Help Understanding The Fentanyl Patches and the Risks?

[Ozworks]

Hi all, I am looking for information regarding the Fentanyl Patch. I have been on the patches for about a year now after trying many other types of Pain Medication.

I am interested in the long term affects of using the patch, risks while using the patch and any other feedback would be appreciated.

Thanks much.

Oz...

[MrFreud]

Dear Ozworks, I'm glad to hear you're getting some relief from your pain. Just to give some background. I am a Psychotherapist and work with all aspects of mental health and am also an addiction specialist. Without going into detail, suffice it to say I have approximately 25 years of experience with severe chronic pain which started with a severe back injury, a month of paralysis, and surgery which resulted in a large amount of titanium in my lumbar spine.
I'm very glad to see how well informed you are, I just wanted to offer a perspective from a professional who has also been living with life-altering chronic pain. Narcotics or Opiates are central nervous system depressants like alcohol and some other classes of drugs. Therefore, over time one of the effects can be respiratory suppression and various cognitive deficits. Also, it has been known for many years that narcotic treatment will invariably make the perceived pain levels worse over time. This happens because the narcotics make a receptor called a nociceptor, which perceives pain, hypersensitive which results in a hypersensitivity to pain over time. Also, the body slowly decreases the production of the natural pain killers, endorphin. In addition, as I'm sure you know, long-term use of narcotic can cause disturbed sleep, gastrointestinal issues, possibly narcotic bowel syndrome, sexual dysfunction, and altered memory and judgment among others. I would recommend anyone be very careful and constantly reassess the need for continued narcotic treatment and the possibility of alternative treatments.
Also, Opiates have a very high addiction potential. I would respectfully disagree with an earlier writer who stated physical dependence was different than addiction. Actually, there's two components of addiction, physiological dependence and psychological dependence. I reality, opiates not only cure physical pain but emotional pain as well. I'm in the process of working with the legislature in my state to pass a bill that would require a doctor who is considering prescribing long-term opiate treatment to refer the patient to an addiction specialist for a consultation so they at least understand what they're getting into. I agree with an earlier comment that most physicians know very little about the long term effects of narcotic use and even less about the abuse potential. Good Luck, I really enjoyed reading all the knowledgeable comments.    

[cybersleuth58]

I've had chronic spinal problems since I was a teenager. I'd have paralyzing stiff necks that would come on without warning. Finally discovered I had some bad discs. Had a laminectomy for C5-6, but also discovered that the rest of vertebrae in my neck didn't look too great, either. As I aged, I started having trouble with my back as well. The pain clinic tried MS Contin which helped. I fell, sustaining a serious fracture which required surgery, pins and screws. They put me on the Fentanyl patch and wow! Mysteriously, I was having far less back and neck pain. When I started with a new pain clinic, I asked them to ditch the MS Contin and switch me to the patch.

This is 4 years down the road. I am still doing very well on the patch. I am taking almost no breakthrough meds. (Down from 5 MSIR tabs with the MS Contin). I am more active and have been doing really well. Hope things go as well for everyone else. I've developed scoliosis probably due to the serious fracture. The scoliosis causes some serious pain but the Fentanyl handles it. (I can tell when it is getting time to change the patch though!!)

[Ozworks]

I know this will sound like a "That's Just In Your Head" type of comment, but it works for me and I will continue to do this. I have been on these for a long time now after trying many other pills, etc.

I put the patch on my lower back, right where I have my pain. I never put the patch on the same spot every time I put a new one on. I have about 4 spots that are very close together and I use a medical cream on my skin to help, it's called Trimcinolone Acetonide and seems to work good.

I have tried many different spots, upper back, arm, etc., but I end up back where I started and my doc says that is fine if it works for me.

Just thought I would throw that out there.

Thanks for all the feedback.

Oz.......

[Jaybay]

One of th problems with narcotic pain meds is that they aren't really "pain killers."  Meds like aspirin and ibuprofen treat inflammatory pain by working directly on the area of inflammation. Those kinds of meds are more properly called pain killers.

