50 mg Fentanyl patches question

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I have a pain management Dr who prescribes me  500mg Norco 3x per day, Baclofen 20m 1x per day and Gabapentin 100 mg 3x per day. I have RA, fibromyalgia, a sciatica issue in lower back and 5 months ago I had my 8th knee surgery which will soon turn into my 2nd knee replacement in a few more months. Since 2013 I've had 4 elbow surgeries and 4 knee surgeries one of which was my first knee replacement. None of these medicines are helping and my Dr will not consider giving me anything else. My tolerance for the Norco is to the point that I receive zero pain relief, and even if I take more than the recommended dosage I receive no pain relief. A friend gave me a couple 50 mg Fentanyl patches but I have no experience with it. My knee is hurting really bad that I can barely walk and have to use a cane every few days when I cannot just  "tough it out" to get to the store or to get my kid from school. Will a 50 mg Fentanyl patch even help? 

Should I even bother to try it? I don't want to take something that is not prescribed by my Dr but since he is unwilling to even have a discussion with me about other options,  I'm at the point of willing to try anything...

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  • Posted

    Hi there. First up, I’m sorry to hear of your troubles. I can well imagine that what you’re taking now, won’t touch your pain, considering what you’ve been through. I’ve done the whole fentanyl thing, and here are my words of advice:

    i definitely think your doctor should be giving something way stronger.

    fentanyl patches start at 12 mcg//r, and usually one would start low, and build up. DO NOT put the whole 100mcg/h on from nothing.

    lastky, it is very slow to kick in. You won’t put them on and feel better, say, an hour later. A day at least.

    but as I said, start low, please be careful.

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  • Posted

    I’m so sorry you’re having so much pain Angron. 

    I have JRA (49 years now)

    I had over 20 surgeries in less then 7 years, mostly joint repair/Replacement 

    I was put on Fentanyl and Dilaudid by my pain Mgmt dr.  If I would have known how brutal it was to get off the Fentanyl 15 years after being put on it, my choice to go off, the side effects from the drug were so awful, I do not think I would have gone on the drug Fentanyl, it’s been the worst 2 years of my life coming off Fentanyl. It’s not a drug to take lightly. 

    It has been almost 2 years that I have been off of the Fentanyl and it has taken me a  the 2 years to feel better and get my life back. 

    Please do not take the Fentanyl and use them without your doctor prescribing the medication. I know you must feel desperate right now with this intense pain, but It will be worse when you have none left.  Find a dr who can help you!

    My fentanyl dosage would be as high 200mcg with surgery recovery, but my maintenance dose was 50-75mcg. 

    Have you thought of seeking out a different pain Mgmt dr?  

    Perhaps Fentanyl  is a drug that would work very good for you. Pain is debilitating and you need a dr who understands your pain. 

    If you do decide to take the 2-50mcg patches you will be worse off then before. 

    I hope you find relief soon!

    Take care. Karen 

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  • Posted

    Dear Angron,

    I am sorry to hear of your troubles and all of the surgeries you have had to endure. I have very serious disc degeneration as well as severe scoliosis, spinal stenosis and osteoarthritis --- all courtesey of an automobile accident in 1995. When I was on Vicodin, I began to develop an ever increasing need for it and the pain management doctor had me on a litany of different medications MUCH as yours does! It baffles me why they all seem to do this when it's REALLY just a recipe for disaster.

    When I returned to my GP, the VERY FIRST thing he did was recognize that I was becoming tolerant to the drugs, take me OFF OF EVERYTHING and put me on a Fentanyl patch. It saved my life and completely manages my pain.

    I have had 3 knee surgeries and will have to undergo a double replacement in the next few years. In total, I have had 14 surgeries to date (none of which were spinal surgeries) and face a minimum of 5 more (1 on each knee and up to 3 on my spine).

    The patch has allowed me to postpone the spinal surgeries until 1 of 2 things happens --- a.) I have to increase the dose of my patches ( I currently wear [2 ] 100mcg. patched

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  • Posted

    Dear Angron,

    First, is like to express that I am so sorry to hear of all of your troubles and the subsequent surgeries that no doubt have contributed to your difficulties. I suffer from an acute case of disc degeneration, severe scoliosis, spinal stenosis and osteoarthritis --- all a result of an automobile accident in 1995. I had a neurologist/ pain specialist managing my pain who had me on a litany drugs some of which you're taking currently. When I returned to the care of my GP, the VERY FIRST thing he did was recognize that I was becoming tolerant to the drugs that were supposed to be helping me and that in no time my liver would be shot to hell. I also had had a gastric bypass which brought about it's own problems because anti-inflammatories were a "no, no" and because of how my stomach had been redesigned, I was only able to absorb about 50% of the benefit of the drugs I was taking. My doctor put me on a Mylan Fentanyl patch --- and took me OFF of evetything else (save 15 --- NOT 50 --- Loratab per month for breakthrough pain). It has completely managed my pain, improved my quality of life and kept me in check. Now for the part you MIGHT not like --- you knew that was coming, Right?

    It sounds as though you need to find a new doctor --- the cocktail of prescriptions that you're on is killing your liver--- the good thing about the patch is that it is absorbed through the skin, stored in your fat cells and bypasses yoyr liver altogether. From what you've written, it sounds like you are not opposed to taking your medication in doses that are contrary to the directions that your doctor has written, which I guess an extra Norco here or there can't hurt if your writhing in pain, but can DEFINITELY kill you when it comes to Fentanyl --- you SHOULD not take a medication that you have NOT BEEN PRESCRIBED --- you have NO IDEA about Fentanyl and the difference between a wave of relief and an overdose is the equivalent of 2 grains of salt --- no lie!!!

