pain is almost nonexistent. My neck and shoulder continue to flare up.
    Fusion at C6-C7 in 9/2010. Now problems with C5-C6
  • That's good to know that these can be detected at the airport. Between that and my new fusion hardware, I'll be setting off the machine left and right. LOL. Anyway, I've been on the patch for months and months now. I have a 10mcg and 5 mcg patch though I might change to a single 20 just to save money. I find it very effective for about 5 to 5 and a half days. I get a rash almost every time and it takes over a week to go away. That's one of the worst things because it itches like crazy. I had fusion surgery (thoracic) about 6 weeks ago and this is helpful for more constant pain relief that can be supplemented as needed.
  • Can someone tell me how this medication is used for treating heroin addicts by blocking their opiate receptors so that when they use they dont get high, yet at the same time I am being prescribed 20mg (started with 5 then 10mg with little response).
    In addition, my doctor is giving me norcos and dilaudid...??? How are the pills supposed to have any affect when the butrans supposedly blocks those drugs from working??!!

    -Pained and Confused
  • It doesn't stop other opioid drugs from working when it is used for pain relief. In very high doses (much higher than the doses used for treating pain) it occupies a greater percentage of opioid receptors, leaving less room for other drugs to bind to the opioid receptors. In the lower doses used in analgesia it doesn't do this, allowing other opioids to be used concurrently for additional pain relief.
  • Hi Huggy, thank you for the response. I am trying to understand how this butrans works and how it will help me. If I use Butrans in high or low doses I have felt an initial relief from pain but after a few hours I am feeling horrible again and can't function. It never works long enough to significantly impact my pain levels and I am completely incapacitated.

    I started with 5mg, then 10 and now 20 - not to mention me PM doc says I can double up on the Butrans (I know about the ceiling amount...) But it isn't helping and he has been giving me slowly increasing levels of norcos and now the dilaudid. In the past norcos helps me with the aid of a muscle relaxer, and when I got in a TERRIBLE accident needing over 70 stitches in my face i was prescribed a lot LESS dilaudid than I have now - which was extremely powerful.

    With the Butrans, my 4mg Dilaudid (or more) is not impacting my pain at all.

    I have been reading as much information as I am humanly able to take in, and I am still not getting how this medication is supposed to hep me get on the road to recovery with my physical therapy when I can barely stand up.

    I read the gigantic pamphlet that the patches come with and it said that if a Butrans user is undergoing surgery or any excessive pain and need to use an opioid to stop using the patch so as to feel the effects of the opioid.

    Am I taking too much and the Butrans is "hogging" my opioid receptors? I have been suffering with a severe back injury for so long that I realize I have a high tolerance, but if I don't get relief I am unable to function and live my life.

    I have stopped using the Butrans patch I am finally able to actually feel the benefit of my normal opiate painkillers like before. I think it's great that this exists to help relieve withdrawal and addiction problems in people who have become overly tolerant and dependent on opiates, but does anyone really truly feel that it enhances their pain relief in conjunction with other pain killers? Does anyone feel that Butrans has a lasting and impact-full effect on their recovery? I have been giving this a really long time to work - many months- and it just doesn't really even take the edge off for me no matter what other drugs I take to supplement.

    Any input or advice - especially from personal experience with Butrans - would be most helpful.

    Thank you so much I just want to get myself back to work and building a stronger body for future health. I am sick of feeling this way.

    Warmth,
    JB
  • Hi JB, sorry I didn't respond sooner. I have been away from the board for a while tending to my sick cat, among other things.

    From what I understand of buprenorphine (from my own experience and from what I've been told by my doctors), it shouldn't be a problem to take doses of other opioids for breakthrough/additional pain relief along with buprenorphine. It says on the leaflet that comes with my prescriptions that the effect of other mu opioid receptor agonists won't be affected when taken on top of buprenorphine. It also says that it could cause problems if someone who is already on a high dose of another agonist starts taking buprenorphine in addition to them (I presume due to the greater binding affinity of buprenorphine). At the analgesic dose range buprenorphine doesn't (according to the literature) occupy so many receptors that other mu agonists have no 'room' to work. I know that at high doses (16mg or so, if I recall correctly) it takes up around 80% of available receptors. But that's way above the doses used in analgesia.

    I wonder if it's an individual thing? In my own experience, I've had no trouble feeling the effects of morphine IR along with my regular Temgesic sublingual tablets (I've never been on the patch, as they don't have it over here). However, I have noticed that while I have no problem getting the full effect of morphine, I didn't seem to get much relief at all from the oxycodone I was prescribed before I started on morphine. I don't know if it's down to the particular brand being a bit weak, or if it's just the way my body works?

