Fentanyl switched a few months ago but not working as well anymore?

[luv2bmomjen]

So my doctor finally talked me into switching over the the Fent Patches a few months ago.  At first I thought it was the best thing that had ever happened to me.  I started on a 25mcg dose to be changed every 48 hours and a 12mcg to be used when needed.  I went to using both patches all the time pretty quickly.  I also get 5 15mg Oxy per day and 4 soma to manage BT.  The last couple weeks or so I am back in pain again.  I hate that my body is coming to tolorate so quickly.  Does anyone think asking my doctor to go to 50mcg would be way too much?  What is the norm for patches as I am new to them?  And it is safe to take the soma and oxy with them all day.  I get scared so easy as I have three young children but I need them to control the BT pain I have been getting on almost a daily basis now.  Also I put them on my ankle.  Is there a better place to put them that they will work better or should I be wearing them longer than 48 hours when I can?

Thanks
Jen

[geminigirl1963]

PLEASE do NOT suddenly stop your Cymbalta or any other meds.  I'm not exactly sure which ones, but some medications can definitely be dangerous to stop abruptly.  Since you already have an appointment set with your doctor next Wednesday, just stick it out and see what he has to say about the weight gain, etc.  But please do not do anything to adjust your meds without first talking to him.

I'm so glad to hear that the Cymbalta is helping you and made your visit with your brother in law so much more enjoyable.  Your doctor may either be able to adjust your dose or maybe even switch you to either Lyrica or Savella - just because you've had weight gain with the Cymbalta does not necesarrily mean you'll have it with one of the others, even though it is a known side effect of all of them.  That really is a significant weight gain in a short amount of time, so being concerned about it is not unusual.  It's not just a "I don't look as good anymore" thing - but gaining that much that quickly just isn't good on your body.  It could be part of it is fluid retention, but again, if that's the case, that needs to be addresed.

I hope your doctor is willing to increase you to the 50mcg.  Even if you can't completely go wihout your BT meds at that dose, you may be able to get away with fewer of them.

There's no need to thank me for anything - I'm glad I can be of some help/give some advice.  Please do keep me posted!
Robyn

[luv2bmomjen]

I agree with everything that geminigirl said about the addiction board.  I have been over there many times to get advice on weaning down on pills etc.  I did see a recent documentary about what is going on down there in FL and how you can walk into any pain med office with cash only and no paper work and walk out with hundreds of Oxys.  I am so very very sorry you have been pulled into this world.  I am sorry for your kids more than anything because I know they want their mommy back.  How many Oxy and what strength are you taking,chrushing, or smoking now?  Just asking not judging.  You can be honest I am hear to help.  I can help you on another blog over on the addiction board to wean down just like detox.  I have in the past weaned from a very large ammount of Vic, Oxy, Soma, Zanex, Ambien all at the same time.  Took me about two months is all and was the hardest thing I have ever done but of course I learned a lot and now I am with a better Pain Doctor who keep tight rains on what I do and don't get.  I also take a urine test at every visit.  I have been able to take my meds EXACT AS PERSCRIBED for years now.  I also turn down the offer by the doctor for more or for the Zanex, Ambien etc because I know how hard it is to get off.  If you go to detox and it is not hard then you will end up right back where you are now or worse.  For your kids please take my help.  Start a post on the addiction board and I will meet you there.  this is not the place to post at all.  

Robyn

Darn it yes I am taking Cymbalta.  Started it about a month after the Fentanyl.  I have been on it a couple months.  I really though I had started gaining before that but I could be wrong.  It really ***** because I went from not wanting to get off the couch or out of bed to running around the house chasing the kids and having fun again.  I also am anxiety free for the first time in my life.  I have taken Zanex and Valium for the anxiety and they never worked that great but the Cembalta worked great.  I just spent 5 days with my brother in law whom a fight with every single time I see him and we didn't fight.  I don't stress the small stuff anymore and I enjoy every day.  I don't want to loose that but I can't keep gaining weight like this.  It will also put me in depression.  I have issues back from my childhood about weight and I NEED to be 110lbs or I will never be happy.  I got on the scale this morning and I am up to 138lbs.  That is a crazy ammount of weight gain.  I can't wear any of my clothes I went from a size 2/4 to a size 8/10.  So ? is do I just stop the cymbalta????  Hope for the best and look for a natural cure for depression?  I see my doc next Wednesday.  I might just ask her if she was planning to keep me at this dose or if it would benifit us both to move to 50mcg so she doesn't have to fill two different strength patches and I can make it through without my BT meds better.  Right now I need more BT meds than I have.
Also I will try another area for the patch.  I do usually put them in the same place I just switch them on different days and needed to move from my wrists back to ankles so....  I will try the upper chest area.  

