Leg Muscle Pain from Fentanyl Patch

I have been on the Fentanyl Patch for five years. I started out on the 50mcg changed every 48 hours and am now on the 25mcg every 48 hours. I want off of this drug, but every time I start stepping down to get off the medication I begin having severe muscle pain in my legs and something like restless leg syndrome. I was wondering if this is a normal side effect from getting off of the Fentanyl and if so, what can I do about it because the pain is pretty severe.
Thank You!

[Jaybay]

Hello and welcome!  Your symptoms are caused by withdrawal from the fentanyl and they would be the same with any other opiate.  It's just the nature of the beast when we taper off opiate therapy.  RLS and increased pain are usually the first symptoms.  Hot baths with epsom salts help a lot with withdrawal-induced RLS.  The relief is only temporary but worth the effort.  I've heard some people say that using heating pads on their legs (or arms if arms are also included) can also help.  

There is also a an over-the-counter product made by Hylands Pharmaceuticals called "Restful Legs."  They have two compounds and you want the one that contains quinine.  Make sure you check with your doctor or pharmacist before you use it to make sure the quinine doesn't interact with any other meds you're taking.  I seem to recall that benadryl is contraindicated with quinine.

Is your pain doctor helping you out at all with a taper schedule?  The patch can be a difficult one to taper.  Some docs will switch you over to a pill which is easier to cut down with.  I've been tapering from the patch too - down to 12 mcg from 75 mcg.  It's taken me nearly a year to get to this point.  With my doctor's blessing, I cut slivers off the patch and taper that way.  You can't do that with the gel patches.  As far as I know, Mylan Pharmaceuticals is the only company that manufactures a non-gel patch that can be cut.  It looks like a piece of scotch tape.  Leave it on the plastic backing, cut off and throw out what you don't need and then apply the rest as usual.  Once you get to equal halves, you can still use the other piece.

You're getting low enough now that I'm not at all surprised you're beginning to feel withdrawal symptoms.  I hate to say it, but it's probably going to get worse as you taper further.  Some people prefer to slow down and let their bodies stabilize before continuing to taper; others look at it like ripping off a band-aid and go cold turkey and just deal with the withdrawal.  Figure on a good week of misery - pain, RLS, insomnia, depression, nausea and maybe diarrhea and vomiting.  There are some prescription meds that can help a bit, like clonidine, but that's something you'll need to talk about with your doctor.

Good luck!

[KrustyBroccoli]

For starters, the fentenyl pain patch has a 72 hr span- NOT 48 hrs. The fact that your Dr has prescribed it every 2 days is BAD. It will build in your system and can have fatal results. Regardless of what anyone says otherwise it should never be taken for any other length of time that 3 days. Ever!! Without exception. It's how the drug was designed, and any other dosage times is against the drug company's dosage recommendations, and can be and has been fatal!!!

IF YOUR DR HAS ISSUES WITH THIS THEN SEEK IMMEDIATE ONSULTATION FROM ANOTHER MORE QUALIFIED DR!!!  My husband's family Dr wasn't familiar with the correct dosage time of 3 days, and thought that every 48 hrs was fine. "A little is good, more is better" mentality. He wasn't aware of the potentially deadly consequences of improper dosing. My husband almost died from opiate poisoning. His Dr now knows, but it was a close call. It was simply a lack of understanding/education on opiate transdermal pain patches.

This added build-up in your system is going to make your withdrawal worse. Technically you have more drug in you that you think.

Opiate withdrawal causes a creepy-crawling feeling, like ants crawling over your body, restless legs, anxiety, itching, excessive pain. There are drugs that can help reduce these symptoms. Ask your Dr about an anti-hypertensive such as clonidine, and if it's suitable for you. Your dr will know best, due to your possibly having other medical conditions. It's not for everyone, but I took it when I went off of the fentenyl pain patch. It has been widely prescribed to ones who it is suitable for to aid in opiate withdrawal. It's not addictive. Check with your Dr. though. It blocks the stress hormone, norepinephrine, from being released. Norepinephrine triggers adrenaline- your body's response to withdrawal. No norepinephrine- no adrenaline- less registration of panic in the body.

