Avatar universal

Just started Fentanyl Patch last night....SCARED

I injured my peroneal nerve two months ago and the pain has been exhausting/unrelenting....allowing me no sleep at night and no position comfortable to sit or stand for long without having to "shift". I work full time but in the last 2 weeks called out 3 times...one being yesterday. I work for a doctor very familiar with this nerve and she has stood by me to get testing to find out what it was initially-and now for pain management. I have used every anti-inflammatory there is...non narcotic pain med....percocet 5 percocet 10...lyrica...neurontin...and yesterday I was going to go to the hospital and demand they put me in as inpatient for pain relief...my doctor prescribed me fentanyl 25mcg and is getting me in to see about gettiing an epidural this week. I really don't want to go down the drug route again (broke hip 5 years ago)...but i cannot last a day without something. Anyway, looking for advice, what to expect, I was terrified to put in on last night-but desperate for a decent sleep...I did wake up two times in pain but NO WHERE near what it was.but uncomfortable to where I felt I wanted to take something to get comfortable. Can anyone tell me if this is already working at "full steam" or not...I put it on at 9:00 last night and it is now 11:00 am. Any advice welcome...thank you
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1331804 tn?1336867358
Hi and welcome to the community.

When starting the Fentanyl patch, it takes about 17 hours for the first patch to take full effect and sometimes it can take a full day for the medication to peak so as I type this you are either at full peak or near it based on the dosing time you included in your post.

Keep in mind that it truly takes about 3 patch changings for maximum steady state concentration in the blood stream.  So be patient and if you are still in considerable pain after about a week a so, I would contact your doctor for an adjustment.

25 mcg/hr is often the starter dose of Fentanyl.  They do make 12.5 mcg/hr patches that contain 12 mcg/hr Fentanyl but this lower dose is fairly new.  I am also on the Fentanyl patch, dosed at 50 mcg/hr.  I take 10 mg oxycodone IR as needed for breakthrough pain.  So another thing to assess is if your pain level is consistently high throughout the day or if it is only high during certain periods of the day.  If the latter is true, an immediate release breakthrough pain medication might be the next step versus an increase is patch strength.  However, if you are getting breakthrough pain 3-4 times a day, an increase in patch strength might be warranted.  Another issue can be the way the patch is dosed.  Many (including myself), require that the patch is changed every 48 hours instead of every 72 hours.  So if you are changing it every 72 hours and have significant pain on the 3rd day, consider talking to your doctor about an increase in patch frequency.

I wouldn't feel terrified over the patch.  Just be sure to check each patch for leaks before applying (if you are using the resevoir patch...push the gel around to make sure it hits the containment walls).  Keep the patch away from heat as that will cause too much medication to be released at once into the bloodstream.

I hope you find it effective for your pain.  I have found the patch to provide the most consistent pain relief out of all the different meds that I have tried and I have tried many different types of ER pill formulations.  Please update us on how you are doing.  Take care.

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Avatar universal
I thank you so much for the information. I think from what you said I would need something just for immediate release-at night-starting around 9:00pm I am getting uncomfortable...the doctor gave me ativan so I take that about 10:00pm and go to sleep as quickly as I can to avoid having to stand more pain. The VERY worst pain I get is during the night....which I feel I HAVE to take something because I can't stand on my leg or get back to sleep...since this all happened the nights have been worse but it gradually grew to an all day pain. I think I would rather just take something during the night than to increase the patch--like you said it is probably at its peak now but really not for 3 patch changes....
I was terrified it would make me so dopey I wouldnt be able to function...but I am not finding that to be true. My question to you is what is a reservoir patch?? Mine says on box Fentanyl Transdermal system...fentanyl 25 mcg/hr patch...seems very flat to me(the patch)...I am also TERRIFIED of any kind of withdrawal from it......
I went for lumbar MRI Friday and going for pelvic mri on monday...to find out if it is coming from either area....trying to get into Rothman this week to see about maybe an epidural to help me. Any info is greatly appreciated.
Helpful - 0
1331804 tn?1336867358
Hi Jill,

I have found that the fentanyl patches don't give me a dopey feeling like many of the ER pills did. I really like the patch. Once it gets into your system you should notice real consistent pain relief. I notice that about three hours before changing the patch I can feel it ramping down but nothing like the steep drop I felt from ER pills. I do need the oxycodone throughout the day.

The reservior patches are gel filled and you can push the gel around. The gel is a mixture of fentanyl any alcohol. It sounds like you have the patch with the fentanyl built into the adhesive. Those ones you don't have to worry about leaks.

If or when you want to stop the patch be sure to get tapering instructions from your doctor and that will greatly minimize the withdrawal symptoms.

I think the 50 mcg/hr patch provides balanced pain relief for me so if you can't sleep at night because of the pain it might be better to increase the patch strength as IR meds only last 4 to 6 hours and probably won't allow you to sleep a full 8 hours. It is important to get an adequate amount of sleep to keep your pain levels down. How are you doing today?

Helpful - 0
1855076 tn?1337115303
I used to take 75 mcg Fentanyl every 48 hours.  It worked fairly well, along with breakthrough and other meds, for my pain. I chose to come off it for a number of reasons.  Fentanyl is difficult to come off, even when you do a taper. Not trying to scare you at all.  Fentanyl seems to work great for many people.  Others find it's not for them.  Keeping communications open with your doctor and maintaining a good relationship with him/her is one of the most important parts of pain management.

I agree with femmy that you do need to give it a few patch changes to see if it's working well for you and also talking to your doctor about BT meds.  I don't know too many people that take long-acting meds without also needing BT meds at times.

Everyone is different and we all need to do what is right for our own situation.  There is no right or wrong when it comes to treating chronic pain.

Keep ups posted on how you're doing.
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Avatar universal
I apologize for not signing back in and checking....I went for pelvic MRI on Monday and when I was leaving I got a call from my doctor requesting a 2nd MRI of my spine (first done previous Friday)....this one with contrast. I got results and what it showed was a tumor on my spine at L4-L5 level...which is pressing on a nerve which explains horrible leg pain. As you can understand I have been on a rollercoaster of emotions...trying to learn alot before meeting with a surgeon this coming Monday in Philadelphia. I am still on fentanyl 25 and using percocet 10 for breakthrough...this weekend has been awful....I am needing something for breakthrough every 2-3 hours which is not good....I am going to ask surgeon what can be done to change on Monday. I will be back on again more regular as I am sure I will have more questions with change....I am having a tough time with everything as you can imagine. Again I apologize and thank you both for taking the time to answer....
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