Thanks for always being there Robyn

[geminigirl1963]

I'm sorry to hear of your troubles and pain.  The forum you have posted on here is a paint management forum where fellow chronic pain patients can ask questions, answer questions, give advice, vent, etc.  There are no doctors on this forum.

I'm not by any means saying you have an addicxtion problem, but just wanted you to know there is an addiction forum here on medhelp that may be able to offer you more advice as to weaning off your medications if that is what you want to do.  They can offfer you some advice as to withdrawal symptoms, etc.  I'm not sure if anyone on there would know anything about teh FL Detox Center or not or any other place, however, you may find someone that lives in your area that may know of some places that could help.

Have you tried calling the DEtox Center to see if they have any type of financial assisstance?  How about your local social service department?  It certainly woulnd't hurt to call a couple of those places and simply ask if they offer any type of financial assistance.   The worst they can do is say no they don't.

You're obviously always welcome to post here on the pain management forum, but please do check out the addiction forum for help and information about getting off your meds if that is what you wish to do.

Best of luck.

[lssmasters5]

I am in my early 30 with 4 children,no friends,(due to pills,not being able to get out of bed most of the time), No family except my father,I have been disabled to due several car accidents,for a while now, I have been waiting four years now for Disability Help/Approval,I feel so tired,and of struggling all of the time,& most of all watching my children go through this. I pray so hard for day that I can truelly feel again & feel true joy & fun again with my children,I would give you my arm or leg just to have the oppertunity to go to a Truelly Great Facility like Florida detox Center & wellness Center,they help fix all of you mot just pieces.....I am presc.roxys & I am so ready to quit,though I need help, please.I am looking for someone near me in _____ Fl,that is also ready to get off of pain meds.we can help each other with the withdrawels,children & so forth..I thought If I had someone that Has the same goal near me & to lean on this process would go allot better,though maybe I am wrong!  Because I will still be left which severe pain after off of pain meds,,thats why I woulld give anything to go to the Fl.Detox Place....Does anyone know about special funding or anything like that....I WISH I could afford to go to florida Detox Center(this was talked about on Dr.Phil)do you know they have a 90% success rate(WOW)& its a Rapid Detox without hardly any withdrawel,I wish,& pray for a miracle like this,(& for everyone who needs & deserves a chance at life,a fair ,fighting chance)....,also they help the underlying issues, & the main thing for me is my pain,I still need surgeries.It is so sad that If you are poor you are not offered these miracles,Why?

[geminigirl1963]

I'm not sure why your doc suggested putting the patches on your ankle or wrist - to me those seem like strange spots to put them because they are areas that tend to get rubbed with clothing more and also tend to sweat (the wrist anyway) more than some others,which, of course, makes it harder to keep them stuck.  But like I said, wherever you find they stay stuck the best.... other than making sure wherever you put them does not have any broken skin.  I've heard of others who have put them on their bikini area, however, again, to me that doesn't sound like the best place - if you don't shave the area, the patch will probably not get a good adherance to the skin due to the hair and if you do shave the area, the chances of the skin being irritated or broken (accidentally) is higher, making it not a good location.  Actually, the instructions/precautions tell you that if you must remove the hair on the area you're going to put the patch, it should only be clipped, and not shaved (I'm presuming for that reason of irritating the skin)

I've not really heard of anyone having a large weight gain on the patches.  I just looked up the side effects again on them and it's not listed as a side efect,but as you know, we all can react differently to medications.  However, if you're finding that it's making you sleepy or drowsy, maybe the weight gain is because you're not energetic enough to be moving about as much as you were?  Just a thought.

Have you changed any othe rmedication in the same time frame that maybe could be accounting for the weight gain instead of the patch?  Lyrica?  Savella?  Cymbalta?  I only mention those because I know all three of them can definitely cause weight gain.