    You don't know how it will interact with ALL of those other drugs and without the guidance and expertise of a physician, you are dancing with a cobra. It takes Fentanyl approximately 12 to 24 hours to get into your system and you would need a well-devised plan to stop taking your other medications and begin the patch. It IS NOT something you jyst "try" and I'm shocked that your "friend" would just casually give you 2 if their 50mcg. patches!!! I'm sorry to be so adamant about how deadly this stuff can be, but facts are facts.

    You MUST get a physician's help to calculate the meds you're on now and transpose that to an equivalent dose of Fentanyl. I ALSO advise that you ask to be prescribed the "matrix" style patches vs. the "resevoir" type. If you have children or pets, the reservoir style patches can kill them in that the medication is in a "pouch" which can be easily pierced and lead to overdose by inadvertent exposure. The matrix style is designed to make abuse much more difficult --- I honestly do not understand why anyone would have a death wish like that, but it is very important (if you want to live) that you have integrity with both your doctor AND your pharmacist. If ALL you truly want is find an effective way to manage your pain, then your honesty with both of those individuals is paramount! I have 1 prescriber and 1 pharmacy --- period. I would rather die than betray my doctor and mess around with a very special relationship. If you are willing to have an honest discussion with your doctor about how you feel physically, demonstrate a willingness to give up ALL other drugs (except maybe a VERY small Rx for breakthrough pain --- the patch isn't necessarily a silver bullet) and work with your pharmacist to help calculate any potential reactions, I think you'll be happy with the relief you'll get.

    If your doctor won't entertain any conversation about Fentanyl, please ask him the rationale behind his position? I would be scratching my head as to how being on the "cocktail" you're on and the harm it's doing to your liver coukd be better than giving all of that up and trying something that could be more effective.

    You could have an agreement with him/her that the introduction of Fentanyl woukd be for a trial period and agree to the "max dose" of which he'd no longer be comfortable prescribing. Once you have a plan in place, do your homework about the drug --- in fact, it wouldn't be a bad idea to do your research BEFORE your next appointment --- your doctor may be more receptive to switching if he feels you've checked into it and weighed the "pros" and "cons".

    My doctor and I agreed that we know it's time for spine surgery when 1 of 2 things occurs: a.) I have to increase my dose ABOVE 200 mcg. per 72 hrs. OR b.) I lose functionality in any of my lungs that make it difficult to walk or conduct my daily life. Once you and yoyr doctor set the boundaries, honor them and be 100% honest!

    I hope you will feel that I am coming from a place of not only concern, but experience. I've been wearing a patch since 2003 and it has TRULY helped me, but it is a drug that MUST be treated with ABSOLUTE REVERENCE. Please do your homework and talk to your doctor. If he won't help you, then find someone who will, but PLEASE don't take someone else's medication without the appropriate guidance and support!

    Mj

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  • Posted

    Hi again, I wanted to second what Mj said. I should have said before. Please, NEVER choose the “Reservoir” type patches. They are a recipe for, literally, a deadly accident to happens. The Matrix (flat) fatches are far safer. Here in the UK, all hospitals I’ve ever been to, use the Duragesic make. I think they are slightly more expensive, but, I m told, the best quality. 

    If you have a “reservoir” patch, and it tears, leaks, is even pricked by a pin by accident, the liquid gel that is inside, seeps out, and a tiny amount will easily kill a child, pet, or indeed an adult.

    about five years ago, here in the UK, a family hit the papers: they were visiting an elderly grandparent in a nursing home, who used parches for cancer pain. All fine. BUT they had the reservoir type, and for reasons which were never discovered, one fell to the floor. The five year old grandson was playing, as the adults talked, and the patch was slightly ruptured. The poor kid played with it, oblivious to everyone. Some gel went on his arm, and also, he licked the area thinking it was some kind of candy. Needles to say, he tragically died. AVOID THE RESERVOIR PATCHS, PLEASE!!!!

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  • Posted

    I would like to thank you all for the advice and genuine concern you have shown me. Its a really good feeling knowing that people unknown to me would show so much concern. I thank you all from the bottom of my heart. I will not take them. I have asked my friend to take them back. And I am going to go ahead and start looking for another pain management doctor. I had an appointment with my podiatrist today and expressed to him what I've been going thru with him and he too was baffled as to why he won't even have a discussion with me other than, no, and this is the best thing he can give me and there isn't any other options. It's been really hard to deal with. My kid is 15 and doesn't ever remember my being healthy and as a single parent it is a thing that has weighed heavily on my heart. But what would be worse is not being there for her at all. So thank you all so very much. 

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    • Posted

      I can't tell you how relieved I am to hear what you intend to do. Coincidentally, the coroner's report on the death of Tom Petty was released today along with a statement from his family. His doctor prescribed Fentanyl patches on top of other strong narcotics and he woke up dead. Not enough people are well informed about that drug --- including the doctor's whom we rely for their expertise and guidance! Fentanyl can be a wonderful answer to a better quality of life for people in chronic pain, but if it is not treated with the reverence and respect it deserves, it can be lethal.

      I applaud you in your selflessness in thinking of your daughter before yourself ESPECIALLY when you're in so much pain --- it's hard to think of anything else INCLUDING your precious children when you hurt like that. I am MORE than sure if you educate yourself and show a willingness to exclude all other drugs from your pain regimen, another doctor will see that you are a responsible person that is merely being proactive with their health in order to lead a better life. BRAVO on your decision--- you'll find an answer soon I'm sure!

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