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1264863 tn?1391118193

Switching from Oxy 50mg to Fentanyl 12 patch NERVOUS

Hi so my pain doc wants me on a long acting and Fentanyl patch is the only one my insurance covers at a low copay.  They took away my 50mg's a day of percacet and are replacing it with 12mcg Fentanyl patch.  I switch it out every 48 hours.  
I am VERY VERY nervous that I am going to go into withdrawl from the percacet being gone cold turkey and that the Fentanyl seems like a low dose.  
Is 12mcg's a low dose compared to my 5 10/325mg oxycodone I was taking a day?  I am so scared tomorrow is going to bring me a lot of PAIN PAIN PAIN!

Any info is helpful

Thank you all in advance for always being there for me.  

Jennifer
17 Responses
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Avatar universal
My gut reaction: if Hydrocodone has been managing your pain, a Pain Pump is a terrible idea.

Hydrocodone is the WEAKEST painkiller on the market.Gives one heck of a buzz (Moderators, please don't delete this), but in actual "real-world" tests, the nuts-and-bolts-real-deal pain killing ability of Hydrocodone is NOT that great.

A Pain Pump is meant for those that have "gone up the ladder", and are on so many pills that the side effects become scary (e.g. "I take tons of pills every day, but the pain is still excruciating, and I fall asleep in them middle of conversation to people"). To "go up the ladder," can take decades.

HOWEVER, there are exceptions.

To be able to "Properly Choose" a treament plan, you have to be well-informed, first. (Not just, "Yes, Doctor, whatever you say.")

To be "well informed" requires you to gather a lot of information. When you have all of the information together in front of you, then you can pick the best path, along with the help of your trusted doctor(s).

A good question to ask to gather some of this information may be, "Doctor, what are the pros and cons of trying different medications, modalities, and treatments *before* installing a Pain Pump?"

You have to make sure that if your doctor is recommending a Pain Pump, it is truly a recommendation based on what is BEST for you. Not for other reasons like your doctor is being investigated for prescribing too many Pain Pills, so therefore, you will be his guinea pig Pain Pump patient so he can tell the Federal Agent "Oh, here, look, I have patients on pain pumps."

Now.... I'm just sayin'

Your doctor may BE choosing what is best for you, however, it is important for you to be PART of the decision making process.
Helpful - 0
7721494 tn?1431627964
Guamdiver, I'd rather be diving the Marianas today, too.

Jumping from Norco to a pain pump is a huge step. I imagine the Norcos are getting less effective due to opioid tolerance.

Now, avoiding opioid tolerance is a good idea, if possible. Using a fentanyl patch, or oxycodone, morphine, etc, is one solution, but you may end up with tolerance problems until your doses are very high. (In fairness, you may not have this problem -- no way to tell how you will respond).

So your doctors are smart and looking out for you. Chances are you'll be trying fentanyl in your pump. Other medications used are morphine and hydromorphine. Sometimes a small dose of steroid is added.

Did your doctors tell you that the amount of opioid used with the pump is about 100 times less than what you'd need by pill or even by patch? With lower opioid doses, problems with opioid tolerance are easily handled.

So, the choice is yours -- the benefits are a better chance of pain relief at a much lower dose of opioid. The risks involve insertion of the catheter and pump, and other problems associated with pump failure.

Ask your doctor about the risks and benefits. Yes, there are a half dozen other medications you can try orally or with a patch. But a pain pump offers many benefits.

Frankly, if I were a good candidate for the pump, I'd jump at the chance. I've been a pain patient for over 30 years and my mediation and dosage options are very limited.

Best wishes.



