I haven't read your replies yet but feel very compelled to reply. I used to be on the 'F' patch I began at 25mcg(micrograms) every 72hrs. I graduated slowly ending with 200mcgs. I have always been prescribed something for break through pain, Tramadol, muscle relaxers and anti-seizure medications were in my medication cocktail as well. My problem was that I over did it, didn't know my new limits thus increasing pain and my dose kept increasing. You mentioned that you feel your patch is not working for the full 72hrs and maybe if a break through med would help. Keep in mind that Fentanyl is 1000 times stronger (just my own opinion) then morphine. Only makes since to me as morphine is dealt in milligrams and Fentanyl is dealt in micrograms? The elements that I lived in per Se summer very well could of affected the safe delivery of Fentanyl. I will add the stronger my patch was the more I slept, ending at approx 18-20hours a day- off and on. I was 40yrs when I was put on the patch. I wish you luck and hope you pain doctor has the absolute answer for you.
Cloe (Keep us posted, I am thinking about going back to the patch myself) Doctor permitted of course.
ETA: Bless your sister in her transplant, my brother had one about two years ago(his wife donated) his condition is doing great right now, much improvement.
Post Edited (~Cloe~) : 11/3/2008 3:40:28 PM (GMT-7)
Mom9mom - I have been on the Duragesic patches a couple of times. Fentanyl works wonders for some people (me included). I just had a lot of skin sensitivity w/ the patches. Two pain drs. told me that it is especially hard on people w/ fair skin (I'm as pale as you can imagine). Once I removed the patch, you could see the "outline" of it on my skin (red, puffy, ugly) for at least a week. To keep it on, kttn251997 had some good ideas. You can get the covers from the company; I used "tegaderm" patches (like a clear band-aid)....I bought them at Walgreen's.
Re: how long they last - for MANY people the patches don't last the entire 72 hours. I could feel the difference in mine at about the 48 hour mark. There is a lot of "creative" things your doc could do. Switch them every 48 hours... Wear 2 patches instead of one, and switch each one at different times (for instance wear two 25mcgs...);
The majority of people in pain management w/ long-term pain issues have some sort of "break-thru" med. To me - espcecially while you are having "issues" w/ your long-lasting med - you should have something for the break-thru stuff. My doctor will only make one change at a time, though (meaning he won't make changes in the dosage of my long-lasting stuff AND add on a short acting med). That way, if there's a problem, you know what you are dealing with. But I really encourage you to talk to your doctor. Depending on how often you need it - good break-through meds are MSIR (morphine sulfate instant release), oxycodone, Norco, Dilaudid, etc.
Fentanyl also comes in two quick acting meds - Actiq (the "lollipop") and Fentora (a "quick-dissolve" tablet). These both worked wonders for me... BUT, taking the Actiq came at the expense of SEVERE teeth damage. I never had a cavity until age 17; even then, I think I had about three. In the last two years, I've had to have three root canals, need two more and lost one molar. The enamel on all of my teeth has thinned out a lot. So, whenever I mention these meds - I feel compelled to say what happened to my teeth. That's all any of us needs is more issues than what we already have. I now think they come in a sugar-free formulation, but I'd still be VERY careful.
Re: hot bath - I couldn't do that or hot showers while wearing the patch. It would make them come off...even while having the tegaderm on, etc. Re: "re-applying" them, I know for the specific brand I used (the "Jansens", I guess), you could "not" reapply" them.
Re: kidney - don't really have any info to add on that. I have enough blood work done every month or two that they are always checking my levels, etc. I've been on these meds for almost five years now, but at the high doses for about 18+months. I've not had any issues so far, in terms of specifically caused by the meds. I'm 35 years old.
Sorry for the long response but I hope it helps. Just my own thoughts/experiences; of course, check w/ your doctor Let us know what you decide!! --Tina
Diagnosed with: POTS/dysautonomia; Fibromyalgia; Severe Hypertension; Hypothyroidism; Adrenal Gland Disorder; Chronic Pain - severe carpal tunnel syndrome, migraines, severe back problems, widespread muscle/joint pain....as well as depression/anxiety.
Current Meds: 480mg MS Contin, 90mg MSIR, Soma, Effexor and MANY other meds (heart, thyroid, etc)
Past Meds: EVERYTHING. Fentanyl patches, Actiq (which caused $$$ in dental work), Fentora, Oxycontin, Oxycodone, Kadian, Avinza, Dilaudid and on the list goes.
Waiting On: Intrathecal Drug Pump Implantation (Dilaudid/Baclofen combo)
Do NOT take hot baths or showers while using the Fentanyl patches. It says so right in the patient information. Doing so, causes more of the medication to be released quicker into your blood stream and can result in overdose or death. It may be that the hot baths are the reason that you aren't feeling that the patches are relieving your pain as well on the third day.
Your pharmacist should have gone over that with you, when you picked up the prescription. Also, do not remove and then attempt to restick the patch, it won't work. The patches have reservoirs that contain the medication and the skin to patch contact is what allows the medication to be absorbed into your system. If you remove the patch, dead skin cells will adhere to the patch and therefore can obstruct that skin to patch absorption.
You can buy tegaderm or bio-clusive dressings on ebay or drug stores , medical supply houses to cover the patch to help it stick better if it is coming loose early.
Mom9mom, I have been on the patch for seven years and like someone mentioned, many people find on the third day that they are not getting the same pain control. I change mine every 48 hours and have had no problems since. I have only been raised 1 time, but I do have breakthrough meds. As far as the hot baths are concerned, I would call Jansen(the company that makes the patches) and speak with someone there about what tempuratures are safe. I take hot baths and also get into our hot tub(although I do not have the water as hot as my husband likes it, I do keep it down somewhat) and I have never had any problems. We are all different in how we metabolize meds, so I would speak directly with the experts. In the pamphelet it says to call your doc if your tempurature goes over 102 degrees so I figure that anything under that is OK. The hot tub I put at about 98 degrees and my bath water is similiar.
I think breakthrough meds are an important part of pain management and if you read any of the medical journals about that, most say that breakthrough meds are necessary. Many docs are hesitant to prescribe them because of abuse issues, but that doesn't negate the fact that it should be part of the pain management plan. Yes Actiq and Fentora are good meds, but be careful because right now they are only approved for cancer pain so many insurances will not pay for them and they are very expensive. A one month supply can run around $5000.00 if your insurance won't cover it. Fentora is trying to get approval for chronic pain, but as of now it's only for cancer pain.
I hope your doc will be willing to consider breakthrough meds, and give Jensen a call so they can tell you specifically what temp your bath should be!