Duration of Fentanyl patch pain control shorter than "textbook dosage time"?

[Rumple2]

I am on 159 mcg. every 48 hours yet the relief rapidly subsides after 28 to 30 hours and it is not safe to put them on any closer in time.  I am also on Opana 5 mg. for BT, up to 4 a day prescribed yet my doc knows I have to take them WITH the fentanyl daily which isn't right by the insert and other health professionals.  Does anyone else have a similar problem?  I have been on every heavy hitter there is and the Doc says that out of 1000 patients, ONLY I AM SO DIFFICULT IN PAIN CONTROL!  I am now going to get a second opinion but don't hear positive responses to my scenario by other doctors.  Thanks fellow sufferers!!
Rumple2

[Grreatful]

Just curious how long have you been on the Fentanyl patches, has it been longer than a couple of years?  According to my Paliatative care doctor it's best to change it up every two or so years because your brain receptors get used to the drug and it doesn't work as well as it used to.  The pain is in your body but it sends the message to your brain that it hurts and that's the part that gets used to the drug and why you end up needing more or it doesn't last as long.
And since I was going to be on pain management forever I listened to what he had to say, he was the best doctor I had until he retired.  
This is just a thought but hopefully you'll get it sorted out hope to hear for you soon , I'd like it hear how they helped you out.

[fntn]

It's amazing to know that they "can" control your pain, but they chose not to do it. I've had major surgeries were they did manage the pain properly and I was surprised that I'd forgotten what normal felt like. Sad.

[remar]

I'm so sorry you're going through this. I've heard this same complaint from many people. Drs, pharmacists and the inserts say a medication is supposed to last a certain amount of time. This is not always true. Some of us metabolize medications at a different rate. I take a short acting med and my Dr seemed a little surprised when I told her they were not working for 4 hours.
I think getting a second opinion is a great idea. Your Dr is saying you're one out of a 1000 but I bet you're not. I've seen a lot of people here with the same complaint. Do you have another Dr picked out that you will see for a second opinion?
I wish I could give you more advice. This has to be so frustrating for you. We have very knowledgeable and wonderful members on this forum. I know you'll be getting more answers from other members

[Tuckamore]

Hello Rumple,

Welcome to our Pain Management Forum. I am so sorry to hear about the difficulty your PMP is experiencing in controlling your pain. As Remar said, many of us have the same or similar issues with the effectiveness of opiates - and sometimes all meds.

We have numerous members that do require changing their Fentanyl Patches every 48 hours - but I've not heard nor read of anyone requiring a change every 24-30 hours. The absorption of the Patch should be unchanged for a minimum of 48 hours. Indeed studies have indicated that it can begin to drop off after 48 hours.

Don't get me wrong. I know studies aren't always correct - and I certainly know that we often metabolize medications differently than the next  person. Indeed it's a proven fact that our body uses certain opiates better than others. Some PMP are now using our DNA to determine which opiates we best metabolite. In your situation it may be a good tool to determine which opiate is most effective in your system.

I know that in today's Opiate Phobic Climate the consensus is you don't take your SA opiate when you take (or apply) your LA one.  I had a PMP for years that told me it was acceptable - as often the patient was waiting for the LA opiate to "kick in" to it's highest therapeutic level. Today many PMPs refer to a SA Opiate as your Rescue Opiate - believing that the LA one should provide 100% of your pain control.

Many of us must exist on small doses of opiates these days - and not what was once RX.  It's all this War on Drugs that has become the War on Chronic Pain Patients. I wish you the best with your second opinion. I hope better solutions can be found for you.

Please keep in touch - and be active in our community. I'll look forward to hearing from you again.

Take Care,
~Tuck