Fentanyl Patch

Hi! I was diagnosed with Fibro and Chronic Fatigue this past August.  I am seeing a Rheumatologist who referred me to pain management.  I have been taking 4 -5  of the 7.5/500 mg Hydrocdone a day. The pain management doctor wants me to use the 25 mcg. fentanyl patch, but my Rhumetalogist seemed to have a strong reaction to this and the pharmacy treated me as if I am a druggie when I went to pick it. I worry about taking medication, but don't know what else to do for the pain.  Does anyone out there use Fentanyl? Is it as addictive as they say?  Should I worry about the amount of hydrocodone I'm taking. By the way everyone acts, I feel like a druggie...does anyone else feel this way or am I the only one?  Thanks for any response.

[Phtartist]

Together hydrocodone and Fentanyl increase sedation. If you wish to be able to function, maybe you should use one or the other.
I understand the need for something to allow us to be able to lessen the difficulty of functioning with pain.
Taking those together will possibly not allow you to function at all. I checked drug interactions and there is a moderate warning as to taking them together. The amount of Hydrocodone you are prescribed can be lessened in the hopes of you taking less Tylenol (500 mg. Per pill) which irritates the liver. Zydone is a good hydrocodone with less Tylenol.
I have been taking Zydone for years as needed. Taking it for reasons other than pain is a sign of addiction. Watch for that.
Always try to be with your pain and ride the day out without meds. Addiction can happen to anyone and it is good to take your meds on a strictly as needed basis.
Right now you need them but if you don't take a break, you don't know if you are having a break in pain.
I am not against relieving pain. I have 15 years of very unsettling pain and discomfort. We do need to continually be aware of our mindset when having a life with pain and having drugs on hand. It is physically taxing but the emotional strain of being changed by it tempts us to change how things are with the drugs.
Always be aware.
I am in recovery for 16 years from alcohol and substance abuse, plus I live with chronic moderate to severe pain daily. Awareness is the key to not being hooked.

[Tklein9495]

Thank you so much for the information.  I'm trying very hard not to get addicted to the pills, that' why I asked my Dr. if there was something else I could use.  He recommended the Fentanyl Patch, but from what I hear it's very addictive as well.  Some times I feel like I'm caught between a rock and a hard place and don't know what to do.

Again, thanks for answering my post.  I hope you're now feeling well and continue to do so.

[geminigirl1963]

I'm sorry you've been having so much pain.  I, too, suffer from both fibro and CFS and can fully understand the pain they can bring.

My guess is that your PM doc switched you to the fentanyl patch because he felt that you needed a long acting pain med as opposed to the hydrocodone (short acting) that you were taking.

I understand about you not wanting to get addicted to the pills, however, you must remember there is a BIG difference between dependence and addiction.  Most chronic pain patients who are on opiate therapy will experience some level of DEPENDENCE to their meds - meaning they are dependant upon them for pain control.  ADDICTION comes into play when you start taking more of the medication than is prescribed, seeking out multiple doctors to write you scripts for the same medications, requesting refills early, taking the meds in another form than prescribed (i.e., crushing and snorting them as opposed to taking them orally).  There is scientific evidence that shows that only a very small percentage of chronic pain patients who are on opiate therapies will actually become addicted to their medication.  Both dependence and addiction can/will cause withdrawal symptoms when the medication is abruptly stopped and that's where many people (some doctor included) think that just because a patient is experiencing withdrawal symptoms, they HAVE to be addicted - it's just not true.  The physical withdrawal symptoms come because your body has been used to having that medication and when it doesn't have it, it will rebel.  Much like when you are used to drinking coffee in the morning and if you don't drink it for a day or two, you'll tend to get a caffeine withdrawal headache.

At any rate, with the fentanyl patch, you will probably notice a much more level pain relief rather than the peaks and valleys of pain control that a short acting medication gives.  Some doctors also prescribe their patients a short acting medication for 'breakthrough" pain - which is pain that "breaks through" the pain control of the patch.  Has your doctor told you to continue the hydrocodone or prescribed you something else for breakthrough pain?  

I, myself, used to be on the fentanyl patches until I started experiencing severe, life threatening side effects from them and had to be taken off of them.  While I was on them, however, I did find they controlled my pain quite well.  I'm hoping you fill find the same.

So long as you use the patches exactly as prescribed, you probably don't have to worry about true addiction.  Dependence, maybe.  