Narcotics work by altering the brain's perception of pain.  It's still there in all its glory, but the "feel good" receptors in the brain are stimulated so that we don't care about the pain.  Typically, as long as the side effects (feelings of euphoria, being high) are present, the narcotics remain effective.  The reason many people don't feel the fentanyl patch works well is because it doesn't take long for those euphoric effects to wear off.  Since the fentanyl is dispensed slowly and evenly, there is no spike in dose to bring on a high such as with the short-acting meds.

It doesn't take long for the body to become used to any narcotic and for those euphoric feelings to abate.  Then we notice the pain again and beg for an increase in dose.  That's where problems with self-medicating - taking more than prescribed - can begin.

There will always be doctors willing to put us on stronger and stronger meds and higher and higher doses, but is that always the best answer for us?  For me personally, the answer is no.  A good doctor will proceed slowly and cautiously where med potency and dose increases are concerned.  Some may even insist on periodic detox to deal with tolerance issues.  I know it sounds cruel, but it's a good idea to at least try to decrease doses for a while and put up with the rebound pain for a few weeks to assess where our actual pain levels are at.  

I've come to learn that there is no magic bullet where chronic pain is concerned.  It's up to each one of us to figure out how to deal with it, with or without narcotics.  Our expectations take a major hit while we learn that pain "management" does not mean pain "cure."

[Mom2four85]

I tried the patches and they didn't seem to work for me, did they work for you?

I'm at the point I'm willing to try anything to get rid of the pain and as you say have some quality of life...maybe mine weren't strong enough (different strengths?) or I didn't try them long enough...

[Ozworks]

Well, Thank you all for the posts, very helpful!

I am aware of most of the side affects, location and other risks. I have degenerative disc disease with two herniated disks that are shot, they offered Fusion Surgery at one point but then took it off the table for now. I have a sensitive left sciatic nerve, rotated left hip, pain down my left leg (dull) to the bottom of my foot and terrible back muscle spasms that add additional pain when they act up. I tried all the pills that they offer but the patch is the best for relieving my pain, I take 150 mg (2 patches) every 48 hours. Yea, 48 hours because I just told them that the patch is useless on the third day. I also have oxycodone for break through pain. Just last week they offered to pay (The VA) for outside pain management and pool therapy at the Courage Center near where I live. Hopefully this will help put me in a place where I have some sort of Quality of Life!

So I am off to get all the documentation I need to give them and then I will sign up. This is where I am after years of dealing with this. Thankfully I have a loving family and my wife is GREAT, I don't think I could go through this as well as I have without her. And get this, she also has a disability that she has to deal with, so we're both struggling together and we will Not Fail!

Thanks again, I will be check back from time to time.

Oz..........

[MommaB2653]

                                                                                                          you seem like you've seen the light on this long hard road of pain.  i also started the patches today actually. I have been prescribed everything you can name it seems since i was 19 with only a growing tolerance unless i detox myself and start all over but we all know how hard it is to withdraw from these poisonous but miracle working at times meds. I had pins put in my hips at 12 then after carrying my first son ended up with degenerative disc desease and 3 bulging discs now i think i may have more or herniated discs.Ive takin meds so long its masked alot of it but after just recently having a second child... i have remembered the true torture of pain. I do not want to take narcotics anymore! i have done weekly physical therapy,chiro,tens,aquabed and massage.also epidural blocks. are these patches the highest there is? i thought i hit that ceiling of no higher dose and now i learn maybe not. but what happens when this is it? i am only 25 hip replacement only lasts 20 years says the doc...and has ANYONE here ever rose above and beat the chain the meds hold us on with something like i have???

[Jaybay]

Long-term issues with the patch are the same as for long-term use of any narcotic.  You will be physically dependent on the medication, which means that you will go through withdrawal if you suddenly discontinue it.

Physical dependence is an entirely different animal than addiction.  Addiction is a psychological issue involving cravings for the feelings caused by the drug.  That craving leads to other harmful behavior.

Opiate therapy is a double-edged sword.  You can't beat a narcotic for pain relief (for most problems) but the body quickly becomes accustomed to it.  Initially, the answer always seems to be to increase the dose to deal when tolerance rears its ugly head.  That's when each of us has to determine if this is really the road we want to take.  At some point, we will reach a ceiling where increases are not possible.  We end up right back where we started: in pain with no realistic treatment available.  

