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Butrans Patch Anyone? Just Got Mine Filled

LaCansadaLLaCansada Posts: 35
edited 06/11/2012 - 8:56 AM in Pain Medications
Hi all. I have been in PM for the past 4-5 years for SI joint pain. I used to be on Oxycotin and, briefly a Duragesic patch, and then the pain got more bearable and I have been taking Percocet 5 mg, four times daily + Lyrica. Just went to PM dr. I am two months post an SI joint Rhizotomy and having a bad pain flare. I really felt that I needed better pain relief when I was seen today and was given the Butrans Patch 5 mcg, to be increased to 10 mcg after 3 days if no results. I did some research on the internet and realized that this is Suboxone! Wow. At first, I was freaked out thinking it would do nothing for pain, that it's for opiate withdrawal. Then I read more and have heard that it does help even severe pain with the added benefit of not having the typical side effects of heavy duty narcotics. I work as a psychologist at a prison so I cannot be impaired on the job and my dr. and I discussed this. I am hoping to hear from someone that this drug works. And I would be so glad to ditch the whole pain pill thing as well if I can. I need a change badly in my PM plan. Thanks for any input anyone can give me.


  • i am on week two of my butrans patch rx and i have to admit i was kinda surprised at the results i recieved as well. although the pain control doesnt last the whole seven days for me ( usually about 5 days) at 10mg i have to admit that my nerve pain has been significantly reduced, better control than i have had in a while. I still have to take some break through meds occasionally and still take my muscle relaxers but not anywhere near the amount i had to take in the past. i hope it gives you some relief. the first few days suck while getting used to it but it does go away. please let us know how it works for you. good luck.
  • I'm prescribed buprenorphine as well, as my main analgesic. The patches aren't available here, but the sublingual tablets are longer-acting than most IR meds (6-8 hours, generally). They don't get rid of all of my pain - nothing does - but they help more than the other drugs I've been prescribed over the years (morphine, oxycodone, dihydrocodeine, tramadol, etc.), and the safety profile is very good, so that's a nice bonus. One thing I have found is that I have to be careful to get the dose just right - I can take 0.8mg sometimes and barely get any relief, but one extra 0.2mg tablet often makes all the difference, giving me significant relief.

    Edit: Just remembered - one other thing I have noticed with buprenorphine, as opposed to other opioid analgesics, is that they cause less heaviness and grogginess. I often feel energized after taking it, and a lot of people have reported similar benefits, including an antidepressant effect (minus all the adverse effects of the usual antidepressant drugs).
  • Thanks to both of you for the replies. Glad to know that it was rough at first so i will not just throw away the patch if I feel bad on it after one day. I am impulsive and that's what I did w/many of my Duragesic patches. As soon as I felt nauseous, in the garbage it went. I am also working w/a rheumatologist and they are trying to rule out a non-rheumatoid inflammatory type of arthritis. My recent MRI showed sacroilitis. Glad to also know that a small dosage adjustment can make a big difference. I am only on 5 mcg and I have a feeling I will need a minimum of 10 mcg. But heck, I've never taken this drug before. Can you take break-through meds on top of it if you are still in pain? Such as the Percocet? I forgot to ask this.
  • Sorry this reply is so late - I've been away for a few days. Yes, you can take breakthrough medication with the buprenorphine patch. I read a lot about the drug when I was first prescribed it, and I checked with my PM doctors too, and they both said it's fine. Trials have been conducted using the buprenorphine patch along with various other opioid drugs, including morphine, oxycodone, hydromorphone and tramadol, and there was an added analgesic effect, but no antagonism. Buprenorphine is sometimes described as an agonist/antagonist because it has agonist effect on the mu opioid receptor and some antagonism at the kappa opioid receptor. My doctor prescribes me breakthrough medicine (morphine and sometimes tramadol) on top of the buprenorphine, and he told me there was no cause for concern within the usual analgesic dose range. I have never had a problem (I take between 1.6 and 2.4mg of buprenorphine a day, on average).

    Buprenorphine is a partial mu receptor agonist, which basically means it has activity at this opioid receptor, but less than, say, morphine (which is a full agonist). At low doses, though (the range used for pain management), buprenorphine acts as a full mu receptor agonist.

    Obviously, like all drugs it works well for some and not so well for others. It helps with my pain - not 100%, but then again nothing does - I'm happy that it just reduces my pain at this point (nothing else has been helping much). I hope it works well for you and gives you relief from your pain.

