Finally, some hope in the wind....

[Cindylou]

So, I had my appt. w/ pain management. Never saw the doctor, but had a real good discussion with the Nurse Practioner. :thumpup: Also had "the bitchy nurse," but I didn't let her get to me....and, she was just slightly better.

Thank you for all the tips/advice too, before my appt., because it really helped. I was very frank about the current drug regime not giving me substantial relief, so the NP switched me to the fentanyl patch, lowest dose initially. Plus, the Oxycodone 1 x a day. I go back in two weeks and will raise the patch dose, if needed. Does anyone know how long it takes to kick in? I asked the pharmicist but she didn't know. She said she would call me with the answer.

Also, they wrote a script for their own pt/evaluation, even tho I am already going. It is part of their "whole person treatment plan" so I have to do it, even tho it seems kind of silly. They also wrote a script for the behaviorial health evaluation, so I need to call and make that appt. That is required too, which is no problem....even tho I already have a psychiatrist. Oh, well. She said if my health care provider balks at paying for either of these two referrals I just mentioned, then they can't see me anymore. I would then have to go to my health care provider's pain clinic, which is brand new, and I have never heard of their reputation. And, they are much farther away. Hopefully, it won't come to that. We also have not heard back about the doctor's letter of appeal for the cauterizing of my facet nerves. Please continue to pray that this will get approved.

I think I covered most of it. I'm just curious now how long it takes for the patch to provide relief. I put it on about 2 hours ago, and I will say I have felt sleepier, as well as slightly dizzy.... but that's it. Oh, almost forgot: Lynn, I don't know what EFT is.

[Cindylou]

Ok, so now I am feeling REAL SLEEPY. This must be the patch correct? And this is ok? It seems I am reading this in the side effects...fatigue, so it must be ok to lay down and take a nap. I also have dry mouth, but that isn't concerning me as much as the real fatigue. Thanks for any and all advice. Much appreciated.

[mark-Perth]

Fentanyl is probably the most sedating of all the opiates so expect to feel drowsy from them, especially for the first week.
Do U have the gel filled or Mylar patch?
We have the Mylar ones in Aus (they look like a flat film of plastic)
They take about 4 hrs before they will start to get up to a reasonable level although this is dependant on the temperature of your body! They release more fentanyl if U R hotter so do NOT have a hot bath or put a heat pad on them or U will risk OD'ing. A warm shower is OK but dont hold it under the hot water for 2 long. I found the best spot to put them is up on the flat area near your shoulders as the skin doesnt move much there and they stay on well and U can reach them yourself, just change sides each time. U R also not supposed to cover them at all so dont put any extra tape on them to hold them inplace. Just press them on firm and hold pressure on them for a minute and they should stay. It is hard to get them to stay on for 3 days, especially if U go swimming but they R usually OK.
If U get a fever or your body temperature gets too hot REMOVE the patch immediately as they will realease too much medication.
Do be carefull as I have had several close calls with Fentanyl patches releasing too much as my body temp was too high and its not pleasant.
The full dose is obtained after about 12hrs and some remains in your system for about 12hrs after the patch is removed.
What is the dose that U R on 12 or 25mcg/hr?
From what I worked out 25mcg/hr of Fentanyl is equiv. of about 60mg/day of morphine, depending on which ratio U use to change. There is a big variation in this ratio but ive included one below from Duragesic's website.
If your patch is not a duragesic patch then it may be alittle different but this should give U an idea.

Source: Ortho-McNeil, Inc. 2006-2008. All rights reserved.
Manufactured by: ALZA Corporation Mountain View, CA 94043 Distributed by: Janssen, L.P.Titusville, NJ 08560 [Add new code post-approval] Revised February 2008
©Janssen 2008. DURAGESIC® (fentanyl transdermal system) CII Pain Patch

Hope this is some help to U and U get some pain relief from it. Its probably the most prefered pain killer post surgery due to its sedating properties but that can make it difficult for some to motivate themselves to do rehabilitation as well which doesnt help.

Best luck

Mark

[mark-Perth]

1: Pain. 1996 Mar;64(3):527-34. Links

Direct conversion from oral morphine to transdermal fentanyl: a multicenter study in patients with cancer pain.

