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fentanyl patch question?

I have a question that I know that not everyone might understand, ive been recently diagnosed with ankylosing spondylitis, and have recently started on a medication called Enbrel that lowers the immune system and makes it very difficult to fight all infections, major or minor. Even a small cut or blister (if it should burst and become an open wound) can put off treatment for weeks until it heals. I have been on fentanyl 75mcg/hr patches for a bit now, and have talked to my Dr about titrating down slowly to something less intense (even though my condition is a very painful chronic disease with no cure) I want to put my body through as little as possible, annnyways, back to my problem. The fentanyl patches now mixed with my weekly Enbrel injectons now cause skin irritation and blisters that ive kept from bursting so far, I would prefer not to titrate off of the fentanyl and move to something different all together, less intense obviously as that was my goal from the beginning. I dont know very much about meds or where to even go from fentanyl downwards (in pill form) as I cannot risk skin blisters that will not throw me into withdrawls that ive so often read about on here, the only other drug ive read about on here for chronic pain is oxycontin and ive already failed that treatment before I moved to fentanyl. My ultimate goal is to only have to have breakthrough meds on hand but at this point in the disease where it has not yet been controlled by my biologic meds it needs to be handled I think with chronic medicine for now. I dont see my dr until the 23rd and I do not like calling for early appointments as we all know how that comes across. I just dont know what any options would be for me as Ive failed oxycontin and no longer wish to be on fentanyl?
(12.24.13) L2-L3 Laminectomy, Discectomy and Coflex insertion. DX'ed with Ankylosing Spondylitis on 5/13/14
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Comments

  • sandisandi Posts: 6,302
    edited 06/02/2014 - 11:43 AM
    from the fentanyl.......with no issues, and then slowly reduce the dosage. They do it all of the time. As far as what medications, any of them are options, so discuss it with your doctor and they will convert the patch back to oral meds.
    It's easily enough done. I just did it not so long ago.
    Sandi
  • Thanks! I was just worried about possibly suffering withdrawls from going from patches to pills, I am obviously undereducated but before my back problems, my only experience was ever percocet from surgeries. I dont know any other long term meds except the patch, oxycontin that I failed and I cant remember what its called but extended release morphine? my dr didnt choose to put me on that as he didnt think it would have good results.
    (12.24.13) L2-L3 Laminectomy, Discectomy and Coflex insertion. DX'ed with Ankylosing Spondylitis on 5/13/14
  • but your doctor will go over them with you, and he will choose one that he feels is best suited to covering your pain and not causing withdrawal......don't worry, it's going to be fine. Congratulations on trying to reduce your meds. I have done it several times over the years and I love being on less meds......and the pain coverage is sometimes even better by switching to a different medication.
  • josbornejjosborne Posts: 86
    edited 06/02/2014 - 12:31 PM
    I have to admit alot of my push for getting off strong meds is fear for my overall health, Im on the way to slowly accepting that I will always been in pain and slowly deterorate but id like to try and be as healthy as I can possibly be until then, medicine was really put into perspective for me as I have to give myself injections that have caused cancer in younger people and will make me super sick. I didnt know medicine like this exsisted so id just love to eliminate as many as my meds as I can :) as long as dr agrees!
    (12.24.13) L2-L3 Laminectomy, Discectomy and Coflex insertion. DX'ed with Ankylosing Spondylitis on 5/13/14
  • I had a double cancer scare last year, and I have never liked being on the meds to begin with, so I try periodically to see if I can reduce them or eliminate one or another......I have resigned myself to needing the muscle relaxers, but over the years have found that by switching the medication that I am , for another, usually allows me to reduce the overall daily dosage of medications and often winds up being a bit better pain wise, switching to a different medication after having been on one for a year or so......I went from 150 mcg of fentanyl , down to 50, then changed to Opana......and the pain control is as good/a little better than it was at the fentanyl dose. I am hoping to go down a bit on the Opana, in the next month or so, and hope that it works.
    So , we'll do it together.........
  • josbornejjosborne Posts: 86
    edited 06/03/2014 - 3:57 AM
    :) Sounds good. I just cant wait to feel the eventual difference in how my body feels overall when I cut down all my meds to the lowest possible. In my head im imagining it as a fresh breath of clean air haha as crazy as that sounds
    (12.24.13) L2-L3 Laminectomy, Discectomy and Coflex insertion. DX'ed with Ankylosing Spondylitis on 5/13/14
  • Loreeann32LLoreeann32 Posts: 76
    edited 06/21/2014 - 8:25 AM
    Sandi, I see in one of your posts that you take Fentanyl. I just recently got prescribed for this from my PM doctor. When I was there, and he mentioned it and told me it was a patch, I did not think nothing of it, and I said yes. That was June 2, and I have been on it for a couple of weeks. How does it make you feel? It does not touch my pain and I am on 50MCG. I wonder when I go back to the PM doctor if he will up it? How 75MCG affect you? I know each of us are different, I was just wondering if it works. Then I get home and I start reading up on this, and now it really scares me. The withdrawals can be bad, but I do not plan to be taken off of it anytime soon, I think I will be on this for a long time since I have chronic pain. But it is scarey to know how powerful it is.
    Lori