  • Thanks Huggy for your comments. Day 4 on the Butrans patch and I am loving it. I am getting as good of relief as I had on the Duragesic patch without the terrible side effects. I did not realize until I began this medication just how bad the Percocet & Oxycotin was making me feel. I did a little bit of research on this drug on the internet and was trying to figure out if it is Suboxone? Or is it Suboxone minus the Nalexene? I am on the lowest dose, 5 mcg, and am plenty happy with the pain relief I am getting even at this low level. But I only have a vague understanding of how it works. Thanks for your helpful explanation. Lisa
  • Hi Lisa, glad I could be of help. I'm happy to hear the Butrans patch is working for you - I've seen a lot of similar comments from people who've tried it after taking other opioids and have been happily surprised by how it works and the lower incidence of side effects. There is a respiratory ceiling dose ith buprenorphine, which means it's practically impossible to die from an overdose, which is another advantage, obviously!

    Buprenorphine is the same opioid that is in Suboxone, but in that formulation it is mixed with naloxone (an antagonist to deter abuse by injecting) and it is typically at much higher doses (from 2mg all the way up to 32mg). In these higher doses it's supposed to be helpful as a substitute for other opioids in people who have addiction problems. It's been used for this purpose for nearly a decade in the US, although it has been used as a pain reliever for at least thirty years in many other countries. It's use for chronic pain is on the rise now, as more and more research has concluded it is a safe and effective alternative to other strong opioids.
  • Yesterday was day 5 - by 6:00 pm, I felt that the patch was wearing off. And i still had 1.5 days to go. Today is day 6 and I ended up changing it at about 3:00 pm. It was not due to be changed until tomorrow at 6:00 am. How have others with this problem managed to resolve it with your dr? My PM dr is pretty nice but also pretty strict. Even if he says I can change it on every 5th day as opposed to the 7th, I'm not sure the insurance will accept this. But first thing's first. I need to get my dr. on board. I hope I don't have to just tough it out for 2 days. I will have no BT meds soon, so filling in this way will not be an option unless the dr. agrees to do it. Or maybe I could stretch out the last two days with the sublingual suboxone. Any thoughts? Thanks again. Lisa
  • I am going to talk to my pm about these patches next week. I am so sick of feeling tired all day from the oxycontin cr, oycodone and zanaflex plus my pain is not being controlled very well on the higher dose any longer. But feeling utterly exhausted all the time is depressing in it self.

    Thanks for the thread

  • Julie, I think you will be very happy w/this patch given what you are on now and have taken. Prior to beginning this medication, I was aware that I had slowly lost my life due to the effects of various pain medications but felt trapped b/c I still need pain relief. I switched over from Percocet 5 mg 4x daily, but had previously been on Oxycotin + Percocet. This is much better. And the Percocet was barely doing anything for me after one year on it. I wish you the best at your appt. Please post and let us know how it went. Lisa
  • Lisa, you should probably talk to your doctor about the patch wearing off before the whole week is over. This seems to be a common problem with many extended-release medications: the period of effective analgesia seems to vary from person to person. OxyContin, for example, is supposed to work for a full twelve hours, but some people find the effects start wearing off after only about eight hours. I expect there are similar variations with the buprenorphine patch.

    It's a pity you don't have Temgesic (the sublingual tablets intended for pain relief) over there. I don't know about Suboxone, to be honest. I hope you can get this sorted out with your doctor. Good luck!
  • Hello All,

    Sorry to jump in so late on this topic, but I've also had very good luck with the Butrans patch. I start my third month tomorrow, and I would say that the 20mcg patch has knocked at least 1 number off of my daily pain scale. Still a bit of break-through pain, but I finished 30 days of the patch and still had almost 1/2 of my monthly script of Oxy IR's left over!!! To me, that speaks volumes about the effectiveness of this medication. I just don't feel the need to take something every 4 hours now, and my pain is much more consistent in regards to flares and spikes. Still the occasional horrible pain days, but all in all a big improvement. Good Luck to all who try this med, I'm glad I have a progressive doctor who looks out for me and keeps me informed of new products.

    L5/S1 Fusion
    L5 Nerve Root Decompression
    Staph Infection post-decompression op
    SCS implant/replacement/removal
    L4 is starting to go......
  • My PM said there is no way the Butrans patches would touch my pain since I am on such a high dose of extended release Oxycontin 40-50 mg every 8 hours (I would need to be around 30 mg total daily) and Oycodone 4-5 mg PRN.

