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Needing advice about fentanyl pain patches

edited 06/11/2012 - 9:01 AM in Chronic Pain
Hello everyone, I have some questions about the fentanyl pain patch.
Let me give you a little history on my cp...

For the last year I have been suffering from CP in my back legs hips feet.. Long story short I have DDD spinal stenosis,IS joint disfunction, 3herniated discs, sciatica Ect....
I have been an the whole gammot of pt and and pain meds from OTC to hydrocodone... I am currently taking 120-150 10's a months and I hate takin so many pills but I am in pretty rough shape! Anyway my doc just asked me at our last appointment if I want to try the fentanyl pain
Patch because we've tried everything under the sun besides surgery Wich I will be doing this year... So my question is, what are your experiences with the patch? Pros and cons? I'm just trying to get some info and advice for
You all that have been there done that"!
I've just got to do something for some relief, I have to have some kind of quality of life!!!! Oh and Im only 24 :(

Thank you :)


  • Best to start on the 25 mcg patch and see how you hadle anything new,

    They started me off on the 50 mcg then we lowered it because i guess i was not use to it and felt a litle stoned so we backed it to 25 where it did help some, I also took norco with it and it helped the regular pain but not so much the nerve pain,

    Some are fine with higher dose 50 and up mcg i am just not 1 of them,

    Good luck hope it helps you,
    Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
    2012 scs implant ,
  • It's great that your Dr. is wanting to help with your pain...

    It's a bit strange to go from Hydrocodone to Fentanyl..

    They usually go to Percocet, Roxicodone, then if the short term ones don't work go to Oxycontin, Morphine Sulfate, Opana, Nucynta...etc...

    Have you been on any of those? Fentanyl is one of the strongest meds out there.

    They also have a 12mcg patch now which going from Vicodin....they usually start with the lowest dosage and tirate up as needed...

    Keep in mind Fentanyl is in MICROgrams....not MILLIgrams like the Hydrocodone...

    Obviously I am NOT a Dr. and just going on the usual tiration of meds...The literature for Fentanyl specifically states that a patient need to be opiate tolerant and be taking a certain amount per day to switch over.

    After my first surgery...I was pain free for a few years....but when it started coming back...I was being treated by my Primary Care Dr. who was absolutely wonderful...but she was not knowledgeable with pain meds...She was just trying to help and we went from 5mg Percocets to the 25mcg patch...I proceeded to take a nice long hot shower like I normally do and literally passed out on the floor as it released too much medication into my system too quickly...It was very scary....She just jumped too quickly from one med to the other and it was way too strong for me...Of course it helped with pain...but I want to be on the lowest amount of medication as possible...A pain medicine is not meant to have someone in 0 pain....I live at a 5-7 on the pain scale.

    The key is reading all the literature on this when you start...follow EVERYTHING it says to do and not do...As well as know that this medicine has a much longer half life than Vicodin...As in Vicodin is meant to last from 4-6 hours...Fentanyl is 72 hours....So it takes time to get into the blood stream.

    I have never cared much for whether a medicine works or doesn't work for others online or even friends or relatives (any medication)....as we are all different and every medication will react differently on each of us...Just because it works or doesn't work for others and their pain....has no bearing on whether it will work for you.

    It's about going in with a positive attitude...and realizin that many side effects (barring anything emergent) take up to a month at times to subside...So it's giving any new medication a full try and not give up in a few days...

    I would certainly make sure that I have tried all the other types of meds that are inbetween the Vicodin and Fentanyl before you jump....but that is me....

    And as we know as CP'ers....an opiate is just one small piece of the puzzle to help with our pain...there are dozens of other modalities to use every day/week/month to have our pain at a manageable level...

    I wish you luck..
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  • i'm currently on the 25mcg/hr fentanyl patch. i recently (3 weeks ago as of this writing) requested that my dr reduce me to these 25s from the 50mcg/hr that i was on. i have found it to be a massive game changer for me. while i was on the 50mcg/hr patch, i felt next to no pain at all on most days. i would occasionally have bt pain on the 3rd day. the patch is typically prescribed for 72 hours. so after 72 hours you take the old one off and put a new one on. my bt pain was usually on that last day, when the patch was mostly depleted. i would put a new patch on, and it typically took 6-8 hours for the new patch to deliver enough fentanyl in to my system to relieve the pain.

