C6/C7 Issues and Duragesic

[Kathi50]

Hi,

I am hoping this question can be answered as I am at a loss.  I have had two cervical fusions, two years apart; one at C3/C4 and another at C5/C6.  Currently, I am having pain at the C6/C7 and have had an MRI and CT scan done.  There are really no major changes just some minor ones and more radiculopathy which I am going into PT for and also a possible injection from my spinal PM.

I also have lumbar issues and according to my Neurologist, Central Pain Syndrome (changed her diagnosis from small fiber PN).  So, my spinal PM wants me to try the Duragesic patch 12mcg.  The thing that concerns me is that even though I am opoid tolerant, I do NOT take more than one or two 5/500 of Vicodin a day.  I DO take Klonopin .5 once a day and have always tried to keep the meds low.  It seem as if the leap from this to 12mcg of Fentanyl seems like a huge one.  My spinal PM thinks I will be fine at this dose since I have been on either Vicodin or Norco for a long time.  I am just concerned because I cannot find an equivalency chart anywhere that mentions Hydrocodone in relation to Fentanyl.  I suppose he feels that since I have been on either one for a long time, that this dose is fairly small.  Can someone please advise.  I am just unsure if I should try this or ask for a longer acting med.  Thanks!

[Kathi50]

Thank you!  You definitely understand about spinal disorders.  For the sake of not repeating myself...and going over ALL the spinal issues, this is precisely why my spinal pain management doctor wants me to try it...and because I am used to taking opoids for CP management.  I wanted to say too that I am sorry you are enduring so much...and the discrogram made me cringe.  I haven't had to have one...but I have heard over and over again how horrible they are.  As for my fusions; they were cervical...C3/C4 and C5/C6.  And I had to have them done.  I really had no choice in the matter as the spinal cord was being compressed. The surgery itself was nothing...the spasms were horrendous.  And now the one wedged in the middle and the lower level C6/C7 is taking on the load and causing radiculopathy...but nothing that warrants surgery...yet.  And another reason for trying the patch.  The way the PM explained it is that he understands I want to kick the relief up a notch or two.  I realize there are sustained relief or extended release meds.  But he wants to try to get me away from the oral tablets for a number of reasons.   And I AM scheduled for a Selective Nerve Root injection in about two weeks.  I was supposed to get one a week ago but the pain was not all that bad.  So, we shall see.  And I wish people would realize not to use the words addicted when in reality we are dependent on medications.  A LOT of people have to up on their meds or switch to something else.  So, don't feel bad for saying you might be tolerant of it.  I had this go around with Klonopin not too long ago.  And I made the decision to stay on it.  As my Neurologist said, "There are far worse things that can happen than staying on it."  I don't know...I suppose because I am older now I will just to whatever I can to enjoy my life...and if that means tirating up or switching over to something else...so be it LOL!   But again, I am sorry to hear what you are going through...the spinal issues are a real bear!   Oops, and I should have added that I may be facing a Laminectomy for the L4/L5 but I am trying my best to avoid it...just not all that bad...yet.  Hang in there and I hope you get to feeling better soon.

[tacc13]

6wks post op fusion on l4-s1 but 12mcgs is equivalent to one milligram of fentanyl over a 3 day period yes it is srtonger much but if u have pain around the clock that needs to be contorolled i had 3 back surgiers trust me been on it for 4 yrs now 4 and half ago a doctor ruptured mmy discs from L1 to s1 by doing a discogram... it has caused me misery fragments from disc walls landed levels down on nerves causing helacious pain!!! first surgery L3-4 microdiscectomy ahh ok but fentanyl was still high never went down on it except in the summer and yes we tried
2nd microdisectomy july 3rd last yr and finally fusion aug of this year that was my last option b4 intrathecall morphine pump and i am only 30 years old no car wreck no falls just a ordinary doctor on a sunny day ruined me and my back forever!!A he ruptured 6 levels all in one day and i went to him with 3 slightly bulged discs never did i sxpect this ... good luck tho hun i also hacve c2 to c6 minnimally bugled but i dotn let them mess with htem ones. till i cant take the pain ill suffer!!i had fusion 6 wks ago and still dotn feel better as far as paiin fusion to the lumbar i have had 6 ruptured discs for 4 in half years nothing but this has worked fo r me i do ino that tho 12 mcgs is equivallent ot 1 mg over 3 days but it controls pain better u dotn have to constantly have to keep takin medicine but good luck in ur deciosn i say ask ursae;f if u have pain around thee clock... if so then fentanyl might be the miracl e drug tfor u it was a wonder drug for me in the beginning i ws cleaning and keepin up with house till it got increased and i became toleratn i guess u can say from it i still feel pain just lessened ats al goodluck tracey in pa