Some people have odd reactions to narcotics to where it actually makes their pain worse.  It may happen immediately or develop with time.  I've spoken to many people who decided to wean off opiates and realized their pain was surprisingly well-treated with non-narcotic meds.  

Like any other therapy, opiate therapy has its pros and cons.  All we can do as patients is make an informed decision to go that route or not.  I'd like to say that our doctors are the best people to talk to about that, but in my experience and talking to other pain management patients, most doctors don't do a very good job of explaining those pros and cons.  

Opiate therapy can be expensive - certainly if you don't have insurance.  You will be chained to a medication not only for the pain relief but to avoid the horrors of withdrawal.  There is a stigma attached to opiate therapy that can cause problems with family and friends who will only see an addict getting a legal fix.  We are held to strict monthly appointments and God help you if you miss one.  If disaster strikes (flood, tornado, hurricane, fire, etc.) and you can't get a scheduled refill, welcome to withdrawal.  Don't bother going to an ER because they can't prescribe schedule II meds like the fentanyl patch.  Travel plans have to be worked around appointments and refills.

While tapering and detox is supposed to be within the scope of practice for pain management doctors, not all of them are well-versed in that area.  Some pain patients have found themselves seeing addiction specialists for help in getting off their meds because the prescribing doctor made a hash of it.  

If the patch is working well for you, stick with it.  Do talk to your doctor about any concerns you have and try to resist the temptation to increase the dose.  Where pain is concerned, we all want instant gratification.  Where narcotics are concerned, that's not always the best answer.

[geminigirl1963]

I hope you have found the fentanyl patch to be more effective for your pain control than previously tried meds.

I'm sure after being on the patches for a year now, you already are familiar with some of the side effects they can cause.  Some of these side effects, such as fatigue/drowsiness, may lessen as your body gets used to the meds, same as with any other med.

One of the biggest risks or things to avoid while using the patch is getting over heated or getting the patch too warm.  With it being a transdermal patch, when your body temperature rises, it can cause more of the med to be released than normal, and could cause serious problems if that happened (including death depending on how much was released).  NEVER use an external heating source on or near the patch - NEVER take overly hot showers (and of course don't let the hot water run directly on the patch).  NEVER cover the patch with anything other than an approved covering (this also varies depending on the type of patch you use - gel or otherwise - some of them you can not put anything over them except around the edges) - NEVER put a patch on an area that you have just cleaned with alcohol (the alcohol opens your pores and if you put the patch on right afterward, it could again cause too much of the meds to be absorbed into your body).  ALWAYS put a new patch on in a different spot from where you had the old one when you change the patches.  My doctor also told me to contact her if I was ever sick and running a fever over 100.5 to see whether I should temporarily remove my patch (again because of the body heat factor).  I did have to do this a couple of times (at her direction) when I had strep throat or bronchitis and my fever was hitting 102-103.  Also, NEVER cut the patch or alter it in any way.

Some people have a hard time getting the patches to stick - I found the best place for me to use the (I'm no longer on them) was on my chest area - low enough that they weren't seen at the shirt collar level, but yet high enough that it wasn't just on breast tissue.  I not only found that this was the place that they stuck best for me, but also the easiest place for me to be able to put them on and remove them without assistance (as well as being able to see if they had fallen off).  The patches I used were the reservior kind and I did have some trouble with them not wanting to stick - not so much a problem in the winter, but definitely in the summer when I was sweating more.  My pharmacist suggested using a surgical type clear tape ONLY around the edges, which I did, and it worked great for me.  Again, when using the tape, make sure that none of the tape edges hit the center of the patch where the med is.

One of the biggest problems I had while using the patch was constipation.  I tried increasing my fiber and water intake, but still found that I needed to use both a stool softener and a gentle laxative (I use Phillips no-cramp caplets) every day and still would only have a bowel movement on average 2-3 times a week (and quite often had trouble doing that).

As with any medication, especially the stronger ones, when you're on them for a long period of time, if you need to go off them for any reason, it's always best to work on a tapering schedule with your doctor rather than going "cold turkey".  

Again, all medications have some long term affects, but as with side effects, not everyone will have long term effects from using them.

I woudl also suggest that if you have more specific questions as to whether a certain side effect could be from the patch, that you speak with your pharmacist.  He or she is an invaluable source for information about medications, their beneifts and side effects and risks.