    Another thing I have noticed with my buprenorphine sublingual tablets is that there is sometimes a fine line between getting little to no relief and getting a lot of relief -- sometimes I think I might be able get by on one less tablet, and I'm always struck by how much difference that little bit can make. These days I make sure I take the right dosage and combination of other meds that work best for me.

    If it doesn't work for you, there's probably no point in taking it. I know some who swear by Butrans/Temgesic, but I also know others who, like yourself, have not found it to be of much help at all. Different things (and different combinations of things) work for different people, I guess. Maybe something else would work better for you, personally.

    Good luck - I do hope you get some relief soon.
  • rob6378rrob6378 Posts: 1
    edited 05/05/2013 - 1:04 AM
    I am on Butran 20mg Patch and I still have to top it up with tramadol and codeine and I find I am still in pain, to be honest I don't feel any different in the 10mg to the 20mg it could just be me . I went through the same problem with my Doc and my work they thought I was making it up it was only after I went for an MRI on my neck and lower spine that it has now come to light and been referred to a surgeon , I was told for over a year that it was muscle sprain and I would be fine in a couple of months, but unless you have had the pain yourself you will never understand what it is like, I thank God for MRI's
  • ...one of the generic Fent patch manufactures will send you covers for free if you are having adhesion issues. Maybe call the person making your butrans patch?

    Also 3M makes waterproof ban aids. They look like the ones they place over IVs in the hospital. They are larger and have a clear window on them. Some pain docs will call them in for you as they are like 10--12 a box of 8 OTC.

    Just food for thought on adhesion issues.
    Jun 2011 -TLIF @L5-S1
    Mar 2012 -NonUnion @L5S1
    May 2012 -Multi Level Discography
    July 2012 -XLIF 2Cages @L3L4/L4L5
    Aug 2012 -All New Hardware @L34L45/L4L5/L5S1
    Mar 2013 -FBSS = Pain Management until they figure it out.
  • Hey everyone...I'm new here. Been dealing with serious pain for many years but only recent;y gotten severe enough to seek support. I'll check out the site, and do a post in the new member section. For now.......

    I'm curious what folks know about this Butrans patch because I was just put on it. I'm on the 20mcg/hr patch and agree with folks that these patches run out at day 5. True too that I don't have to deal with the sedation and other sides, including withdraw. But the overall efficacy is mediocre in my opinion. It actually seems pretty mild.

    What I'm confused about is if you do the math on a 20mcg /hr patch...that equals 480mcg in a 24 hr period. 480mcg = .48 mg. Round up to .5 mg in a 24 hour period. The standard dose of Suboxone with everyone I've talked with (patients and staff) is the 8/2mg (8mg Buprinorphine & 2mg Naloxone) twice a day. That's 16 mgs of Buprinorphine a day. That's an extreme difference in dosage. The Butrans is .5 Mg a day and the Suboxone 32mg!! What am I missing here? Is my math that bad? Yea, maybe a person needs a bit more with the addiction factor, but come on, that's 32 times more! I suppose the continual release of the patch keeps blood levels up, but that still doesn't add up. Can anyone tell me what I'm missing here?
    Tristen
  • TristenTTristen Posts: 2
    edited 01/08/2015 - 6:32 AM
    Hello everyone....I'm new to this board and will post in the newbie thread soon. I've been dealing with chronic pain for many years, but have only recently gotten bad enough to seek support.

    I found this site searching Butrans because I was recently put on it. I'm on the 20mcg/hr patch and have to agree with some posts here that it wears off after day 5. I have to say as well, that the efficacy pain relief is mediocre at best...and I'm on the strongest patch. Because I know people on Suboxone, and the typical dosages they use, and my inadequate relief with these patches, I'm questioning why the doses are so low.

    I'm thinking I must be missing something because doing the math ...... 20mcg/hr = 480mcg in 24 hrs. That's just 0.48mg in a 24 hr period. The typical dose of suboxone is the 8/2 twice a day. That 8mg Buprinorphine & 2mg Naloxone. 8mg twice a day is 16mg a day. So if my math is right, the typical daily dose of suboxone is 32 times stronger than the Butrans. Maybe it requires a higher dose for people really strung out on heavy opioids, but no way would it take that much more. So since I get such inadequate relief of pain with the Butrans, I'm just wondering if it's just because the dose is so extremely low. Very odd that the strongest Butrans would be that low of a dose. Anyhow.....anyone have any insights on this?

    Thanks much,

    Tristen
    Tristen
  • I was on the patch for almost a year. I understand the conversion difference, but I tell you what. I had to stop the patch because it caused me to stop breathing at night! I can't imagine taking any more of it. I would be dead.
advertisement
Sign In or Register to comment.