The withdrawal is horrible feeling, but it can be tolerated. Your dose isn't that strong, so you'll suffer a while, but it'll go away.

Your body will create excessive pain, more than you had to get the drug, in an effort to get your to cave in and give it more. That's the addiction in your body. It wants more, and will do anything to get it. It only lasts a few days, though.

Change your patches every 3 days instead of two. Read the information that comes with them, consult your pharmacist- 2 days is potentially fatal- even if you're coming off of it.

Cutting the patches into smaller pieces to help wean off of them slower is a wonderful idea. Novo and Apo make patches that can be cut. They are thin, tape-like, non-gel patches as well. Ask your pharmacist what is available in your country.

Be educated about opiate medications- even if you are coming off of one.

[Jaybay]

Krusty, I'm really sorry to hear that your husband overdosed on the fentanyl patch.  That must have been extremely frightening for both of you.

I do have to disagree with your strong words of warning about changing the patch every two days.  Yes, the manufacturers studied it and the USFDA approved it for 72-hour use.  Like any other drug, once it's approved any doctor can prescribe it however he wishes.  Take Lupron for example.  It was intended for men with prostate cancer but once on the market it was used for women with endometriosis.  Lupron has many serious side-effects but nobody blinks at it.

Many pain patients, after being on the patch for quite some time, find themselves in withdrawal on the third day.  I've experienced it myself, mostly with the gel patches.  That is a well-documented problem with the fentanyl patch.  Rather than increase the dose, doctors have found thant changing the patch a day early answers that problem.  Of course, a 48-hour change is not warranted for people who are new to the patch or don't experience withdrawal symptoms on the third day.  

I also agree that many doctors well-schooled in opiate therapy for chronic, non-malignant pain.  That's one reason why the pain management specialty has exploded here in the US.  Many primary care physicians won't attempt to treat such patients and refer them to pain specialists.

I do hope your husband's pain is either resolved or well-managed now.  He has a wonderful advocate in you.  :-)

[mellie4]

I have to agree with JayBay.  What your husband experienced was terrible and thankfully he's okay.  But everyone metabolizes things differently.  I was originally prescribed to change my patch every 72 hours but they changed it to every 48 hours.

Coming off the Fentanyl patch can be very difficult.  I knew someone who abused it and did it cold turkey.  They told me that it was a very rough withdrawal but faster than other opiates.  They also got hooked again and were taking it orally.  They withdrew from that by using it as directed and then doing what JayBay did by cutting it.  They also had the same type patch as JayBay, and she's right in that cannot be done with gel patches.

I took my dosage down very slowly and also extended it back to the 72 hours.  I was also, however, on other narcotics for breakthrough pain.  When I got very low, they switched me to a long-acting narcotic.  This was done all through prescription and the long-acting med was only used for a very short while.  I did still feel some withdrawal but it wasn't too bad, maybe one day.  (Though I personally feel Fentanyl was not the right med me.  Lots of people have great success on it.)  Again, great advice from JayBay on the Hylands Restful Legs.  It works great and fast.  It's nonaddicting.  My friend used it in her withdrawal from the Fentanyl and it helped tremendously.  My dad also uses it at times just for bad leg cramps he gets from time-to-time.  (Tonic water also has quinine and is often used for leg cramps.)

I also had similar trouble as JayBay with the gel patches.  I think for me it was because they didn't stick well and I wasn't getting proper release of the medication.

Best of luck.

[mechanic100]

i 100% disagree with the 72 hour thing
I was in withdrawals by day 3
I have now been on 200, 2 100 patches for over 6 years at 48 hour intervals

[mechanic100]

I recently tapered down cutting the patches until I was at 1/16th of a 100 patch, CHEWING THEM, AS THE WITHDRAWALS ARE SO LESS SEVERE
it was hell, but doc gave me clonodine, and some tylenol 4 with codein.
Using heating pad for rls, and taking mega amounts of NIACIN, it really helps with depression
clonazepam 2mg will help with sleep
THATS THE WAY I DID IT, STARTED 2 WEEKS AGO, AND FEELING HUMAN AGAIN.
iGOOD LUCK