Helpful - 0
Avatar universal
re: I take 10/325 hydrocodone and have been on it for about 6 years u gave both rotator ligements and not only torn but gone also my shoulder pops in and out and I have dvt's and have a lot of leg pain ive talked to 4 drs and a pain management place and they want me to get a pain pump I heard about fentenal and they have patchs and lollipops for bt pain does anyone know if it works well or at least better? I haven't tried percosets yet am allergic to all nsaids like naproxen and ibprophen so cant take those only leave me with opiods
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Avatar universal
I have been on the pain patch for at least ten years, when I started using it the dosage was 75 but that medication made me feel like I could not exhale. And anything fast moving before my eyes sent me into a tizzy.  Now I am on 100 and take 7.50/325 Percocet for bt pain meds. My doctor and I had a long discussion a few days ago about how the patch makes me feel. I was in his office and my body started its usual sweating, I was all sticky and clammy so he told me that the patch isn't really doing what it should do for me at this point so he suggested that I wean off from this and use Percocet only, so starting next month I go onto 75 with additional Percocet to control withdrawals. Frankly, I cant wait but for those of you starting this medication expect that you will be very itchy especially where you apply the patch. This will actually go away with time, use Benadryl to help ease itching. And avoid getting water under the patch, use tegaderm, it works. Patches that start to come off are basically useless. They do work for a good 48 hours beyond that they are again useless. DO NOT USE more than the doctor instructs you to take; you can and will die. This is a very powerful medication and if you use up your thirty day supply the doctor is unable to give you additional dosage. At my dr's office I had to agree to random drug tests, random drug medication counts and absolutely NO Drinking because of the potency of this medication. And if you do not follow your dr's instructions taking this stuff he can and will fire you as a patient.
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Avatar universal
I'm sorry I didn't see this post earlier. I just responded to your post about the fentanyl and erythromycin interaction.  so if you haven't read that one yet, please do.

In reading THIS post, I'm hoping that you both told your oral surgeon what pain meds you were on and also told your PM doc that you were going to be having your wisdom teeth out.  That way both doctors can confer together to get you the appropriate pain control.

It very well could be that the patch will not cover the pain from ether your toe fracture or yoru teeth extraction because they are more "acute" pain - and the patch is designed tohelp with "chronic pain".  That is why they usually have a notation right on the box o fpatchs that states they are not to be used for acute pain, such as after surgery.  Your prescribed BT meds may or may not be sufficient to help with both the broken toe and the wisdom teeth, however, after reading your post about the antibiotic, please don't take any o fthose either until you've spoken wtih your doctor.  The chance for interaction between the patch and the antibiotic they prescribed for you is so high an dcould be so severe, that it's definitley not worth risking.

Put an emergency call in to your PM doctor tomorrow and explain the whoel situation to him and see what he wants you to do.  And as I stated in my resposne to your other post, please don't take any more of the antibiotics until you've spoken to him.  Sure don't want to risk your life.

Take care and best of luck!  Feel better!
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1264863 tn?1391118193
I go in in the morning to get all four wisdom teeth pulled.  I have no idea if the dentist will be able or willing to help with pain control.  AND tonight I broke my pinkie toe.  It hurts so bad.  Throbbing.  So shouldn't the patch be helping with my toe?  Is it even going to help with my teeth.  I am SO SO SO scared.  Getting teeth pulled is a phobia of mine.  That is why I am just going in to do it at 34 years old and only because they starting coming in last week through my gum line.  
Any help, comments, etc and how do I know how to keep this patch on???
Helpful - 0
1264863 tn?1391118193
Just checking in.  It has been almost a week since my switch.  I have been waking up so happy (compared to normal) and not in pain.  This morning was bad, had no energy, felt withdrawl and pain of course.  So when I saw my doc we decided to go with the lower dose of 25mcg instead of 25 and 12mcg.  I felt more fuzzy on both patches.  That was the main reason.  But my body had just begun to adjust to the 37mcg and now that I backed back down to the 25mcg my body is not very happy I think.  I am not as fussy as I was a week ago but not doing as good as I had hoped.  I don't go back to see her for two months, any thoughts?
My biggest compaint is that the first three days or so after I switched I felt awesome, happy for the first time in years, no pain, no fuzzy, no ephoria, just like myself again without anxiety etc.  Why did I feel so great and social and happy and then it went away?  Was it just the Fentanyl hitting my system that made me feel good or will I ever be able to get it back?  I thought that the 25mcg dose was perfect and when we upped it to 36 that is when I felt yucky again so that is the reason I asked to stay at 25mcg.  Should I have given it more time to "kick in" and adjust to the higher dose and then I would have felt good again?
If anyone takes the patch and experienced this please please let me know.  I need to be happy and without pain for me, my kids and my husband.  The last four years have been hell and I felt for two days like I had my life back and then it was gone again.  I'm so sad.  
Helpful - 0
1264863 tn?1391118193
Yes it is very difficult with the kids so young.  We manage and my husband and kids are all very excited for this new change and hopes that I will not have to pill pop all day.  I think if anything this is going to be the best thing that could have happened to control my cp for my family and I.  As long as  the mood swings stop soon.
Helpful - 0
Avatar universal
If you're allowed to have BT medication, then of course you can take it.  But I would take what you're prescribed ... if it's the 15 mg oxycodone, then take that (or half if you're too anxious.)  The Fentanyl and BT meds should not affect you having the kids.  (I had 4 kids when I started my CP journey.)  (Actually I still have 4 but they're older and it's, in some ways, easier than when they were younger.)  I will say I never drove when my meds were changed until I was certain they didn't affect me in a way that would impact my driving.  And even then, I used to try to take my meds around the driving schedule.

