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Duragesic 75mcg - Newly Ordered...

TrixieMamaTTrixieMama Posts: 64
edited 06/11/2012 - 8:59 AM in Back Surgery and Neck Surgery
Hello my beloved spiney friends!

Merry Christmas to you all! I hope that you all have a blessed weekend!

I was hoping that over the course of the next few days a few of you may weigh in on my med therapy and help me determine where I should go from here or just give me your opinion :)

For those who don't know or have forgotten, I am 6 weeks post op from an ALIF and had complications 3 days after d/c resulting in a readmission. Total hospitalization for both admissions = 14 days! When I was in the hospital I was taking Dilaudid 2mg q 3 and Percocet 20mg q 6. I mainly took the Dilaudid while there because it helped me sleep and I wasn't up a whole lot either admission. On d/c I was suppose to come home with 20mg percocet because that is what my paperwork says but I was given an rx for 5mg percocets and told to take them with my 10's I had at home for a total dose of 15mg. I did that and alternated the two meds, percocet and dilaudid q 4 hr. I was suppose to have my PLIF to complete my 360 on the 17th but I had really severe anemia so they cancelled until January. Last week I was able to cut out one dilaudid dose but had an increase, dramatic in my pain level.

Saw my surgeon for f/u on Thursday and had xrays, everything looks great, gained 14mm on one disc height and 10mm on the other. Spondy will be repaired in January when I have my PLIF. So we discussed pain control and he said he wanted me to get Duragesic 75mcg patches and then take 10mg of Percocet for breakthrough pain, d/c the Dilaudid. So this week I d/c'd the dilaudid but because it's workers comp, I don't have my meds yet. All I have are percocets so I went back to taking 20mg which is what I was on a couple weeks ago and now i'm able to go 6-7 hours with pain relief and am able to be very mobile vs. staying in bed all day and not doing much of anything except sleeping and crying in pain with the 15mg perc's and 2mg dilaudid.

So now i'm caught because i'm afraid to take the Duragesic patch at this point since i'm so well controlled. I'm also not sure how my surgeon will handle the fact that I changed things around. I didn't do it because I was drug seeking or looking to get high, I did it because my 5mg's ran out and all I had were 10's. Okay, so why not split it in half, can't get a straight cut. they aren't slotted pills and they break apart in small pieces. Totally useless to gauge a dose by at that point.

I figured that I would call the pharmacist tomorrow and tell her that I stopped the dilaudid and am now taking 60mg total per day of the percocet so she can better gauge my dose. At this point, I think 75 mcg is too high. I have been on them before and was on 75mcg but I was hospitalized at the time and was on cardiac monitors/pulse ox so no worries about respiratory depression, at that time I was also getting 6 of morphine IVP, 4 of dilaudid IVP and 100mg of Demerol IM. (I was having internal hemorrhaging that caused excruciating pain that was intractable). All things considered, given the fact I was lucid while I was getting all this I suspect I could probably tolerate it but this was in 07, not sure how the body changes with regard to opiod tolerance. Silly to say that considering i'm a nurse but I don't deal with that type of stuff in my field right now so i'm kind of lost on that point and figured you all could help me out because I know many of you are on similar drugs and have had the conversion.

Also, after a lot of reading the past two days, I really don't want to take the patches. Since the perc's at 20mg are working so fabulously, I would prefer to stay where I am. Surgery is in 3 weeks. Do I say something to my doctor or just call the pharmacist and tell her and then not take the patches or call my doctor and tell him? I really like him and have a good relationship with him, I just worry he will think i'm drug seeking or something. TBH, I feel so great I think I can taper the dose a bit this week too. My hope is that by surgery (second week of January) i'll be back down to 10's and in decreased pain. Each day seems to be getting better.

Thanks for your help on this. Funny how it can be so hard to make what seems like a simple decision. This is all new to me and I just don't want to get hooked on Duragesic patches. The w/d from them is horrible. I worked with patients doing through w/d from multiple meds and have witnessed some horrific symptoms.

IDK. Give me your thinks and thoughts :) I always value your varied opinions and am so grateful to have this forum as a support net.

I hope you all have a very blessed Christmas/holiday/Hanukkah/etc. :) and that you find blessings behind every corner, share the sweet sound of laughter and make wonderful memories with your friends and families. God bless you all and thank you so much for your help.

Hugs and blessings..


  • SavageSavage United StatesPosts: 5,427
    Me personally, I would not involved the pharmasist in this kind of decision.

