Fentanyl patch placement , itching and Fentanyl withdrawal.

[mersilkee]

Hi,
I am on a high dose of the Fentanyl patch.  I have been on the patch for many years.  I change them about every 48 hours.  I tried every 72 hours but I would have pain and withdrawal symptoms.  My husband has put them on my upper to mid back for years.  About 3 weeks ago, I started having intense episodes of itching.  It seemed like it would start at one place under the patch, not many places on all patches, and then the itch would spread to my arms, head and other places on my back not covered with the patch as well as my chest.  He tried putting Benadryl, Cortisone and Benzocaine sprays on my arms and other places where the patches weren't.  I even tried taking oral Benadryl.  But, the itch wouldn't go away.

I've heard of the no patch below the waist rule but have never been able to find out why it would make a difference.  I worked with physicians in the medical field for several years and read up on all the Fentanyl literature I could.

So my husband decided to put them on the outside of my left leg.  I had an episode that had all the earmarks of early Fentanyl withdrawal which included yawning, aching, sore joints, and that flu like feeling.  We wondered, did they not release the med as well there because there wasn't enough contact as there was when he put them on my back?  

Then he put the patches on my lower back.  Same problem of possible Fentanyl withdrawal symptoms.  My husband deduced that there was more subcutaneous fat there so some of the Fentanyl was being stored in the fat.

Then he tried putting them up high on my back.  The bottom one started itching in one place under the patch and then I had the itching episode again.  

Now he has put the patches more on the side of my back and I think everything is okay so far.

But, I am wondering, is the itching due to a reaction to the Fentanyl patch?  I have been wearing them for years and there was no redness.  I am very sensitive to any decrease of Fentanyl in my system and will have withdrawal like symptoms.  Why do I still have withdrawal symptoms when I take Methadone and Dilaudid which are my breakthrough pain meds?

Thanks,
M.

[Tuckamore]

Hello M,

We have a memeber that has been on the patches for years and has had a similar problem. Just as you, she developed this itching and rash after several years of being on the patch. Unfortunately she is on vacation and can't comment. I do beleive her itching finally straightened out too.

Here's what happened to me. I was on the Fentanyl Patch too for several weeks. Suddenly I had almost the same thing happen to me. The itching was almost unbearable and the rash was definitely hive-like but blistered under the patch. I too had it on my upper back, just above my shoulder blade. My physician said that it was a reaction to the adhesive and not the medication. She prescribed a steroidal cream in hopes it would help. It didn't. I tried it for several more applications. Like you, if I didn't put it on my back it wasn't quite as bad but I felt it did not absorb as well. I simply cannot tolerate the rash, blistering and itching so the Fentanyl Patch is out for me.

Placement is important. You need an adequate amount of adipose (fat) and muscle tissue in an area with good circulation. Very thin, frail ppl do not absorb as well. For some ppl the thigh is ok for others it is not for various reasons. I was taught that it is best placed on the torso but preferably not over the heart and the site needs to be rotated with every change.

As far as your withdrawal symptoms I just haven't a good response. It makes sense that you would have some w/d but nothing severe with the other opiates on board and at least some of the Fentanyl being absorbed. But we are all different as our our systems. Your system may just be very sensitive.

Other's may post with more information or comments. Thanks for sharing your experience with us. I hope you will keep in touch and let us know how you are doing.
  
Take Care,
Tuck