Fentnal question

[bkdotson4]

I was just increased to 75 MCG from 50MCG on the fentnal patch and was wondering why I can't get to much longer on this patch.  it is not giving me as much relief as I thought it would.  Yes it has helped about 40% decrees in pain I expected about 60-70%.  Can anyone tell me if wearing the 75 alone or going with 1 25 and 1 50 patch would be better ?  Does anyone thing that would give better relief some how? Lets just say the 50 gave me about a day and a half before things got pretty bad and I was hoping 75 would give me almost 3 days.  now I am just getting up to 2 days before hell breaks loose when I was hoping for 2.5 to 3 days.

[namnam46]

I'd use your REGULAR PM Doctor to get this done as the other WON'T prescribe your meds for you.  You DON'T want to take ANY CHANCES!!!

Let us know what happens...........Sherry  :)

[monsterjam2]

Check with your insurance company, and make sure they will cover the MRI through the second doc, first.  I wouldn't pay for it out of pocket. Docs are wary of people that are 'doctor shopping', especially if they are on narcotics.  That is why the second doc won't touch your meds, and the MRI may just be a way of covering his *$$, that he isn't missing something.

Choose whichever doc you are the most comfortable with and stick with them.  The best way for you to get good pain management is to talk with your doc.  That means being up front and truthful in all your communications. Sometimes, the 'tried & true' doc we've had for years is really the best one to stick with, we just need to be more assertive & truthful of what is working and what is not, and also trusting their judgement that they are trying to do the best for you.

Make sure, too, that you evaluate your pain & your perception of pain relief.  What is your acceptable level of pain??  Chances are, you are not going to ever be completely pain-free, so at what level do you function?? Discuss this with whichever doc you decide to stay with.

Also, (please bare with me) seeing a psychologist might help.  Sometimes our coping skills are out of whack, and having someone to help us cope with the pain and make adjustments in our day to day living helps with pain control.  I know it is an extra expense, but it is one that was worth it for me. Learning when to say when, and when to say 'no', and still being there for our children can be tough.  Don't be afraid to get some help in this regard, too.
Prayers and best wishes for a great solution!

[bkdotson4]

is it okay that it is through a different PM dr though or should I ask my regular PM Dr to do one?

[namnam46]

I HOPE that you will have the MRI done.  That may be the answer to your problems with your Doctor when it comes to the pain meds.  IF there is even MORE damage to you than your PM Doctor thinks there is THEN he MIGHT understand this increased pain that you are having each day.  SOMETIMES if just takes the PROPER Diagnosis for a Doctor to understand what his patients are describing to him in the way that their pain is effecting them.

How soon can you get the MRI scheduled?  The SOONER the better!!  HOPEFULLY, you will get your answers when you have the MRI done!!!  I hope that you will let us know what you find out from th MRI as we will be ANXIOUSLY waiting to hear from you!!!

Melissa - thank you so much for the kind words.I can say the SAME things about your posts too.  :)

BK, I will be looking for your updates. {{{{HUGS}}}}...........Sherry

[bkdotson4]

would someone be able to help with the question in here about seeing the second Dr.  I am not sure if I should do the MRI through him or not.  


The Dr I did see "that wont touch me" did do some tests and is wanting me to do an MRI.  He told me to keep seeing my current pain Dr because he just wont touch the medication I'm on and should just keep seeing him, however he wanted me to get the MRI through him.  He had tested my reflexes and noticed a considerable lag in reaction on my left reflexes and that is the same side I normally have the MOST problems with.  sometimes the right side or both, but mostly the left side.  He also noted I am positive to 14 points out of 18 for Fibro, but said he wouldn't say I have Fibro because most do not have Nerve issues along with it.?????????  

[bkdotson4]

thanks both of theses posts were VERY helpful.  I have been doing better since with the patch since the increase I have noticed more the past three patches or so, but that second day is still a doozy LOL.  

I know what you mean about Doctor Shopping.  when I did go to the other Dr I was scared to even go that my PDr would find out and get upset.  

The Dr I did see "that wont touch me" did do some tests and is wanting me to do an MRI.  He told me to keep seeing my current pain Dr because he just wont touch the medication I'm on and should just keep seeing him, however he wanted me to get the MRI through him.  He had tested my reflexes and noticed a considerable lag in reaction on my left reflexes and that is the same side I normally have the MOST problems with.  sometimes the right side or both, but mostly the left side.  He also noted I am positvie to 14 points out of 18 for Fibro, but said he wouldn't say I have Fibro because most do not have Nerve issues along with it.?????????  

My BT meds and I'm frustrated because he will not do anything for it.  I have been trying for over a year now.  

I will try what you said with the patch when changing it because I have noticed the same thing because I am almost to my wits by the time 48 hours if up I have a hard time getting through the first 2 hours or so after changing the patch, but after that I'm good for the next day then right around the 36 hour point things go down hill for me.  

It is really frustrating when you know that a change in something will really make the difference and the Dr looks at you and says no way sorry.  

