? about Fentanyl patches, anyone that can help.....?

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Regular Member

Date Joined Jun 2005
Total Posts : 28
   Posted 9/14/2009 11:17 AM (GMT -6)   
Hello everyone,
My doctor has prescribed Fentanyl 50 patches to deal with back pain and related Crohn's Disease pain.  I started them last Thursday.  I have been pleased that it greatly reduces my pain overall.
Yesterday I changed a patch for the first time.  They say to change locations each time, so I went from my side to my upper arm.  Today, I'm having a lot of pain in my lower back.  The instructions for the patch indicate that it is okay to use the upper arm, but I wonder -? I'm not getting near the pain relief today, maybe that's an area that moves too much?
Also, once you place a patch, can you very carefully move it?
Sorry the silly questions but I'm approaching these with an overabudance of caution, since they are apparently quite powerful.
Thanks for any help you can provide.
-Diagnosed with Crohn's Disease, 1989, two resections small intestine
-Lumbar back pain, two bulging discs, L4/L5, diagnosed 2008
On so much medication it's absurd.

Regular Member

Date Joined Jul 2008
Total Posts : 243
   Posted 9/14/2009 12:42 PM (GMT -6)   
Since you've just started on the patches, keep in mind that they don't build up enough to reach their peak effectiveness for about 10 days/3-4 patch change cycles. This is from the package insert:

package insert said...
With continuous use, serum fentanyl concentrations continue to rise for the first few system applications. After several sequential 72-hour applications, patients reach and maintain a steady state serum concentration that is determined by individual variation in skin permeability and body clearance of fentanyl (see graph and Table B).

How often are you changing your patch?

Some people on the 72-hour changing schedule get a loss of effect at the end of the third day and it takes about 8-10 hours into the new patch for it to start to ramp back up, which leaves them with a lot of breakthrough pain during that "trough" between patches. I had that problem, so my doctor switched me to changing every 48 hours and it eliminated that problem. If you're on the 72-hour schedule and you continue to have pain between patch changes, you might want to talk to your doctor about changing your schedule. Some doctors are not receptive to changing the frequency, but that information is also contained in the package insert, if you have to argue the point. redface

package insert said...
The majority of patients are adequately maintained with DURAGESIC® administered every 72 hours. Some patients may not achieve adequate analgesia using this dosing interval and may require systems to be applied every 48 hours rather than every 72 hours.

Also, a lot of people experience different absorption rates when they place it over a fatty area (belly) vs. a muscular area (chest, arm) and differences among the various generic manufacturers, so you might have to experiment a little bit with placement areas and generic brands to find out which combination works best for you. :-)

Post Edited (BionicWoman) : 9/14/2009 11:49:50 AM (GMT-6)

Regular Member

Date Joined Jun 2005
Total Posts : 28
   Posted 9/14/2009 1:13 PM (GMT -6)   
BionicWoman, thank you so much.  I had read on the boards here about people needing adjustments (every 48 hrs. vs. every 72 hrs.)  I did not see in my directions where it might take several patch changes to reach peak effectiveness, so thank you very much for that info. 
I'm changing every 72 hours, and I'm only on my second patch, so perhaps I just need to be more patient.
Also, thanks for the tips on body placement (fatty v. muscular area).
I guess I'll stick this cycle out, not move the patch, and we'll see what happens. 

Regular Member

Date Joined Dec 2006
Total Posts : 275
   Posted 9/14/2009 5:06 PM (GMT -6)   
I too use them on my abdomen as they work well there. Yes, you can take them off and move them as long as you can get them to stick.  Sometimes all it takes is keeping your hand over it once you reposition it so the glue can readhere or, I've used the bioclusive cover when I've either moved it or it came off. 

Regular Member

Date Joined Jul 2008
Total Posts : 243
   Posted 9/14/2009 9:20 PM (GMT -6)   
You mean you missed that itty bitty little paragraph in all that tiny little text on that double-sided poster size package insert that takes a PhD to re-fold proprely? Gosh Sheryl.. I can't imagine how.. LOLOLOL!!

Veteran Member

Date Joined Dec 2007
Total Posts : 1235
   Posted 9/15/2009 1:16 AM (GMT -6)   

Post Edited (mrsm123) : 9/17/2009 8:56:01 PM (GMT-6)

Regular Member

Date Joined Jul 2009
Total Posts : 23
   Posted 9/15/2009 6:33 AM (GMT -6)   
I found that they never worked after taking them off to move. It appeared to me that the skin layer came off me and blocked the transfer system if it was moved at all. I used tape to keep the edges down on the skin. As with others - put them on a fat layer, as they smooth out better going through that! Cheers - C45
25+ Years, Sciatica, Lumbar back pain, Severe Stenosis L3-L4, DDD, Chronic pain - because the acute pain was never treated, Duh!

Regular Member

Date Joined Jun 2005
Total Posts : 28
   Posted 9/15/2009 9:34 AM (GMT -6)   
Thanks so much for all of your responses.  I'm still amazed at what a supportive group this is.
I moved the patch and I'm hurting like *** today.  I'm due to change tomorrow, I wonder if I ought to go ahead and change today and tell my doc what happened.  He is hypersensitive about abuse/addiction having gone through it himself.  I'm afraid he will react negatively.  Now that I've moved it, it doesn't seem to be working at all.
I know I'll get the hang of this, feeling a bit overwhelmed right now.....

Forum Moderator

Date Joined Feb 2003
Total Posts : 16793
   Posted 9/15/2009 1:02 PM (GMT -6)   
SheryIn I was on the patches for awhile myself and it did take a bit for them to cover the pain. But, I will say I don't believe moving them around is a real good idea. Look at your insert and see what it says for in the future. I started sweating once I was bumped up to the 50's and bought Tegaderm, which is like the sticky clear dressing they put over an IV site, you know the one that takes your skin of when they decide to take the IV out, lol. Between the sweats and showers keeping one intact became such a problem until I started using the Tegaderm. Pay close attention to see how you do on the 3 rd day. The 3rd day was hell for me I started having withdrawals. My daughter said she could tell a big difference once I quit the patches. My dr was not willing to let me change them every 48 hours so it was not very good for me. when he bumped me up to 75's I was unable to urinate so I had to go off of them and I was glad, too many hassles for me.
Moderator Chronic Pain
crohns disease dx 2002 & small bowel resection, still looking for remission whatever that is, chronic pain 22 yrs, added ulcerative colitis 6-05 to the mix, high blood pressure 28 yrs, aortic heart valve insuffiency, depression, osteoarthritis, osteoporosis lumbar spine, scoliosis lumbar spine, peripheral neuropathy hands & feet, COPD & on oxygen therapy, lupus & decreased circulation in both legs. Several other health issues just not enough room to list it all. Too many surgeries to list and too many medications to list. Currently on 16 different daily medications. Intrathecal pain pump implanted June 05.

Regular Member

Date Joined Jul 2009
Total Posts : 236
   Posted 9/16/2009 4:03 PM (GMT -6)   
Hi ... just wanted to say we seem to be right on schedule with each other . I too just started the pain patch... tomorrow will be my 3rd patch...
and also the 3rd day I seem to be taking almost as many pain meds as before the patch.. but on day 1 I only took 4 perc.. Wow... thats great for me.. compared to 6-7 a day... day two 4-5 .. but day 3 is bad.. lots of breakthough pain...
you know its the fisrt time in about a year I felt breakthough pain.. and not constant pain. what a difference my life has been already ...
Good luck with your Hope you get it figured out .. I'm sure you will.
I hang out at the Fibro side a lot.. almost every day ... I come over here on Occ..
Take care.
Spirit ~

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