    I do not/will not up my meds since taking the higher dose already makes me a zomby :jawdrop:

  • have been taking 5 to6 7.5 norcos a day for back pain.they have sucked the life out of me.no motivation to do anything,feel like a zombie.talked to doctor and he is going to switch me to butran patch in 2 weeks,10 mg.has anyone had similiar experience and been able to enjoy life again?
  • Butrans is dosed in micrograms, not milligrams. Each medication works differently for someone than it does for another, but those who have tried butrans seem to like it, and it's pain relief properties. Like any pain medication , you want to use the lowest dose that offers you pain reduction to a tolerable level. No amount of opiate will eliminate all of the pain, so reaching a reduction of about 50% of your unmedicated pain is usually the goal. The only major problem is that for some, the adhesive causes an irritation but talk to your pm doctor. I have found that using an antihistamine nasal spray on the skin, then letting it dry seems to prevent the irritation.
  • I have been on Butrans patch for several months. I wanted it so I could get back to living again! Tired of being a Zombie! I am now up to the max 20mcg. But what a relief! Combined with Tramadol, I can do everything I did before. Definitely try it! It is 50 times stronger than morphine without the high.
  • I just starting on Butrans (called Norspan here) today. I'm really excited about it. I like that you only need to change it once a week. I have been taking pills every four hours for nearly a year and I'm sick of it. According to my PM tolerance isn't much of an issue with this med and it causes less drowsiness and constipation. I've also read of possible anti depressant effects.
  • Okay for me except really irrates my skin. I will probably have to change
  • It seems to work best when I put it on the side of my chest (maybe skin is thinner there?) It does itch and get irritated sometimes but it is def. a lot better than the strong narcotics!
  • robynmomrrobynmom Posts: 1
    edited 03/27/2015 - 2:42 AM
    horselady21 said:
    I have been on Butrans patch for several months. I wanted it so I could get back to living again! Tired of being a Zombie! I am now up to the max 20mcg. But what a relief! Combined with Tramadol, I can do everything I did before. Definitely try it! It is 50 times stronger than morphine without the high.

    thought u might want to know u are wrong about but ran being 50 times stronger than morphine. Fentanyl is 50 times stronger than morphine. Fentanyl is the strongest pain med out there. That's why butran is a schedule 3 drug and fentanyl is a schedule 2. u do get a fog at first but like almost any pain med your body just takes time to get used to it.
  • akanaeaakanae Posts: 4
    edited 05/08/2015 - 4:56 AM
    I've been on PM for 7 years. I used to only take 5mg Hydro when I needed it. i.e. Working too hard, long ect. 3 years ago, my pain got worse and I have been on pain meds every day since then. I've worked my way up to 10/325 Oxycodone every 4 to 6 hours. I didn't realize how bad I felt until the doc put me on 20mg Butrans patch. I went from feeling like I was moving through thick pudding, to walking on air. Not a high at all. Just much easier movement and more energy. The doc gave me my 10/325 and then cut me back to 5/325. My favorite days are when I don't have to take any pills!!!! Since the doc took me down to the 5's, I'm exhausted by 5pm. I can't keep my eyes open. My surgeon gave me 10mg oxi IR and no fatigue. What the heck in the 5's that make me so sleepy?
  • It is the Butrans patch. They make you VERY sleepy (actually, they depress your respiration)). I have been on it for over ayear, and had to stop for a while because of the interaction with other meds. I stopped breathing at night in bed. Found out my thyroid was underactive. Now all is good. I would be lost without the Butrans!
  • nanaofmanynnanaofmany Posts: 1
    edited 08/26/2015 - 8:28 PM
    I have been on patch for 6 days. Today I noticed it not working I have it on my left upper shoulder where is the best place to get the most relief?

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  • dilaurodilauro ConnecticutPosts: 9,818
    edited 08/26/2015 - 1:50 PM
    that came with the patch shows you the best spots.