    Not knowing what the doc said to you, but my experience, when we do med change, I stay on the d/c'd med until the new arrives..so I am not left without anything.

    Another thing about switching meds..my doc doesn't want my body to...like get resistent to the daily routine med, so we go back and forth each year.. same breakthrough med.

    Initially, I was on the patch, then the oxycontin, now back on the patch. For me, I have never had any trouble with the patch.

    As usual, everyone so different. I like the patch..I put it on and that's it few days. Of course I still need breakthrough med...but...

    Also,just curious if doctor wanted you to taper you med..or your idea? For me, I would want to stay ahead of the pain and as controlled as possible before next surgery.

    I wish you luck with your decisions and best of luck on upcoming surgery!

    Spine-Health Moderator
    Please read my medical history at: Medical History

  • Hi Savage!

    Thanks for responding!

    I am a WC case and when my meds run out, i'm out until they approve a refill. Mind you I do not over medicate. I stopped the dilaudid because I was tapering off which he knew about my cutting one dose and noticed after doing this that I began waking up during the night when the dose was due, not from pain but from severe shakes and anxiety. Likely w/d s/s. I'm a nurse so I know not to go cold turkey. I tapered down and he was/is aware. I have not spoken to the pharmacist at this point..

    Basically at my appointment, he told my sister and I that I was to stop the dilaudid, he no longer said to taper, I was down to 2 doses per day along with the percocet, he just said to stop it So I did, no more problems after that with the shakes or anything. As for the percocet change, he decreased my dose starting when I got my patches, unfortunately it is a holiday weekend and my wc insurance company was closed Friday so they couldn't get the authorization for the patches so I was left with either starting back on the dilaudid or trying to come as close to 15mg as possible with the percocets. Trust me, I am not self adjusting on purpose or want too. Problem is, 10mg doesn't touch the pain, if I split a 10 to get to my dose of 15mg, the pill splits in a dozen pieces so i'm back at square one.

    Even if I called the surgeon this weekend, nothing would be done because it's a holiday and the insurance company is closed. No authorization no meds. I can't afford to pay out of pocket several hundred for 5 prescriptions so I have to wait. I can't even afford the necessary patches, they are too expensive and to top it off the pharmacy doesn't carry them, they have to order them. Either way, I was/am stuck waiting.

    IDK, I just was curious since the perc's are working now, do i really need the patches? I will call my surgeon tomorrow and ask to have him call me back. I'm sure i'm just nervous about the patch because I read too many bad stories :) The anxiety that has accompanied my year long wc story has been unbelievable, the littlest thing can turn into something huge, likely like this patch deal :)

    Thanks again.

    I hope you have a blessed Christmas.

    Hugs and blessings...
  • SavageSavage United StatesPosts: 5,427
    ..nothing is easy any more. As you said even script change can be so complicated. But thank God for the meds! I don't know what people did ages ago,

    Also, just want to clarify..and hope in no way I offended you. That was never my intent or in my mind.

    When I mentioned the meds and doc knowing...I was more from the perspective ...hate to see you suffer without meds.

    I know I and am pretty sure noone else here in our "cyber neighborhood", would ever think of you being a drug seeker. We are all so much in the same boat... just wanting pain control.

    Take care!
    Spine-Health Moderator
    Please read my medical history at: Medical History

  • MetalneckMetalneck Island of Misfit toysPosts: 1,364
    The action and uses of perc vs fentynl are very different and for very different purposes (IMHO)

    THe percs are used more for breakthrough pain - the patch is to provide a long acting 48-72 hour coverage.

    Its great that the percs are controlling your pain at the moment .... but it sounds like you have more surgery comming .... Heck I wouldn't wanna second guess the doctor but have him/her explain their thinking as to the change now. It maybe to better handle what is comming in the near future.

    Just thinking openly and honestly!!

    Merry Christmas!!

    Spine-health Moderator
    Welcome to Spine-Health  Please read the linked guidelines!!

  • If the Percocet dose is working I would stick with it until you speak with your Dr. tomorrow. That`s what I would do anyways. `

    I know your upcoming surgery may be different and you may need the Fentanyl after then but you will have talked to him by then. Especially since you had a hard time with the Fentanyl before so just let your Dr. know tomorrow that the Percocet 20mg is enough for you and you were concerned about starting a high dose of Fentanyl and don`t think he would think you were drug seeking. I`m a RN also but think its good to have clear communication with him.

