Pain Management Appt, Need some advice

[ChronicPain1]

So I'm on the Fentanyl 25mcg patch, switched from 180mg of Morphine ER because of tolerance. As I've said here before, but reiterating for those who may not know, it doesn't work for me. The Fentanyl that is. It was pointed out that the dosage is most likely low and I should be on the 50mcg patch, but I'm not a big fan of the patch in general. Maybe the dosage issue has just soured me, but I feel like having the patch on all the time, and the possibility that it could stop working short of 72 hours is an issue for me.

I ask for advice because my PMP brought up taking a sabbatical from the meds. I am all for this idea except that my pain is considerably worse now than it was a year ago, and I work the overnight shift and that causes the pain to become worse as well.

I've told them it doesn't work, but I'm afraid if I keep telling them and try to convince them to switch it, they'll take me off everything and the suffering will increase. Mind you I'm dependent on these things, but when I first started the Fentanyl and got sick from an unrelated illness I didn't take anything for 4-5 days, so I'm not worried about withdrawal. I don't crave or desire the meds except for pain relief.

I just don't know how to say it to them without it automatically going to the med holiday as a solution. I wish they'd try something else, preferably in capsule form, but I'm guessing they won't as they already said they don't want to switch me again.

[Tuckamore]

Mollyrae has good information and knowledge of the Fentanyl Patch. However one of us have misread your post. She stated that you are back on the morphine. I thought you said you are on the Fentanyl but would prefer to return to the Morphine. Please clarify. And I do not think that once you take Fentanyl (25) and it doesn't work for you that morphine won't work for you again. We all have different systems and what works for one doesn't necessarily work for another.  

I tried it at the 25 dose of Fentanyl and though it worked somewhat I was severely allergic to the adhesive. It scared me too. I hear of a lot of unnecessary deaths from the patch. On the other hand it has been a miracle drug for some patients. I guess their are risks with any 'Big Dog" opiate.

I know you are afraid of the drug holiday but I still encourage you to discuss this with your prescribing physician. Some patients system seem to tolerate opiates better than others and don't experience w/d to the degree that others do. After 6 months in the hospital on Demerol and Oxycodone every four hours I was discharged home. I refused a perscription of narcotics and though I had some anxiety, restlessness in my legs and difficulty sleeping it only lasted about 48 hours. If someone told me that prior to my experience I would question their truthfulness. So I do know that minimal w/d symptoms does have....for a select few of us. Never would I recommend going cold turkey as I did. I was not as informed than as I am now.

There are other physicians out there if you are not satisfied with your current one. I urge you to tell him what you have told us. Pain is no fun and life is too short to live it with uncontrolled pain.

[Mollyrae]

Hi ChronicPain:

Did you talk with the Doctor about the Fentanyl Dosage? Like I told you, It is too low and instead of changing the patch every 72hrs. you most likely needed to change it every 48hrs. I have to change the patch every 48 hrs. in order to get relief.

Now that you're back on the Morphine after being on the Fentanyl, I will tell you that it isn't going to work. I'm surprised that you're not going through some sort of w/d at this point.

In my opinion, you should march right back in to the Doc's and give the Fentanyl another try. This time have him adjust the dose.

Take care,
Molly

[ChronicPain1]

Well they switched me back to the Morphine ER at 30mg 3x Daily, half of what I was taking before. I'll return in a week and see if it's working, I'm just hoping a month off of it did reduce my tolerance enough.

However I need to go get the horrible torture test that is the EMG. Gotta build up my courage to do that again, between that and the Myleogram....I've never had more painful tests.

[ChronicPain1]

Yeah I'd almost rather be on the Morphine despite tolerance than the Fentanyl.

I guess my point is, we shouldn't have to worry about being seein in the wrong light for asking. I was told to call and let them know if it wasn't working, I did and they pretty much ignored me anyway.

We'll see how it goes, but I have a feeling it's either the higher dose, and if it doesn't work suffer for another month, or nothing at all.

[nick30]

i guess i should add that the dr probably thinks that if he puts you back on morphine you won't be happy with anything less than 180mg a day, which he is obviously not comfortable with. to be honest it was a high dose for someone your age. you could always see if he will go for a reduction in the original dose, but the dr will still be thinking that you will need another increase soon anyway.
can't see any other ways out of it.

[nick30]

i would just concentrate on the issue of it not actually being strong enough. if you talk too much about changing drugs too much they may just get the wrong opinion of you. my own dr isn't comfortable prescribing pills so for me it's the patches or endless rantings about pills and junkies. personally i don't like the choice being left to dr's as they make thier decisions based on what they feel comfortable with, not what we are comfortable with.
perhaps just try one more time to try the stronger patch and if that doesn't work, find another dr. i'm sure tuck will agree with the latter point.