Where to put Fentanyl Patches for the best relief?

[Ozworks]

Hi all,

I need some feedback, I use Fentanyl Patches (150 mg) for pain relief. I have Degenerated Disc Disease and it just seems that I cannot get the pain relief needed to manage my life.

So if you or someone you know uses these patches, where should or where is the best location to place theses patches???

My pain is from two lower discs in my back that are shot!

I also have Oxycodone for break-through pain, but I hate taking these drugs, I am going to a pain management group in the near future for hope that I can find a better way to manage this.

Any feedback would be appreciated...

Thanks, Oz

[TheMadMan]

Thanks for the information. I am in the process of finding a new doctor here to do this procedure but I went to see an Orthopedic doctor who reviewed my MRI's and my hip joint looks good But I still have pain. He recommended I see a Neurologist who can refer me to a doctor that does these RFA's. It is a big run around for me because my new primary care doctor does not have the IN-SITE to know what to do. I have an appointment to see her Monday to get her focused on what needs to be done in my case. The other doctors I have seen at lease recognize my problems. Orhto doctor said my right leg had radiculopathy (sp) and put all these comments to my primary care doctor. Sometimes it takes a team of doctor to wake up one doctor who doesn't know or understand. I am looking around for another primary care doctor but I have a lot of research to do. (just don't have the time)
Maybe I should send your information to my primary care doctor. Thanks!!!

[philnoir]

Hello Mad Man. Thank you for your valuable post.

Radio Frequency Ablation (RFA) is a treatment for a special case of degenerative disc disease (DDD) called facet syndrome, which is an osteoarthritic condition of the zygapophysial or facet joints.

We have two facet joints per disc, one on each side of the spinal cord. These joints are synovial joints, similar to a knee or shoulder, but are less complex. They allow movement of the back, flexion and extension, and slight bending from side to side.

With DDD often comes an arthritic condition of these joints, which cause terrible pain. Only within the past 15-20 years as this new treatment of interventional pain management, RFA, been avaialble.

The procedure is normally done under concsious sedation. A board certified interventional pain physician will place electrodes along the side of the spine where you have facet arthritis under flouroscopic guidance. These electrodes are connected to an RF oscilliscope that generates minimal current, but enough to neurolyze the medial branch nerve that innervates the facet joint.

Once probes are in place, current is applied for approximately 4 minutes to neurolyze the nerve, and after a few weeks recovery, pain is reduced by 50% or more. I'm usually on the way home from my procedure within 90 minutes from start to finish.

I've had this procedure 4 times now and am scheduled for a fifth later in the month. They generally last a year or so before the nerves grow back and pain returns.

Without RFA, I'd not be able to tolerate my low back pain.

Find a skilled interventional pain specialist, board certified by the American board of Pain Management (DABPM). These doctors are generally anesthesiologists with advanced training in these procedures. If you cannot find a DABPM in private practice near you, search for a university teaching hospital with a department of anesthesia.

Best wishes.

[TheMadMan]

Please get off the fentanyl!!! I had the same experience with fentanyl but mine had a negative result from the fentanyl. I was on 150mcg also.
Let me tell you about RFA's. Radio Frequency Abliteration. What this is is burning the nerve that is causing the pain. When the nerve is burned, it stops the pain signals to the brain and the body for the most part. I highly recommend this. I have had this done many time BUT one bad point is that the nerve grows back BUT you can get this procedure done about every six months.  My second RFA lasted almost a year. The growth of the nerve varies. I am due for another RFA. My last one was in November.
RFA's do stop the pain for me. I can actually do physical therapy and even Pilates after this procedure kicks in. It is worth any pain medication you can ever take!!!!!
My experience with fentanyl is that it had me so doped up that I lost so much weight. I went down to 108pounds from 150. I finally looked in the mirror one day and it scared the hell out of me to see myself looking like a skeleton. I could go on and on about the pain medication  but understand that the pain medication works on the brains perception of pain.
Please read up on RFA's and find a doctor that is familiar with this procedure. Do some research into the doctor. Do research into the drugs you are taking and you will find out that the body becomes immune to the pain medication and eventually you will need stronger drugs to dope up the mind.
I have DJD/DDD for many years and this is the only thing that works for me (RFA's) I have had positive experience with this procedure and I highly recommend it. Give the RFA's a chance. If the first one does not work, the doctor may need to try a different nerve but eventually he/she will find the nerve and burn it to stop the pain signals.
Get off the drugs and give you body a chance to heal from all the damage these drugs do. I developed pancreatitis from all the drugs I was on. Don't let this happen to you and it will if you continue with all these strong drugs you body will eventually revolt!!!! Pancreatitis is very painful. Not something you want to experience when you have enough pain already. Read up and do research on you condition and the options that are available to you. Pancreatitis is just one more pain you will develop and another pill for that.  Is that really the way you want to spend your life with just one more pill around the corner?
Research and do your own homework and that is why you have not heard about this till now. Your doctor obviously does not know anything about RFA's so research and find a doctor that does. It will save you a lot in pain and money you pay for in pills!!!!