    I've used them many times and I felt that the best spots were:

    • Front of my chest
      Sides under the arms
    One thing that I have always noticed about these patches and why I like them is that you dont know if they are working or not! But, for myself when I can reduce the number of breakthrough medication from 8 to 2 per day, something is really working.
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • I've been using Butrans for a little over a year now. It took several months to settle in on the correct dose, but I have really benefited from this patch. My doc prescribes me 15mcg Butrans and Norco for breakthrough pain. The first couple weeks, I did have some fogginess and suppressed appetite, and I had really annoying itching issues for probably 2-3 months. I remember some days I thought I'd scratch a hole through my skin because it itched so badly, but I am SO glad that I didn't give up. At this point, I have no discernible side effects (other than redness of the skin after removing the patch), and the patch takes my constant, baseline pain down a good 2-3 points on the silly pain scale. It took me a while to realize that, for me at least, these patches are only effective for that baseline pain and not for the spikes. But (as long as my insurance keeps covering it) that reduction in baseline pain is well worth it.
    I do have complaints though, but what pain medication doesn't come with complaints? I do not get 7 days worth of relief out of the patches. By the 5th day, I am definitely feeling more pain. And on the 6th day, it often feels like I don't have it on at all. I talked to my doc about it just yesterday and if insurance isn't going to cause me grief, he's going to write my next RX for me to change after 5 or 6 days. Also, the patch does not stay on for me for more than 3-4 days unless I cover it with tegaderm to seal out water. I would HIGHLY recommend picking up some tegaderm film when you pick up your Butrans. It's worth it IMO.
    Something I found out the hard way (on several occasions... I'm slow sometimes) is that the heat related increase in how much medication is released (more medication is released when you are hot) can make it easy to overdo things and not realize it until a while after you cool down. I was on a beach on vacation in April and it was hot and I was active. I felt great and kept playing with the kids because my pain wasn't ramping up as it normally would. But an hour and a half after we left the beach and got into the air conditioning, I was in such pain that my breakthrough meds couldn't touch it. I couldn't leave the hotel room for 2 days after that. The increase med release from the heat had masked that I was overdoing it with kids at the beach and the result cost me a big chunk of my vacation. Live and learn.
    I have not noticed any increased tolerance with Butrans so far; it seems to be as effective today as it was a year ago. For me that is HUGE.
    As far as placement of the patch, the literature that comes in the box covers that pretty well, but it might be worth talking to your PM about it as well. Mine gave me instructions that contradict the placement instructions that the manufacturer suggests, and I've had less skin problems using his advice (which I don't want to give to others because it contradicts the official instructions).
    Overall, it did take about 5 months to settle on the right dose, placement and care (tegaderm), so be patient. For me it was well worth the wait. I have a very good friend who has also been using Butrans for close to a year, and he has had even better experiences than me... but then again, he's generally a more patient guy as well.
    I hope sharing my experience with these patches helps someone out there. Good luck to you all!
  • My PM Doc has prescribed my patches for every 5 days, not 7. What a difference it makes to get a new patch every 5 days instead of every 7 days. I used to suffer from terrible night sweats on day 6 and 7 and I didn't understand why until my PM Doc told me it was withdraws. Once we changed the frequency of a new patch , poof, better relief and no more night sweats.
  • DedalusDDedalus Posts: 92
    edited 09/25/2015 - 5:02 AM
    akanae said:
    My PM Doc has prescribed my patches for every 5 days, not 7. What a difference it makes to get a new patch every 5 days instead of every 7 days. I used to suffer from terrible night sweats on day 6 and 7 and I didn't understand why until my PM Doc told me it was withdraws. Once we changed the frequency of a new patch , poof, better relief and no more night sweats.
    I finally just got the change from 7 days to 5 days approved by my insurance company!
    I too have night sweats on days 6 and 7, but I thought it was just my anxiety disorder. I never thought that it could have been withdrawal. Now I can't wait until next month when I can start changing every 5 days. I'm excited to think that I might get better sleep and better pain relief for those 8 days that normally suck.
    Regardless, I am still so thankful for these patches.
  • Good luck with the patch it worked for me for short time since it created a rash so bad that I had to stop using.
  • Stellarpuc1SStellarpuc1 Posts: 1
    edited 12/11/2015 - 7:40 AM
    grammaof9 said:
    Good luck with the patch it worked for me for short time since it created a rash so bad that I had to stop using.
    - Mario D. D.O. Oregon Health Science University
  • SavageSavage United StatesPosts: 5,422
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  • I have been on a Duragesic patch 75mcg and I have to switch thanks to a new bill passed in Jersey.  I'm on an immunosuppressant because I have Lupus and I don't want to go to a pain clinic which is required with these patches.  I went once.  I ended up sick as a dog from all the people there.  Anyway, I'm scared of this Butran patch.  I'm starting at 20mcg, but it keeps warning about being so life threatening.  Anyone out there have an opinion?
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