    L3-L4 minimally invasive spinal fusion L3 - L4 with cage and rods. Aug 24th, 2012
    Hardware Removal Feb 24, 2014
    DDD, Thyroid Disease
    Lumbar Spinal Stenosis
    SI Joint dysfunction
  • The nice thing about the patch is that you don't necessarily feel it......but you should notice a reduction in the pain levels. It is not uncommon to need a dosage adjustment, because the conversion over the patch is based on your total daily intake of other opiates, and then converted to fentanyl. Most doctors will do a conversion reduction of about 20% for what is referred to as cross tolerance.....this simply means that your old medication wasn't working so well, so they convert your dosage to a new /different opiate and reduce the amount of the new dosage in hopes that you won't need as much to meet the pain needs. Sometimes it works , and sometimes not.....there is another strength of patch available 12.5 mcg that might be worth giving a trial along with the 50 mcg to see if that better controls your pain. Usually, I suggest that patients give a medication dosage increase at least two weeks, and with the patches, at least three patch changes to find out how it is working or not before changing dosages/strengths.
    I love the patch, it gives me the best overall pain control that I have had.
    Converting back to another opiate is not difficult, and tapering off it is not anywhere near as bad as you hear.....it is no different than any other opiate conversion or taper.....if you go slow and reduce your dosage , you will be fine. I cut mine by 50 mcg at a time and didn't have difficulty doing it. The longer half life works in your favor, keeping a pretty steady blood plasma level, even once the patch is off for about 18 hours or so.
  • Sandi- today my dr has moved me down to 4x10mg oxycodone a day to see if that works since my ultimate goal was to be down to breakthrough meds to begin with. Im terrified of the withdrawl since there was practically no tapering set up because of the condition of my skin ( I didnt want to taper down with patches because of the chances of getting more open wounds) I tried wearing them for a few extra days but then I had a particulary bad flare and ran out of breakthrough meds and had to put a 75mcg patch on for the 3 days before my appointment. My dr told me to prepare my workplace and myself for the withdrawls that could come on but I do have one fent. patch left and said I could go up to 6 oxy the first 2 days to fend off the worst of the w/d but I am terrified!! I have had it off all day today and I feel alright but I dont know when the withdrawls would start...any advice Sandi?
    (12.24.13) L2-L3 Laminectomy, Discectomy and Coflex insertion. DX'ed with Ankylosing Spondylitis on 5/13/14
  • because you will only find yourself in the same position in another couple of days.....follow the instructions given to you by your pm doctor regarding using the 2 extra doses for two days........but I would strongly encourage you to use only half of the second tablet at each dose of oxycodone.......and only if you find that you are starting to experience major withdrawal symptoms.
    As your blood plasma levels continue to fall, you may or may not experience some withdrawal.....if you do, start with the 10 mg oxycodone, and wait for a half hour or so.......it should help to keep the withdrawal symptoms in check......if not, then try to take the half a second tablet.........on the second day, I would avoid using the half tablet if at all possible, or maybe only twice the second day. That way, you are still within the guidelines that your doctor gave you.
    Why did you not tell him that you ran out of your breakthrough meds? How did that happen? You should have had enough to carry you through the appointment......unless you increased the amount you are supposed to take on your own.
    Why didn't you tell him that you put the patch back on? For how many days? How many patches did you do this for?
  • josbornejjosborne Posts: 86
    edited 06/23/2014 - 9:48 AM
    my breakthrough meds were from the appointment before last, He offered another script at the last appointment but I still had almost a full script left and since I knew I would be off the fentanyl soon I didnt want a whole new script of breakthrough meds without knowing what new med he was going to put me on, my breakthrough was 5mg oxycodone so if I would have called and asked for another script when I ran out and then today he gave me a script of 10mg oxycodone my insurance would not have let it go through. They are very strict when it comes to pain medication (for obvious reasons) I tried everything before sticking the patch back on, I took my naproxen as im supposed to, I took tylenol, I iced/heated and used those icy/hot patches (which actually was a really bad idea with my sensitive skin) but finally when it got to the point where I could not move any limbs or walk I broke down and used the fentanyl since it was still prescribed. I know it was stupid and that I will probably experience withdrawl symptoms as my Dr has told me I probably will. I have never experienced them before.. I am still feeling fine today, and im hoping the oxycodone will keep them under control. I will be disposing of my last remaining fent. patches tonight. I was tapering off of them before the last one which I wore for the prescribed 3 days, I was wearing them for 4-5 days to wean down off of it before this most recent patch. (as my pharmacist recommended) when my dr told me I should wean by cutting them in half ( I knew that wasnt right so I asked the pharmacist) so I followed my pharmacist prescribed weaning process to a T until the last patch that I wore for 3 days before my appointment today because of an unbearable flare. I did tell my Dr about it and he just said that I would have to deal with the withdrawls if I had any and to take the two extra oxycodone if it got too bad. I think this covers everything.. I did what I could think of with my dr not being a dr who is on call and without breaking any laws during a horrendous flare
    (12.24.13) L2-L3 Laminectomy, Discectomy and Coflex insertion. DX'ed with Ankylosing Spondylitis on 5/13/14
  • sandisandi Posts: 6,302
    edited 06/23/2014 - 3:52 PM
    Using the oxycodone will help and you will get through this, since you weren't taking the oxycodone and it was less milligrams in dosage, the 10 mg should help to make up the difference.
    Good luck and don't forget to stay hydrated by drinking gatorade or powerade should you start to experience any of the typical withdrawal symptoms.
    You should be fine, and if you do experience any withdrawal, it should be minor symptoms.
  • So far no withdrawls. (fingers crossed it continues) but ive been reduced to having to use my dreaded cane because my AS flare has gone from dreadfully annoying (the past couple days) to debilitating last night into today. :( But thank you so much for all of your support Sandi, its wonderful to have a place like this to go to!
    (12.24.13) L2-L3 Laminectomy, Discectomy and Coflex insertion. DX'ed with Ankylosing Spondylitis on 5/13/14
  • The pain may flare a bit, but hopefully will subside in a day or so, if not sooner......hang in there, and we will hope things settle down quickly.
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