[jna7476]

I have been having problems keeping the patch on due to sweating, I have moved them to the different spots suggested by my PM doc and they just come right off. The only place I can think of that doesn't sweat alot  would be my legs. Is this even an option of where I could put the patch? Or any other suggestions are appreciated.


                                                                      Thank You

[philnoir]

Please clarify -- what kind of pain are you experiencing from the patch.

Are you rotating your sites? When I used Fentanyl patches, I used sites on both upper arms, and both sides of the chest, so that each site had a week's rest between applications.

I also used a cortisone based cream (triamcinolone) for a couple of days to treat the skin irritation after removing the patch. Make sure that you clean each site after use  with a soft wash cloth and a hypoallergenic soap like Johnson's Baby shampoo to remove all traces of glue.

And always, speak with your doctor about these kinds of problems, as soon as they begin to arise. Doctors cannot help if one dose not communicate negative side effects.

[Timsters928]

I hve been on the fentanyl 75mg- every 3 days. I also take vicodin 10mg. I also have fibermialgia. Recently the pain from the patch is getting to hurt severly. Is this a severe reaction or common? I have been doing this for over a year. Please any help would be appreciated

[Timsters928]

I hve been on the fentanyl 75mg- every 3 days. I also take vicodin 10mg. I also have fibermialgia. Recently the pain from the patch is getting to hurt severly. Is this a severe reaction or common? I have been doing this for over a year. Please any help would be appreciated

[Nanat11]

My doctor prescribed me fluticasone propionate spray ie. Flonaze spray for the irritation of the patch. I know that it sounds crazy but you spray it on your skin and then let it dry and you apply the patch directly where you sprayed the medication. This stops any irritation you will have from the patch. I hope that this helps you out.

[Ozworks]

Hi all,

Yes, the 3 day length does not work for me at all, I have the script written as every 48 hours. I did relocate my patches the other day and it was a complete failure. I put them on my upper back very near my shoulder blade. The first day was tolerable with Oxycodone but the second day I was in tears and we went with new patches back to the lower back where I get my best relief! I know that it does not make sense, but that's just how they work for me. I do not know what to say any more about the location...

I wanted to send a little update as I try to work with the VA and get an appointment setup for a nerve block. I did find out that the procedure mentioned throughout this thread as RFA is also known, at least by the VA, as a Medial Branch Block. If you Google Medial Branch Block you will see other names and what they are, there is just a boat load of information out there.

I will send an update as things progress.

Thanks, Oz

[namnam46]

I, too,change mine every 48 hours, as I said.  I was having an extreme amount of pin on the 3rd day and my PM Doctor told me then that I'd be surprised at how many patients do have pain on the 3rd day.  I was having to take all of my BT meds on the 3rd day and not nearly as many on days 1 and 2.  When he switched me it made all the difference in the world to my pain.  I'm so grateful that my insurance, Medicare, pays for them to be changed every 48 hours. If it didn't I'd vbe in extreme pain on that 3rd day!!!  :(

I don't know your patches are affecting the pain depending on where you put them.  I've never had that problem with mine, but then eveyone's different!!  :)  

I meant to tell you that I take my long hot showers on the 2nd day when I take my Patches off before I get into the shower and I can take as long and as hot a shower as I want then.  On the other day I just don't take as long or as hot a shower as I would like too. :(  You can imagine that I really look forward to the day I change my Patch (which was today) and I really enjoyed my shower this morning!!!!  :)

Believe me, I have this post and your other on the RFA on my watch list.

Thinking of you and looking forward to our next posting...........Sherry  :)

[Ozworks]

Hi all, Again, thanks much for all the feedback.

I will definitely look into the RFA thing. Well I put a new set of patches on last night, right on the L5-S1 location and have little pain this morning. This location seems to give me the best relief, but we are going to try the upper back with the next set. After all, is it true the the medication really tells the brain that there is less pain rather then affecting the nerves in the lower back???

I have the prescription written for changing every 48 hours. Normally they are written for 72 hours, but I found the 3rd day I have so much pain, they agreed to allow me to change them every 2 days.