Believe me, I understand having a non-stop life.  And it's hard when you have CP and you still have to keep going.  What I found helpful is realizing things don't have to be perfect.  CP took a lot from me and my kids and we all still struggle with it at times.  But you have to pace yourself and prioritize things or else you wind up worn out and not being able to do anything.

I hope you're feeling better.  Maybe you can take your BT med when you settle the kids down for the night.
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1264863 tn?1391118193
Yes you are correct
" Right now, I'm reading it as you have the 12.5 mcg. Fentanyl patch with the option of adding another one, plus you have 15 mg. oxycodone that you can take up to 5 times a day. "
I was just asking if I took one of my old percecet while I am waiting for the patch to kick in if that could hurt me.  
I am just going to tough through today.  I have three little kids at home ages 8 down to 4 so my life is NONSTOP.  I just have a hard time with med changes all together.  My life does not have room for days like today.

thanks everyone
My plan is to add the second patch tomorrow and hope for better pain management

Helpful - 0
Avatar universal
Well, you'll have to wait and see on the Fentanyl.  You did say you have the option of putting another patch on and maybe you will have to do that.  In the meantime, what did your doctor tell you about the BT meds?  Are you saying you have five 15 mg. oxy for the breakthrough pain?  (The 15 mg. oxy, is that oxycodone or OxyContin?  I'm guessing it's oxycodone since you said you had fought going on long-acting meds.)  (And I guess that looks like an unusual prescription to me.  Previously were you taking five 15 mg. oxycodone and five 10/325 percocet?  It seems unusual to me since essentially it's the same medication, just that the percocet has Tylenol in it.  But there are lots of combinations of medications that get prescribed for people.)

I'm a little confused (sorry, I'm still recovering and I'm slow-thinking these days.)  In your last comment you first stated that you were only dropping the five 10/325 percocets but you still had the five 15 mg. oxycodone.  But in your last sentence you ask if you can take a Percocet or two.  Which medication did your doctor tell you to use for the BT pain, the 15 mg. oxycodone or the 10/325 Percocet?

Whatever you're prescribed won't be dangerous as long as you take it as prescribed.  If you're worried about the combination, you can call your pharmacist and he/she can ease your mind.  I often would get worried about the combination of medications and even though I would have discussed it at my pain appointment, until I got used to it, I would get a bit anxious.

If you're having bad pain and the Fentanyl hasn't kicked in or isn't working for you, then take your BT meds as prescribed.

But again, I'm just a little confused as to what the directions are for you.  Right now, I'm reading it as you have the 12.5 mcg. Fentanyl patch with the option of adding another one, plus you have 15 mg. oxycodone that you can take up to 5 times a day.

I hope the meds start covering your pain soon.  And try to rest and relax a bit ... anxiety and stress can certainly add to our pain levels.
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Avatar universal
I'm glad to hear that you decided to put the patch on.

IF your doctor has told you that you can take the oxycodone for breakthrough pain with the patch and you're having pain, then yes, you can take it.  However, if he has not specifically told you that you can take it since he put you on the patch, then please do not.  And most definitely do not exceed  what he has permitted you as breakthrough meds if you do take them.

Since you are new to the patch and still not quite sure how your body is going to react to it, if you are permitted to take the oxycodone, I would suggest starting at your lowest permitted dose - so if you're permitted 1-2 say every 4-6 hours, I would start off with 1.  Fentanyl (the patch) is very strong and especially if you're not yet accustomed to it, even taking the same oral medications that you were previously used to in the same dosage may very well be too strong.

Again, I'm glad you decided to go ahead and put the patch on - I think it was a wise decision and hopefully by this time tomorrow you'll be feeling much better.
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1264863 tn?1391118193
So I decided to put the patch on about 10:30 this morning.  So far all I am feeling is the lack of my percecet.  Trying to reset my body to not taking a pill every two hours is very hard but freeing also.  I am in pain but it is not too bad yet.  I DO have bt meds.  I still have oxycodone 15mg to take up to five times a day.  I was taking five 15mg oxy and five 10/325 percs a day and 4 soma.  So I am only dropping the five percs and replacing with the patch.  
I feel like I have a bit more energy today and no ups and downs so that is the good news.  Also no reaction yet.  Just the pain being worse.  I should have put the patch on early ;(
So can I take a perc or two if needed since the medication will not kick in for a while or is that dangerous?  I have like 20 left.  
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Avatar universal
GeminiGirl gave you great advice.  And I agree with her about you putting your patch on now.  Otherwise you are risking going into withdrawal.  I also agree with her about having some Benadryl on hand in case you do get a reaction.