    I heard the PLIF you will be having may be more because they cut your back muscles so it may be more painful so you may talk to your Dr. then about pain control and you can ask him for an adjustment with the Fentanyl. Of course you know that as we`re nurses also to always talk with your Dr. about any changes to medications.

    I didn`t want to try Fentanyl patch myself since I`m older and with menopause I still get hot flashes and want to go in a warm pool for aquatherapy so I`m worried about the drug being released too quickly myself. I take Oxycontin for pain and can have a breakthrough Percocet but only one 5mg day.

    I hope you will know more tomorrow since you haven`t taken the Fentanyl anyways for 2 days as it is. Wishing you a Merry Christmas and thinking of you for your upcoming surgery. 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
  • No worries my friend, i apologize if I came off in a way that implied I was upset. I wasn't and sometimes it seems that the irritation of the mere situation creates havoc with anxiety and I have trouble conveying my words. I apologize if I came off in the wrong way :) Sorry about that.

    I didn't mean to be strong about the whole thing with not thinking I was drug seeking, I forget sometimes that SH is a "safe" place where people don't judge you or pass quick assumptions.

    The past year getting to this point has been pure hell. I think i'm caught up on the "drug" thing because for 5 months of treatment I had a surgeon who kept refusing to treat my pain and each time I saw him he kept telling me I was going to get addicted and end up drug seeking, so it's probably a defense i've built up in response to that. I kept telling him that after my horrible experience with abdominal surgery in 07, after 3 days in ICU when I went to the floor I refused all drugs and took nothing for the 5 more days I was there or for my recovery at home after d/c. That surgery left an 8 inch incision that was horrible, they cut through all my gut muscles so I had no core strength and it hurt, really, really bad but I was determined I wouldn't take anything else because they had me on so many things (fentanyl, dilaudid, morphine and demerol) all together! The first two days after that were horrible, I had sweats and was just in horrific pain but after those two days I got along just fine. Anyway, my point was that I kept trying to tell my first surgeon that I wouldn't have a problem stopping and he still wouldn't give me anything other than Tramadol 50mg q 6hr and that didn't do anything for my pain so I didn't take it and only took the Soma. It wasn't until I went to a new doctor that my pain began being controlled. Anyway, sorry to get side tracked here :) I'm blonde and medicated, it's easy to do, LOL.

    As you said, nothing is easy. Dealing with a broken wc system makes it even more complicated. There is so much red tape and getting good treatment is so hard.

    Today has been a fairly good day pain wise. So far i've only medicated twice since 6 am and the second one I only did because I knew i'd be up more than usual and was trying to prevent rather than treat, thankfully it did. I will probably take one more dose today just because i'm exhausted and don't want to wake up in horrible pain. I did that once already and couldn't catch back up for almost 2 days. It was horrific. I've never felt so bad in my life. Learning curve though I guess.

    As for the continued changes, I will call him tomorrow and tell him that I think i'd like to wait to use the Fentanyl till after the next surgery. I really thought a lot about it and i'm really, really afraid that going into surgery with a high dose will only require me to use more when I come out on the other side. I'd rather try to continue tapering the next two weeks as much as possible without compromising myself pain wise and see if I can get down to 30-40mg of percocet per day instead of the 60mg i'm taking now. It seems reasonable, especially since the past two days have been much better since I cut out the Dilaudid. I almost wonder if the Dilaudid wasn't messing with my system and making me require more meds by increasing my pain. Sounds crazy at this stage in the game but everyone is different as is every experience.

    I'm sorry if there was a miscommunication/misunderstanding. Meds, exhaustion, and anxiety are not the best mix sometimes when I try to convey my true feelings so I do apologize.

    Your opinion and advice are invaluable to me. Everyone here has been so wonderful and SH has been such a blessing. Thank you again! I will post an update after I talk to the doctor on Monday. I too believe communication is a top priority. I think my anxiety got the best of me this weekend and my nerves got frazzled worrying about the patch dose. Anyway, God bless you my friend, thank you again for your help, it means so much and is greatly appreciated. I hope you had a very blessed Christmas!

    Hugs and blessings...
  • Dave, aka Metalneck, I love your sign on name :) So creative!