Back in 2000 I had surgery mostly because I had a pinched nerve and they went in to scrape some bone away to relieve this. It took and I was great for about 5 years, then the muscle spasms started in on my back and my discs started to go bad. This was in 2005-2006 time frame. But from then til now I have developed the Back Muscle Spasms, DDD, a rotated left hip, a bad sciatic nerve on my left side, a dull pain down my left leg to the bottom of my foot and my left leg is thinner than my right. Also lost about 25 pounds while I have been on these meds. I just hate them with a passion...

Thanks for the feedback and I will be posting more when I think of other questions I might have, so keep it on the watch list and we can post regularly.

Thanks, Oz

[teflon_jones]

Definitely try the process of killing nerves in your back to help. I've been through the process and basically they'll do novicaine injections two separate times at the same locations to make sure it works, then do the actual nerve burning. The nerves grow back after 6 months so you have to continue doing it, but it definitely helped me (3 degenerative discs plus 2 shot hips).

As for the best place to put the patches, I've gone through a bunch. The recommended places are on your upper biceps/shoulders or on the upper part of your back/shoulder. The problem I have with this is that you can't stand in a hot shower with them there unless you block them off or you can cause an overdose from the hot water causing the medication to absorb WAY too fast. Trust me I passed out on my bathroom floor once from this. I switched to putting them on the insides of my biceps and even on the insides of my thighs instead. The only issue I ran into is I have sensitive skin and it caused a lot of irritation. I actually recently had to stop the patch because it was irritating my skin so much 3 weeks later you could still see a mark on the outside of my arms.

[namnam46]

Meant to add that I will be out for awhile but will be back later today. so that if you have any more questions I'll be checking in.........Sherry

[namnam46]

Oz, I don't know if it's a matter of your mind or not.  :)  I put them on my upper back because that's where my Doctor said that his patients have received the best results.  LOL.  I always listen to my Doctor as he has never led me astray as of yet.  :)


I hope you will ask about the RFA as it has worked wonders for me.  I was always walking stooped over and had such horrific pain down my legs and in my buttocks that it was hard for me to even be able to function.  I didn't even want to get out of the house as it was so hard for me to get in and out of the car.  :(   It has made a world of difference for me!!

I look forward to hearing from you again as you find the answers to your problem.  Hope it works for you.

I'm giving you a link to WebMD that will tell you all about the RFA.  Hope you enjoy it.

Here's the link:

/www.webmd.com/pain-management/radiofrequency-ablation

Good luck............Sherry  :)

[Ozworks]

Hi Sherry,

Thanks for the input, I have never heard of the RFA before, I will bring it up with my doctor.

Also, I think I have a mind or brain issue when it comes to pain relief from the patches.

The pain relief seems to work best when I put the patches right on my lower back where I have the bad discs! If I put them up my back I do not get the same relief. Am I just in such a state where my mind says I get relief here, but not enough when I place them somewhere else? But I will try the upper back on the shoulder blades and see how it works.

Thanks much for your feedback,
Oz...

[namnam46]

Hi Oz,

I know what you are feeling as I have Severe DDD and have been on the Fentanyl Patches for 19 months now.  I'm on 87 mcg's evdery 48 hours and take Percocet 10/325 3 times a day.  I normally cut them in half but sometimes do need to take a whole one.

I was told by my PM (Pain Management) Doctor to place them on my upper back and switch from side to side with each new application.  I've been doing this for 17 months and they don't come off and the sweat doesn't effect them.  It's my understanding that this is by far the best place to place them.  It's definitely helped me to manage the DDD.

I hope that you will be able to get to a PM Doctor or Clinic soon as they can afford you several options to help you with your pain.  I've had tremendous luck with the RFA (Radio Frequency Ablation) where they "burn or kill" the nerves.  I know that it sounds terrible, but believe me it's not bad at all and I have mine done without any anesthesia.  I do have a very high tolerance to pain but it truly isn't bad at all. This has helped my Lumbar DDD (which is the most severe) almost 100%.  However, unfortunately, I have it over my entire back along with 5 bulging discs in the Thoracic as well as the Cervical areas.  That's what I use the Fentanyl and the Perc's for.  I wouldn't be able to function without them. :(  I don't enjoy having to use them either but it sure beats the other option of not being able to get out of bed in the mornings or being able to do anything at all!!!

I hope that you will be a candidate for the RFA and will be able to get the same results that I have from it.  I have been almost completely free from pain in the Lumbar area for 16 months now.  I'm hoping to make it to the 24 month time period!!  :)

I wish you the very best and hope that this information has been helpful to you.

Please keep us updated on how you are doing as I'm hoping to hear very good results for you.

I wish you the very best and will be looking for your updates...........Sherry  :)