I do have one question - when you say you "feel like a druggie" - is that simply from the way you were looked at and treated at the pharmacy when you picked up your prescription for the patches?  Or do you FEEL drugged on the patches?  If you're feeling as if you're "drugged", it could be that the 25mcg that your doctor has given you is too strong for you.  They do also make a 12.5mcg, so if you're feeling that the patch you have is too strong, talk to your doctor about starting you out on a lower strength until your body can get used to it.

Also remember that with the patches, you must be VERY careful about not getting overheated and not exposing the patches to external sources of heat such as a heating blanket or hot water.  Because the medication is released transdermally (through the skin), the higher your body temperature is, the more medication is going to be released.  When I was on them, my doctor also told me if I started running a fever above 101.5, to call her and she would instruct me whether to remove the patch temporarily until my fever went down or what to do.  At one point while on them, I came down with a horrible case of strept throat and was running a fever of almost 104 - she had me remove the patch and only use my breakthrough meds until me fever had come down below 101 and had stayed there for at least 12 hours.

There are some non-medicinal things you can try to help relieve your pain also.  Simple stretches sometimes help to keep muscles limbered up and not getting stiff.  I also use a heating pad, but again, I'm no longer on the patches, so be sure and double check with your doctor or pharmacist before using a heating pad to make sure it's safe for you to put it on an area of your body NOWHERE CLOSE TO THE PATCH.  I also use warm (not hot and not cold - I find that extremes in either direction bother me) showers.  Again, with the patch, it's especially important to make sure the water is not too hot and if you're taking a bath, make sure the patch is above the level of the hot water.  One thing I would do when I was on the patch and I wanted to soak in a tub is to time my soak for when I was to be changing my patch anyway - remove the old patch, do my soak and then let me body completely cool down before applying the new patch in a new location.  I still did not use overly hot water, though - but like I said I personally find that extremes either way increase my pain.

I also like to listen to soothing music when my pain is high - it sometimes helps me to relax enough so the medications can help better and the relaxation alone can help soothe aching muscles and joints.

Best of luck!

[Tklein9495]

Thank you for responding so quickly and for the information you've provided.  In answer to your question about being a druggie, it's just the looks I get, not a reaction to the medicine.  However, that being said, I would really like to know what kind of problems you had with Fentanyl and the symptoms you experienced from it.  My doc didn't really tell me a lot about it when he  started me on the 25 mcg every 72 hours and so far I've been tolerating it pretty well. The fact that it is so dangerous really scares me though, so any additional information you provide will be greatly appreciated.

Again, thank you so much!

[geminigirl1963]

The problem I had with the fentanyl was that it basically shut down my entire GI system, which not only caused pain and nausea/vomiting, but also was a very real possibility that because ALL GI function was not working (neither in nor out), that I was in very real danger of a complete blockage and possible rupture of my intestines.  Constipation is common with any narcotic, but my GI system is extra sensitive anyway, so please don't let me experience with the patches scare you away from them.  As I said, while I was on them (I had been on them for about 3 or more years when I began having trouble), they did offer me really good pain control.

The important thing to remember is that ANY narcotic has its dangers (as well as any over the counter med), but so long as you use them exactly as prescribed, and be careful about the heat source thing, you should be fine.

I'm more than happy to answer any qeustions you may have, however, in the event that you have a question or concern that you feel needs an "immediate" answer, your pharmacist (and/or doctor) are great sources of information when it comes to your medications.

In addition to being careful about external heat sources with the patch, also be sure to place your new patch in a differnet location from where the patch was that you just removed.  This will not only help with absorption of the medication, but will also lessen the chance of a rash/reaction to the adhesive on the patch.

some people find they have difficulty getting the patches to stick and stay stuck.  There are also two different types of patches - one that has a gel reservoir where the medication is and the other is a non-gel reservoir type where (I believe, not 100% sure because I was on the reservoir type) the medication is in the adhesive on the patch.  Depending on which kind you have, your options for helping the patch stick may vary.  For the ones that I used, the medication was in a reservoir in the center of the patch, so I was not permitted to cover that part of the patch with any dressing or tape (to allow thepatch to "breathe" and not get too warm, thus releasing too much medication at once).  I was, however, permitted to tape around the EDGES ONLY of the patch and I did find tha this helped to keep them in place.  Again, your pharmacist would be a great source of information regarding what to use (if anything) if you find you are having difficulty keeping the patches stuck.

I'm glad you seem to be tolerating the 25mcg well - did your doctor also give you something for breakthrough pain?  If so, are you finding that you're still having to take as much as you were prior to getting the patch?

No need to thank me - I'm glad I was able to provide some information.  Let me know if I can answer any other questions.