I agree, if you're not comfortable with or feel like you're not getting the best care from your current doctor, it's a good idea to look around to see if you can find another one.  

When is your next appointment with your current doc?  Do you plan on asking about increasing the patch to the 50 mcg?  I do think that would probably  be beneficial to you so that you don't have to take as many of the BT meds during the day.

One last suggestion I have - and I honestly don't know if it will make any difference or not, but is worth a try - instead of putting each of your patches on different areas of your body, try putting them both in the same area, one next to the other - and see if you get better pain control that way.  My thoughts on this is that perhaps one of the areas you're using now is not allowing for good medicine penetration so you're really only getting the full benefit of one patch - whereas if you put them both in the same area, the absorption of both patches SHOULD be equal.  I may very well be grasping at straws here, but just trying to think of any possible way to give you better pain control with the patches that you currently have.

Please do keep me posted on how you're doing!

Robyn

[luv2bmomjen]

Thank you so much for all the information.  That helps a lot. My doctor is not the best sometimes and I am always looking for a new one.  She told me to use my ankle or wrist.  I thought that was because they would absorb better but?????  I currently have one on my arm/wrist and the other on my ankle.  I will switch back to my bikini area or upper chest for a while and see how I do.  I have been told it is ok for me to stretch the length of time I wear them.  I asked to do so so that I would have extra patches on hand for those times when one gets rubbed off or falls off in the shower etc.  I am a couple weeks ahead now and that is great!  Now I can not worry too much when that happens.  I am back to using them for 48 hours now though.  

One more question.  Did you or have you heard of anyone gaining weight on the patch?  I have gained 25lbs since I started them just a few months ago.  I went from a size 2 to a 6/8.  I am less than happy about it.  Any ideas?

Thanks again

[geminigirl1963]

I'm a little confused as to why your doctor gave you the additional 12mcg to "be used when needed" - the way that the patches work is they are definitley not quick acting and the med must build up in your system before you will notice pain relief.  Therefore, the idea of using it "when needed", to me, completely contraindicates the way the med is supposed to be used.  At any rate, I'm guessing you also found this out since you said you had to go to using both patches all the time pretty quickly.

In my opinion, since you are having to use your BT meds so often, it probably would be beneficial for you to approach your doctor about increasing your patches to the 50mcg.  Based on you using both th 25mcg and the 12.5mcg, this would be a less than 10mcg increase, so shouldn't be a problem as far as you not being opiate tolerant and that incrase may allow you to decrease the amount of Bt meds you're having to take.  You may also find that with an increase in the strength of your patch that you may be able to go the 72 hours before changing instead of 48 hours.  HOWEVER, NEVER ADJUST HOW OFTEN YOU CHANGE YOUR PATCHE/S WITHOUT CHECKING WITH AND GETTING PERMISSION FROM YOUR DOCTOR.  Therefore, definitely do not try and stretch the amount of time you're currently wearing them without his permission and advice.  If he has written it for you to change them every 48 hours, that's exactly what you should do.

You may find better pain control if you put the patch in a more "fleshy" part of your body as opposed to your ankle.  The med is basically absorbed through your skin and fat layer and if you're wearing it on your ankle, it may not be "fatty" enough for a  good absorption.  It also may not be getting a really good adhere to you skin both because of it being a more bony area as well as an area that gets a lot of use/activity.

When I was on the patch, I used to put them on my upper chest area - high enough so they weren't on the actual breast area, but low enough that they did not show over a shirt's neckline.  I personally found that a good area for me because it wasn't constantly being rubbed by clothing, wasn't an area that I sweated a lot and also a relatively flat area where the patch could get good adhere to my skin.  It may take some trial and error to find the best place for you - just definitely be sure and never place a new patch on the exact same spot you just removed the old one - your skin can get really irritated very quickly by doing that and if your skin gets irritated and broken, it could possibly cause too much medication to be absorbed.

I would say it's definitely worth having a talk with your doctor and let him/her know while you do find the patch/es are helping, you don't feel you're at the right dosage yet because you're still having to rely on your BT meds so often.  Then see what he/she says from there.

I hope you can get some relief soon!