    Thank you for responding! I always love meeting new people when I post :)

    I totally agree with you about the differences with the percs and the patch. I think my first surgeon traumatized me because every time I saw him and told him the 50mg of Tramadol weren't even taking the edge off, he refused to help me and kept telling me i'd get addicted and have trouble "down the line". Since then, i've obviously switched doctors and my doctor now is of the school that you treat the pain now, worry post op after all recovery about any addition problems. While I appreciate that school of thought, I still get really worried about it. I have so much to lose with my job as a nurse and wouldn't want to compromise anything. I mentioned in my most recent reply to Savage that I thought my first doctor (wc choice) kind of brain washed me. LOL to some extent sadly.

    I agree about not second guessing my surgeon, I just figure if the percs are really doing a great job controlling the pain, then I don't need the patch since it's really very likely i'll need them after my PLIF. IDK. It's all so overwhelming! It's really tough. Part of me thinks it would be great to be on the patch but part of me is really weary of it because I know my dose would need to increase after the next surgery and i'm just not sure 75mcg is the right dose now that I stopped the dilaudid. I think i'd be much less concerned wtih 50mcg than the 75 at this point.

    I will def continue to be open and honest :) I have no reason to be anything but!

    I greatly appreciate your input and value your opinion, thanks so much for responding! You all really come to my aid every time I post any questions and it's so uplifting to know that i'm not alone on this journey. Because i'm sure it's safe to say, at one point or another on this journey through chronic pain, we all have experienced the horrible feeling of being alone so SP is a blessing to me. It's really fabulous to be in the company of people who are going through similar things and who are so accepting, loving and supportive! So awesome!

    Anyway, thanks again! I hope you had a very blessed Christmas!

    God bless you my friend!

    Hugs and blessings...
  • Hi Charry!

    Thank you so very much for posting a reply! It means so much to have everyone reach out to help :)

    I continued with the dose again today and did really well, especially considering I was up more today because of the holiday and circumstances. At 6 1/2 hours out after my first dose of 20mg perc, I took another 20mg only because I went to my parents house and knew i'd be up more than usual, it was more prophylactic than needing it at that point. My mom kept urging me to take it rather than push myself today so I did. I have been comfortable all day and well controlled. I am just now starting to have some pain though and wasn't planning on taking anymore until closer to bedtime but since i've been up more than usual today i'll see how long I can go before I have to give in BEFORE intractable pain sets in! LOL.

    So fabulous you too are an RN. I am terribly sorry you are injured yet i'm really glad i've met you here :) Kind of an oxymoron I guess, LOL. This sounds crazy but i'm always pleased when I meet another nurse, you know how we nurses love to talk shop! :))(

    I am not sure what to expect with regard to the PLIF. My internist said the ALIF was the worst of it and the PLIF will be a cake walk compared to it so IDK. I hear different things all the time. I guess I won't know until i'm on the other side of it all ultimately.

    I think after staying up all night thinking about it, I want to wait as long as possible to start the patch. I just have so many reservations and while I would be wiling to take it at a lower dose, I think waiting until after the next surgery is the wisest decision because I really don't want to require more meds this time around even though I know it's inevitable.

    You mentioned you didn't want the patch, are you still refusing it or have you started it? I'm sorry, my mind isn't processing things well today off of 2 hours sleep and the meds today, mix in the holiday chaos and i'm a hot mess, haha!

    I use to work ER when I first started out at an LVN, trauma ER and I loved every minute of it! Is your injury work related, I didn't catch that specifically in your sig line. It is SO hard to be off from work, at least for me. Nursing is my passion so it's been rough for me personally! I hope that i'll be able to go back to it eventually but at this point after a double fusion, I believe my chances are slim to ever doing bedside nursing again. I have been told case mgmt is likely where I will end up. That is really a tough thing for me to stomach since I really love the interaction with patients while providing care for them. I know you get to work with pts as a CM but it's just not the same. I'm sure you know what I mean.

    Well, I have a tendency to be long winded so i'll close for now. I do hope you had a very blessed Christmas! Thank you for replying and for sharing what is working for you! I value your input!

    Again, Merry Christmas and I hope you had an amazing day filled with laughter and many fond memories. God bless you...

    Hugs and blessings...
  • Definitely ask your doctor. I was switched to fentanyl before my last fusion (posterior), and honestly had horrible pain control in the hospital
    after the first day...however I recently saw some paper that the less pain medicine you have in you going into surgery the less you will need post-op,it wasn't back-surgery specific. I got off the fentanyl after 3 months...anyway if percocet is lasting you 6-7 hours I personally would be pleased as well.
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