I've changed medications so many times.  I would have side effects and we'd try something else.  It was a process trying to find something that would give me adequate pain relief without having too many side effects.  (In fact, we're still working on it.)  Every time I change I get anxious about the chance of withdrawals, getting a reaction, etc.  Truth is, the switches have never really caused me much of a problem.  I'm sure you'll be fine with the patch, and you will have the benefit of continuous pain relief.

I was hesitant to go on long-acting meds as well.  I've tried several, including the patch, and the patch probably works best, at least for me, in most ways.

Keep us posted on how you're doing with this.  I hope you rethink putting the patch on today.  I don't think it will interfere with you watching kids at all.  I was put on a fairly high dose and it didn't really affect me other than I found myself going to sleep a bit earlier at night.
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Avatar universal
I can understand your concern about switching medications - it's always a scary situation for me if I'm not familiar with the new one.

I'm a little concerned, however, that you haven't started the patch today as instructed.  If you no longer have the percocets (and I'm presuming you don't even have them for breakthrough pain from what you've posted) that your pain levels are just going to continue to increase higher and higher over the course of today and into tomorrow when you put the patch on.  The way the patch operates, transdermally, means also that you will not get the immediate relief like you do with oral medications.  It can take 12-24 hours (usually about 10-12) before you really start to notice whether it's working or not.  And if your pain levels are especially high, it could take even longer.  So therefore, by waiting an extra day before starting, you're already going to be in so much pain, it's going to be really, really difficult for you to be able to tell if a) the patch is helping at all and b) if the one patch is sufficient or if you'll have to add the second patch that you've said you have the option of doing.  Also your chance of experiencing some withdrawal symptoms from the percoct are higher the longer you wait to start the patch (again, presuming you're not takinga ny percocets now)

I would suggest putting one patch on now like your doctor had instructed rather than waiting until tomorrow.  Like I said, it usually takes a good while for the meds to really start being absorbed into your body and you noticing any relief.

Do you, by any chance, have any benadryl or anything like that on hand on the off chance that you do have an allergic reaction?  That might not be a bad idea with your past history of medication allergies.  Most of the allergic type reactions thave I've heard of from the patch has actually come from the adhesive rather than the medication itself, so if you do start itching wher eyou have the patch, it could be a reaction to the adhesive isntead of the medication.

I agree - one of the best "selling points" of the patch is the no peaks and valleys of pain control like you get with oral short acting meds.

Best of luck and please do keep us posted.
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1264863 tn?1391118193
Thank you for your response.  I have been fighting my doctors on going to long acting medicine for years now so this was not easy for me.  
I am watching my nieces all day today and don't have help so even though they told me to start today I am holding off until the weekend when my hubby will be around.
I am trying to think of this in a positive manner.  Better pain releif, no up's and downs, gives my liver a rest, no waking up in withdrawl.  
I am allergic to many things so that is my biggest fear beyond the withdrawl and it not helping my pain.  
I will keep you updated though.
Oh and she gave me half the dose of what would be on the conversion from the 50mg percs.  I have to option to use two patches if I need to.  

Jennifer
Helpful - 0
Avatar universal
When your doctor switches your medication, they have a conversion chart they use.  I don't know exactly what the ratios are but I have switched lots of meds, including going on Fentanyl and then coming off it, and have never gone into withdrawals due to a medication change.  You can also ask your pharmacist about it.  They are very, very knowledgeable about this.  My pharmacist actually checks the conversion on their own.

Fentanyl is a very, very strong medication.  I would think 12 mcg of Fentanyl would cover 5 10/325 mg of oxycodone.  The patch does take a while to kick in when you first put it on.  Even though you are on the lower dose, Fentanyl is something like 80 times stronger than morphine.

Remember, too, that if for some reason you do go into withdrawal, you can always call your doctor, even on the weekend.  Did your doctor give you any medication for any breakthrough pain?  A lot of people on the patch often take something for BT pain.

You may find you really like the patch as it releases the medication over time so you don't have the up and down when taking just immediate release medications.  I hope you will let us know how things go.
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