[Melissa_1982]

The Fentanyl should be in your system now.  From what I've encountered myself & heard from others you don't really feel it's there, but you'll definitely know when it's not. I've found when I change my patch I have to keep the old 1 on for anywhere from 2-6 hours & have been told by MY pharmacist that it won't hurt any & will give the new patch time to start working.  Fentanyl is at it's highest peak in our system around 17 hours after you've applied the patch & from there it slowly decreases.  Another thing I have found helpful in getting the patch to work is take a cloth with very warm water & gently rub the area you plan on putting the patch.  This will ex-foliate your skin & open the pores.  While doing this have the patch tucked under ur leg if sitting down so it's a little warmer then if it were sitting on the counter. Make sure you completely dry the area & then apply the patch.  Personally I've found it does help & have checked with pharmacists & the actual manufacture & have been told it's harmless AS LONG as you aren't rubbing the skin raw, using scolding hot water & using a heat source on top of the patch or to warm the patch as it will cause too much medication to be released too quickly.

I must say you are both VERY lucky that you have dr's that will prescribe something for BT pain.  I've been on the patch for YEARS & any time I've mentioned it to my dr she actually suddenly decides to DECREASE my Fentanyl & still not offer anything for BT pain or to make up for the difference.  She doesn't decrease slowly either... she goes by 25mcg decreases every week or so instead of 12.5mcg every month.

Sherry you always have such helpful posts & I hope you are getting the relief you need from ur patch.  

BK - I hope that you'll get the relief you need soon & things start to get better for you

Melissa

[namnam46]

Good, that's not too far away, Feb. 7th, that is. :)

I JUST posted on your OTHER post - this is why we stick to ONE thread on a subject - LOL - I feel like I'm going in circles.  LOL

As I said on the OTHER one - PLEASE be careful because at LEAST you do have Pain Medication that is working RELATIVELY well for you - WITH the exception of the Ultram.  I'd just keep TELLING him that it's NOT working for you.  You may have been taking it for such a long period of time {4 years} that it NO longer works for you anymore.

IF he won't help you then talk to your PCP and let them know the problem that you are having and ASK he/she if they can send you to a DIFFERENT one {not the one that won't touch you} until you can find one that will.  ALSO, as I said earlier, check the internet and start doing some digging and ask him/her to send you to one that YOU have found.  I'm just afraid that IF you do it on your own they MIGHT consider you to be Doctor shopping so BE VERY careful.  :)

{{{{HUGS}}}}..........Sherry

[bkdotson4]

I tried to get a follow up with him at end of this month's fent medication, but he said no I will see him in one more month and I am to do a Med review with the nurse.  the is Feb 7th

[bkdotson4]

I have talked to my Dr and his Nurse they wont do anything about the Ultram have  been asking for over a year now on that one and nothing.  He kept sending me to other dr to see if he was missing something etc. and as far and my family dr we did have him send me to another one and the one I did go to does not even do pain medications and wont even touch me.  I'm pretty much stuck then???????????

[namnam46]

The Fentanyl would be in your system now FIRST posted this on the 18, weren't you?

I'm REALLY sorry to tell you this, BUT we DON'T recommend Doctor's on MedHelp.  A Doctor that MIGHT be a good fit for me, might NOT be a good fit for someone else.  

What I CAN recommend is that you look on the internet OR ask one of your OTHER Doctor's {such as your PCP} to recommend someone else. I hope that you understand.  :)

You may need to talk to your Doctor about changing your meds.  I'd wait until your NEXT scheduled appointment and THEN talk to your Doctor about the changes as well as the ADDITIONAL  BT {Break Through} meds.  It's VERY unusual NOT to be given something for BT Pain.  You WOULDN'T need much, from what you have described, so HOPEFULLY, there won't be a problem for you.  :}  When is your next PM Doctor's appointment?

I'll be waiting to hear your next update..........Sherry  

[bkdotson4]

anyone know who long it can take before the medication would be a full dose in your system and I would know for sure that this level will work for next several years?

[bkdotson4]

Update on PM. Well I have been on the Ultram for 4 years now.  It never really did much from the start to be honest and the headaches I get are horrible and I take way to much Maxsult in order to combat them.  on the 75's I am actually getting about 70% relief from the patch and about 50% on the second day.  I'm not sure if he would be willing to give something extra just for the second day or not, but it has not only been a month yet and that may take some time to get into my system yet.  Is there anyone in Ohio that has a Dr that is EASY to talk to and keeps an open mind about your problem who is not to scared to change medications around if needed?  I live in Canton and am willing to travel if needed.  I'm not sure if I will change, but may be looking to if he is still not willing to do anything about this ultram.  

[namnam46]

Hi bk,

Your thinking is about right.  In all actuality, I, too, think that the BT meds is your MAIN problem here.  HOPEFULLY, your Doctor WILL change your BT meds for you.  