[Kathi50]

Thank you...but I will trust my spinal PM's decisions as well as my Neurologist's as they both know my full history.  The question still has NOT been answered though...and I believe it is because no one really knows the TRUE equivalency of Vicodin to "12 mcgs of Fentanyl".  If someone knows, please let me know.  

[NautyOne]

It was not my intention to be insensitive to your pain.  I don't know you and what pain levels you deal with.  The reason I responded to your post is because you want to know the difference between 1-2 vics a day an fentynl.  and the difference is huge.  Your statements to me just dont make sense and i dont want to turn this into a battle.  I am just going to answer your question.  If your that particular about how much pain medication your taking.......there is a huge difference between the patch and what your taking now, and just because its a patch and is time release there is no difference if you were popin a pill or having it done for you through a patch.  Regardless, it is a huge jump and if you want to keep your meds low.......dont use the patch.  I promise you.................you will regret it.  you will probably get better pain relief from it......or just plain sick.  but there is always the addiction and substance abuse forum on here.  Go on the patch, and I guarantee you will be there at some point.  there are so many other options and .  I am just sad to see another victim on there way to journey into fentynl addiction.

I wish you all the best, Kathi.......I really do.  
Nauty...............

[Kathi50]

Thank you Nauty and I am sorry you have undergone what you have.  But I take exception when you are speaking of my pain not being that bad.  As you stated, I tolerate the pain and push past it.  It does not mean that it is not bad.  There are plenty of spinal disorders people who DO keep their meds low in order to function...even if in pain.  Anyway, I didn't intend to spark a debate.  It is your perogative to choose what you say or do as it is mine as well.  And, sorry, but my docs are very good and I trust their judgement and they DO care. They have all helped me tremendously.  I have only been with them for 7 years...so I know what they think and what their reasonings are.  The problem with the internet too, as I have been finding out, there are just way too many horror stories.  You have to remember there are success stories as well.  And by the way...it is spelled Fentanyl not Fentynl.  And just keep in mind...there is a difference between addiction and dependence.  You need to read up on chronic pain management.  And quite frankly, I cringe when I hear of people on Neurontin.  That was the worst drug of all for me.  However, I KNOW it helps other people.  Therefore, I never really "down" any medication someone takes because what doesn't work for one might work for another.  I also heard the same remarks when I started Klonopin.  But it was a wonderful med and helped me a great deal for a long period of time.  But I became tolerant of it and now it is time to taper off.  So, you see, it can happen with a lot of meds.  You could even say the same things about Vicodin.  People can eat those things like candy and become severely addicted.  So, no, what matters most is what works the best at the lowest dose possible.  

[NautyOne]

I promise you that if you go on that evil drug for no reason, and when i say no reason is because your pain cant be that bad if you only take two vics a day.  it makes no sense.  Its your choice, but i have heard so many people screaming in misery to get off this drug at a level only twice your dose.  Within a short time you will be on 25mcg.  and then 50 then75 100 and can go up to 200mcg.  The most evil drug next to street heroin and methadone..........hun, I just get the chills when I hear the name of that drug.  that mole hill will turn into a mountain.  ask for something with less acetomenophen that could be whats upsetting your stomach i think vic even comes in liquid form.  prob hard to get, but even a longer acting time release pill like morphine or oxy but your still dealing with the devil with those meds too.