    as stated above, there are some warnings about fentanyl:
    fda said:

    fentanyl patches are only for people who are opioid-tolerant and have chronic pain that is not well controlled with other pain medicines. the patches are not to be used to treat sudden, occasional, or mild pain, or pain after surgery.
    be aware of the signs of fentanyl overdose: trouble breathing, or slow or shallow breathing; slow heartbeat; severe sleepiness; cold, clammy skin; trouble walking or talking; or feeling faint, dizzy, or confused. if these signs occur, get medical attention right away.
    if you are prescribed the fentanyl patch, tell your doctor, pharmacist, and other health care professionals about all the medicines you take. some medicines may interact with fentanyl, causing dangerously high fentanyl levels in the blood.
    read the instructions on how to use the fentanyl patch in the patient information that comes with the patch (view pdf).
    do not use heat sources such as heating pads, electric blankets, saunas, or heated waterbeds, or take hot baths or sunbathe while wearing a patch. if your temperature is higher than 102 degrees while wearing a patch, call the doctor right away.
    source = https://www.fda.gov/forconsumers/consumerupdates/ucm100223.htm

    so the warnings are very clear and, as stated above, it's for opioid tolerant patients. your doctor seems to have that in mind. based on your statement, you take more opiates than i did when i started the 50mcg/hr patch, and i didn't experience any major symptoms. i did feel the fentanyl, but wasn't overly euphoric or 'stoned'. each person is different, as has been said 10000000 times, so keep an eye out on the possible adverse reactions. some people on these boards have related adverse reaction experiences.

    i want to stress the heat source warning. i liked to take hot showers, and never exposed the patch to the direct stream of hot water from the shower head. however!! i experienced overdose signs. on 3 occasions. my first hot shower caused extreme drowsiness. i slept for about an hour, and within 10 minutes of waking was extremely nauseous, vomited, and had other symptoms. i didn't put two and two together at the time and, unfortunately, experienced this again after another hot shower a month later (i don't take really hot showers every day). after this second experience, which was almost identical to the first, i finally correlated the shower and patch. i only take showers on "patch change" day now, and wait to cool off before i put a new patch on.

    i experienced a 3rd overdose back in february, and have not been able to determine what caused it. there have been issues in the past with "leaky" patches, though i've seen nothing within the past 2 or 3 years. there are a lot of things that can change the rate at which the medicine will penetrate the membrane of the patch and enter your bloodstream through the skin. the patch causes a little irritation and rash on my skin, so i take care never to put a patch on the same skin area i took the last one off. i wait until the skin is fully healed before placing another patch in the same place. especially if there is any sort of broken skin. i try to put the patch in the same general area (my chest) so it's consistent when it comes to fat in the area, etc. sorry to scare you, but i went to the er the 3rd time, it was that bad. luckily i just sat in the waiting room for an hour and felt better, so i went home. i took the patch off every time i immediately started to experience symptoms, but once the medication is in, it's in for a while. it's not like a pill you can partially disgorge (vomit).

    some tricks to keeping the patch on: i try to put the new patch on after a shower, but if it's a weekend and i'm lazy, i'll wash the skin with a wet towel. don't use any kind of alcohol or chemical to clean the skin before you place the patch on. it could affect the patch membrane. put it on dry skin. i put the patch on, then place the palm of my hand over it for 30 seconds. for some reason, this makes the patch stick really well, and i haven't had any issue with it peeling off since i started doing that. if it doesn't stick, you can get some special tape cover that goes over the patch. sports tape is cheaper and works as well, in my experience.

    i'm taking the 25mcg/hr patch now, but have a lot more bt pain, especially on the 3rd day. i'm going to ask my dr if i can switch it every 48 hours instead, but my dr warned me that the insurance companies will sometimes deny this. if that's the case, i might go back to the 50s. i feel that, after my recent rfa, the 50 might be an overkill.... so a bit conflicted on that.

    the 50mcg patch, before the rfa, was truly a life saver for me. i didn't have any negative side effects when the patch was on (other than those 3 bad experiences...). it didn't make me feel high, or stoned, or any of that. i hardly knew i was on pain meds, i just had no pain 80% of the time. it's fantastic! i love the patch. i think it's great vs. taking a pill all the time that sometimes doesn't even work. be careful with them though. follow all the directions. i didn't mention disposal, but if you have kids or animals, be real careful how you throw them out. and please don't flush them and put them in our water supply.
  • I've got cervical hpll with myelopathy and radiating pain to my shoulders, triceps and forearms, and hand numbness. It has been 16 months and I think they're finally going to surgery as 5 spinal injections haven't done much to help, except drain my bank account, and PT, traction, acupuncture, etc. provide fleeting relief at best. I've been on every pain med I can think of over the last year, including lyrica and other nerve blockers that did nothing because they're designed to treat nerve endings and not spinal cord pressure. What has been helping over the last two months while we figure out the surgical option is 10/325 hydrocodone twice a day, a fentynal patch 12mcg, and 75 mg of diclofenac twice a day. I can still function and go to work, and it greatly reduces pain, but does not eliminate. I'm finding things bearable now. If things are bad and waking me up at night, which happens on occasion, 10 mg of valium takes care of that so I get good rest at night. Good luck, and I hope you find relief soon. Trust me, I know how bad this sucks.
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