Donner B, Zenz M, Tryba M, Strumpf M.
Department of Anesthesiology, University Hospital Bergmannsheil, Bochum, Germany.
Direct conversion from oral morphine to transdermal fentanyl with a ratio of oral morphine/transdermal fentanyl (100:1 mg) daily was examined in patients with cancer pain. Patients with a 'stable and low level of cancer pain' receiving a constant dosage of sustained release morphine during a pre-study phase of 6 days were included in the study. Initial fentanyl dosage was calculated by a conversion table. The transdermal system was changed every 72 h and the dosage was adjusted to the needs of the patients according to the VAS scores and the requirement of liquid morphine, which was allowed to achieve sufficient pain relief. Regression analysis at the end of the study revealed a mean morphine/transdermal fentanyl ratio of 70:1. Pain relief during treatment with transdermal fentanyl was identical to sustained release morphine. However, significantly more patients took supplemental medication with liquid morphine during transdermal fentanyl therapy. The number of patients suffering from pain attacks did not increase with transdermal fentanyl. Constipation and medication with laxatives decreased significantly during fentanyl therapy. Other side effects and vital signs were identical. Three patients suffered from a morphine withdrawal syndrome beginning within the first 24 h of transdermal fentanyl therapy. Cutaneous reactions to the patch were rare, mild and transient. Patients and physicians reported satisfaction with the transdermal therapy. 94.7% of the patients chose to continue the transdermal fentanyl therapy at the end of the study due to better performance in comparison to oral morphine. Due to these results an initial conversion from oral morphine to transdermal fentanyl with the ratio of 100:1 is safe and effective.

[Katie]

Hi Cindylou,

I'm glad you had a better reception this time at the doctor's office. Good for not letting the witchy nurse get to you this time.

As to Fentanyl, it can be a very effective pain medication. I believe that Justin said he was on it for awhile, but I'd have to check his old posts.

Remember when I mentioned that I had bad reactions to a number of drugs? Fentanyl was at the top of that list, for two possible reasons. First, it could have been a sensitivity because of my 'red' gene which makes me super sensitive to things that don't bother others. The second is that it could have been a 'bad batch', because after my episode with it, my husband found a warning in a news article explaining that there was a fault in the patch, that more than the proper amount of medication was being released from the patch at one time, causing patients to overdose.

I had a severe reaction four hours after putting on my first 50 mg 12 hour patch, and from Mark's description above, it was the Mylar type (thanks for that description Mark, as I didn't know there were two types.) My friend called an ambulance as I was extremely ill and incoherent, definitely an overdose type reaction.

If you're OK enough to write your second note, then I think you'll be fine Enjoy your pain free existance! They are tough to get off when the time comes, but that can be handled later. I'm glad they finally gave you something that works.

[Cindylou]

Oh, darn....I just wrote a long response to Mark and Katie and the whole thing went up in smoke. Let me see if this goes thru before I lose another one.

[Cindylou]

Hope this goes thru. Thank you Mark for such valuable information that you posted. I really do appreciate it. I am on the Fentanyl Transdermal System, the lowest dose. 12.5 MCG/HR. They said they start you on the lowest dose initially and move up as needed. I got very tired yesterday as you could read from my prior post. My back is locked up from pain still. I think I need a massage to loosen things up....then hopefully I will reap more benefit from the patch. Thank-you again Mark, and Katie too. Hopefully I won't have the kind of reaction you did Katie. Very scary. Right now I am just hopeful for the kind of relief that will help me get out of my chair and walk. Anything beyond that is gravy.

[KBear]

CL- Mark gives excellent advice, be very careful when on Fentanyl as many have overdosed from them, by not using them properly. When I was first put on them (the 25mcg patch), reading the warning scared the crap out of me. I was taking benadryll and muscle relaxers too and read in the warnings that it said not to do this. I freaked, as I had already taken them together, called my primary care doctor and went in immediately. He told me that it was ok to take those things, since I was already opiate tolerant and had been taking them before with opiates. I also wore my patch on the back of my shoulder, as this was the best place to stick it, keep it from getting too wet in a bath, avoid contact with my heating pad, etc. They also made me tired; but that went away with time. The Kadian I am on is having the same effect on me, I am very tired and usually have to take a nap to get through the day.

I hope I am not scaring you; but just want to make you aware to use them exactly as prescribed. Most if not all of the deaths I read about from them, were from misuse or abuse of them (ie. people wearing more than one at once, using them for a high, cutting them, etc.)

So happy that they gave you something stronger and wishing for many pain free days for you!
Kathy

[Justin]

Hi CL,

Mark's post is filled with a ton of great info. I was on Fentanyl for quite a while. It is an effective opioid: the transdermal delivery of drug is constant, so you will avoid the "peaks and valleys" associated with oral medications. However, be very careful on this medication--it is extremely powerful. As Mark said, an increase in temperature will increase the rate of opioid delivered.

Feeling tired when just starting Fentanyl is completely normal. There is an adjustment period to get used to the narcotic (narcotics are sedating).

Never cut your patches! This can be deadly. If a patch is cut, the membrane that regulates steady delivery of the drug is compromised and can cause significant respiratory depression and death.

Fentanyl is effective for pain relief, just be careful and be aware of the risks of this medication.

[Justin]

Oh, darn....I just wrote a long response to Mark and Katie and the whole thing went up in smoke. Let me see if this goes thru before I lose another one.

Hi CL,

Just an FYI: the current settings on the Forum help ensure that posts created by Members are protected from timeouts.

Operator error including incorrect keystrokes (hitting delete by accident) are the only reasons I can think of for lost posts. The only other time would be server downtime where the website is not available.