I have ONE MORE question for you.  How long have you been taking the Ultram?  When I first started on the patch a year ago, My PM Doctor kept me on the 10/325 mg. Norco that I'd been on for 7 YEARS!!  The Fentanyl was EXTREMELY helpful but the Norco wasn't doing much.  I stayed on it from January of 2010 until March 2010 and then talked to him about it and THAT'S when he switched me to the
Percocet 10/325 mg's and that made a WORLD of difference in my BT pain meds.

That's why I'm PRETTY sure that it should work for you, too.  The LONGER that you are on the Ultram the MORE chance that your body has become immune to that particular medication.  :{

I will be looking forward to, HOPEFULLY, a POSITIVE outcome with your Doctor on the BT meds!!!

Can't wait to hear from you........Sherry  :)

[bkdotson4]

yeah I realize exactly what you are saying.  I had run out of the Ultram and realized that it was absolutely better than nothing even though it doesn't necessarily give me relief it does help prevent it from getting any worse.  my pain base was at a 6 with increases up to 9 before the increase on a daily basis, with the new patch it has decreased to a daily base of a 4 up to a 7.  the past four years has never been pain free I know I will never be pain free, but just fee enough to be able to go out with my kids for a full day and not hit a wall in the middle of it on a more regular basis . the base pain I can deal with at a level 3 or 4 even, but when I get the break though and it goes up is when i have the problems I was really hoping this would help decrees the amount of break though and help bring it down a bit lower to the base level.  I agree I think the Ultram needs to be changed I just asked him today if he would be willing to do that and haven't heard back on it yet.  I'm keeping my fingers crossed

[namnam46]

Hi bkdotson,

I'm sorry that you aren't getting the results that you thought that you would get by increasing the patch up to a 75 mcg.

I'm ALSO, on the 75 mcg as I just took another 12 off of mine this month.  There is NO difference in whether or not you have a 75 mcg patch OR a 50 mcg + 25 mcg.  The math works out to the same thing!! That said, increasing the Fentanyl is NOT the answer to relieving your pain.  

You need to give it a few days before you will know what amount of relief you are getting.  That said - even Fentanyl ISN'T going to take all of your pain away. If you are getting a 40% reduction with the increase I would say that it's doing it's job AND very well too.  Some people on MH have even gone OFF of their meds because they didn't think that they were getting ENOUGH relief from their meds and they REALIZED that they just didn't realize how MUCH pain relief they were ACTUALLY getting.  I'm thinking that you don't realize JUST how much pain you would be in WITHOUT the Fentanyl Patches.  You need to stop and consider that fact when you say that you ONLY get about a 40% relief - BUT add that to the amount of pain relief that you were getting on the ORIGINAL 50 mcg patch and you will have a CONSIDERABLE amount of relief.  You just need to put it in it's proper perspective and think about it in those terms. :)

I'm REALLY afraid that you are wanting to believe that the patch is going to take MOST of your pain away when in essence it will make it a VERY livable pain that you will be experiencing.  

I'm thinking that you need to change your BT meds. I take Percocet 10/325 3 to 4 times a day.  I've reduced mine down today back to 1/2 Percocet 3 times a day.  That's what I took BEFORE I had my 3rd hip implant on Sept. 8th of 2010 -  4 1/2 months ago.  I'm getting back to the levels I was on BEFORE my surgery.  I will be decreasing my patch by another 25 mcg's - 12 mcg's at a time over the next 2 months AND even lower if possible.  So far STILL no w/d's at all.  

I HOPE that you will keep us posted on what is going on with you as you find what is going to work for you!!  Hopefully, you will get the relief that you deserve.  

I wish you the best and look forward to your next update...........Sherry  :)

[Melissa_1982]

Unfortunately you most likely won't get any better coverage using a 25mcg & a 50mcg compared to just the 75mcg.  Fentanyl does take awhile to build up in your system & to start working.  Some doctors have no issues increasing doses of it as if it were a weak medication & others absolutely refuse to increase it regardless of how much you may be suffering.  I'm sorry but I won't be any help on breakthrough meds as my doctor STILL refuses to prescribe any even after I've been on Fentanyl for almost 3 years.

Good luck & hope you get some relief soon.

[monsterjam2]

Using 1 25 and 1 50 won't make that much difference.  You will most likely get the same result.  It does take a few doses, though, to notice a difference in your pain level, so give it some time yet.  Check back with your doc in a about 10 days or so if it is not making a difference.  Best of luck!

[bkdotson4]

thanks if someone could just tell me if it would make any difference to put on 1 25 with 1 50 or would it just be the same?  I know I can't go any higher it took me a year just to get my Dr to increase to this.  I had been on the 50 for 4 years.also was wondering what type of break though medication someone may be having some good luck with.  right now I am on Ultram and it does not help much, but does prevent pain from increasing.  I have also taken Vicoden, but to be honest the ultram works better.

[mellie4]

Sorry this isn't working the way you hoped.  I don't have any answers but I'm hoping by bumping this up, someone else may have more answers for you.