As far as the doc's .....yeah i trusted them too.  you think it's ok because its prescribed.......its not~ they dont give a ****.  they'll pull you off as fast as they put you on it..........dont do it.  I've been on the same vics that you have been on for many years at about 4 a day and they dont work anymore and I refuse to go to any higher dose.  I'll deal with the pain.  and, again, Im sorry but if you can tolerate your pain with the doses you take........tolerate it.  nothing is going to take away all of your pain. until you start getting into drugs like that.......not only do they take away your pain but they take away your brain.  You just don't sound like a candidate for fentnyl.  Sorry to ramble.......I've seen nothing but misery come from that drug unless your terminal or really, really in pain.  your going into an entire league of meds on this one.

Good luck and make the right choice.........say no to fentynl.

Nauty..............

[NautyOne]

the difference is huge!!!  compared to what you are currently taking and they are two different types of med.  When you try it you will know what Im talking about.  Fentynl is highly, highly highly, addictive..........and from what i  hear the hardest drug to get off of and your tolerance will most likely graduate much quicker than with the vics.  

Nauty

[Kathi50]

Okay, I guess I am just not making myself clear LOL!

There are other issues besides just the spinal disorders.  There is GERD, Gastritis, small fiber neuropathy and minor prolapses.  I have been on so many meds in the past 7 years is is ridiculous.  Just know that I cannot tolerate the anti-seizure meds or the anti-depressants.  Last September and after the 2nd fusion I was on Norco for a long, long time.  It didn't do much of anything for the residual and ongoing pain.  Then my PM prescribed Vicodin; 1-2 a day was just fine for a long time along with taking .5 mg of Klonopin.  I am now in the process of tapering off the Klonopin.  But that is beside the point.  During this past year lumbar stenosis has appeared along with pelvic floor dysfunction and prolapses.  To take more and more of the Vicodin will present major issues with constipation.  I didn't want to graphic but I have been told no straining AT ALL!  And yes I know I can take Colace or Miralax and I have.  So, all of this are other reasons why the docs want me to try the patch; one for having been on opiates for a long time (give my liver a break), two to avoid more issues with Gastritis and GERD and I do take Nexium (also a constipating med), and three, they believe that the patch would be far more beneficial than taking any more oral medications.  And know too.. this is not the standard 25 mcg patch...it is the newer one 12mcg by Janssen.  Both my Neurologist and my spinal PM doctor have told me it IS an "old lady dose" and that they have many patients on it.  As far as addiction goes, a person can become addicted to Vicodin or Norco as well.  But I am not going to worry about addiction as I am almost 51 years old I would prefer to view it as dependence.  What they are trying to do is to get me something that will help with pain WITHOUT upping or taking any oral medications and avoiding the peaks and valleys associated with oral meds.  I realize there are slow release medications but again...there is the tummy issues and all else I have mentioned.  They just want me to try something that bypasses all of that.  And the patch would be the best thing considering ALL of the issues I have.  It would be nice if 12mcg worked and I could eventually be rid of the Vicodin.  And I have talked with other spinal disorders people as well who also use the patch.  They are telling me it basically gave them their life back.  And while they are not totally painfree, they are now able to come down off the oral medications and or go to lower doses.  So...basically...that is what I was trying to make clear.  Again, my main concern was the "leap".  But according to the docs I am tolerant of opoids so I should be fine at this low dose patch.  But these are their words and not mine.  I am willing to give it a try.  

[Kayano]

Not being a doctor, but having great experience with pain meds I too am very confused as to why your doctor wants to take such a huge leap for 1-2 vicodin a day to a fentanyl patch!  I cannot see how you are opiod tolerant on such a small amount of vicodin. Usually, one is given meds in progression... and Vicodin has 500mg to 750 mg to 10 mg (Norco). True, pills don't last as long, but when I progressed to Norco, I had satisfactory relief for some time. Before considering a patch, know that it is highly addictive and usually, once a person makes that leap, they find getting off the patch very difficult. It took me 6-months of out-patient detox(of course I was taking Norco and a few other drugs in addition to the Fentanyl).  And another 6-months to feel 100%.  Irregardless, do a lot of research and know what you are getting into. This drug is great for pain management if you need it, but it is a very strong type of pain management.  If I were you, I would start taking Vicodin 4x per day or switch to Norco (less tylenol) Good luck to you!

[Kathi50]

Oh my gosh...no LOL!  I have been with my spinal PM since 2003.  HE is the one that suggested the Duragesic 12mcg for overall pain.  He knows I keep the meds low due to GERD and Gastritis even though I take Nexium.  And he knows my FULL history...including my pain levels.  He wanted me to try the patch to avoid more pills and stomach upset.  I also saw my Neurologist last week and she is in full agreement.  I have been with her for several years too and her final diagnosis was Central Pain Syndrome.  ALL my specialists know I am hypersensitive to a lot of meds...including my Neurosurgeon.  But the main reason he recommended it was so that I wouldn't have peaks and valleys as I would with oral tablets.  I don't believe Fentanyl is a big mistake at only 12mcg.  He and I had this discussion again yesterday.  And as far as tolerance goes, everyone builds up a tolerance if they are on a med long enough.  As a matter of fact, I am tapering off of .5mg of Klonopin now.  My MAIN question again was...what was the equivalency of Vicodin to the patch.  It is equal to 3 Vicodin?  Things of that nature.  Anyway, I have since resolved this after speaking with my Neurologist and my spinal pain management doctor.  I am opoid tolerant...that is why he is starting me with a low dose.  I realize it is potent that is why "I" was questioning everything and precisely why I met with him yesterday.  And another reason I have been able to keep the meds low is due to injections which I receive periodically.  Otherwise, I would be eating meds like Neurontin like candy.  Been that route and don't ever want to go there again.  And I should add that I also have script for Voltaren.  But again, a lot of these meds are messing with my stomach.  And yet another reason to try the patch.  

[NautyOne]

I understand what the doc is saying.  what your saying is a little conflicting and i think the doc sounds suspicious.  1-2 Vicodin a day is nothing so I can see where he feels you cant be in that much pain.  I understand about wanting to keep your opiate intake low, but from what ive heard about fentynl.  Don't mess with it.  you will regret it.  Either talk to the doctor about mabe increasing your dose slightly..........sounds like its the choice you have made for yourself.  Fentnyl is very strong 12mcg is pretty low, but i guarantee in time like everything tolerence builds and you will need more and its' not your fault it just happens.  Stay away from it.  If your truly concerned about your intake then fentynl is a big mistake.

[Kathi50]

Thank you for answering.

You are right 1-2 Vicodin a day is a very, very small amount.  But I choose to keep the pain meds low...not that the pain isn't bad now.  My script is for one every 4 to 6 hours.  For a long time 1-2 a day was working fine but the pain has worsened.  I, too, think Fentanyl is extremely potent...that was my concern.  But again, I BELIEVE my spinal PM thinks that the 12 mcg patch would alright because I have been on opoids a long time...not so much the dose.  I should rephrase my question.  How many Vicodin 5/500 a day are equivalent to a 12 mcg patch?  When I read the insert, Hydrocodone was not mentioned.  Thanks again.

[Stephen Ryu, MD]

There is a small discrepancy in what you say. You say that you are opioid tolerant yet you only date 1-2 Vicodin a day. 1-2 Vicodin is very very very very little pain medicine. The medicine only lasts 4 hours so you must not be having bad pain the remaining 12-20 hours? Klonopin is also a very short acting medication.

Fentanyl is very potent as far as equivilancy to morphine/hydrocodone goes, but opioids all work a bit differently. Fentanly is very very short acting but the patch allows fro 24 hour administration of a low does. Pain specialists use it to cover baseline pain/opioid tolerance in chronic pain patients.

So, I can't really say in your case what to do beyond trusting your healthcare professional's opinion. I cannot adequately assess your pain tolerance, level, or needs based on what you've mentioned. Good luck.