My dad switching off of Fentanyl patch -50mcg....what are his other options?

[Ashelen]

My dad has been on the Fentanyl patch (50mcg) for the better part of a year now for severe DDD and osteo-arthritis in his back. He LOVES it. He says the stability is worth SO much to him....but he has very oily skin and very often the patches are just chugging medicine into his system, to the point where they aren't lasting the 3 days so the doctor has him replacing them every 2...the downside being that if he sweats even a little, which is skin already so oily, he gets a huge jolt of medicine. It exhausts him and makes it hard for him to function.

What are his other options? I know there's one other dlivery method of Fentanyl (under the tongue?) but he's been so happy with the PAIN MANAGEMENT...just not the side effects. Does he HAVE any other options? Morphine makes him itch like crazy and he doesn't like oxy....anyone have any other suggestions? I hate that he's feeling like this because the patch was helping SO Much...but he can't take the bouts of exhaustion when the patch is giving him too much. He's used 3 different brands..Duragesic, Mylan, and the Reservoir one that I don't know the name of....all have had different degrees of problems for him.

Like I said...it's just his skin type making this so difficult. His mom is from Italy so he has dark, oily skin, and it is hard to keep the patches on much less keep them delivering at a steady rate.

Suggestions? he goes to his doctor today and needs to know if he can bring anything up to his doctor.

Thanks guys you're the best...

update on me: waiting for my neurologist to fix the mix-up he made with my script. he wrote it wrong, once again, and was out of the office this week for a death in his family so I've been patiently waiting for my meds for several days now...luckily (??? luckily? LOL) I was sick so my husband was home anyway so I was able to curl up in bed through the headaches that I had no meds to deal with. I'm awfully sorry he had a death in his family but I've been waiting all week...getting a bit antsy about it, lol.

[Tuckamore]

Hey Ashelen,

I have heard of the fairly new procedure for SIJ treatment. When you post I'll share what I have learned about it. It's being done in the area that I currently reside.

My Best,
~Tuck

[namnam46]

I'm sorry  but I don't know ANYTHING about the SIJ surgery that you are talking about.  I have a suggestion - why don't you start a SEPARATE thread on your question so that you will get the MOST possible responses to it.  I'm just afraid that the title of this thread is REALLY going to limit you. :{

Looking forward to your NEW Thread.  :)..........Mama Sherry

[Jaybay]

Where is he placing the patch?  Where oily skin is concerned, location is even more important.  He also needs to clean the area thoroughly with alcohol and let it dry before applying the patch.  I've found the Mylan patch to be less sensitive to temperature changes, but as you mentioned, each brand seems to have its own issues.

There is a new pain patch on the market that contains buprenorphine and is supposed to last a week.  I have no personal experience with it.  Bupe is a partial agonist synthetic opiate with a very long half life that is also used in oral form to stabilize opiate addicts while they get their lives together and taper off.  I understand it's been used in patch form for pain management in Europe for several years.  Since it's new to the US market, I would guess it's going to be expensive.  It's worth asking the doctor about anyway since your dad likes the even coverage of the fentanyl patch.  Maybe this one will stick better and not have so many problems - you won't know until it's tried.

I'd hate to see your dad revert to short-acting meds like vicodin or percocet.  He'll just end up chasing pain spikes day and night.  He'll definitely need something long-acting, but it sounds like the usual choices have already been ruled out.  Sublingual or the lollipop form of fentanyl isn't a good choice because fentanyl itself is a very short-acting drug.  Those forms of delivery are used for breakthrough pain.  It's the patch delivery system that allows fentanyl to be used as a long-acting pain medication.

[Ashelen]

Thanks Sherry! You're the best :-). He and his doctor have the sort of relationship where he could suggest a med without a problem...I envy his relationship with his doctor, actually, lol. But I agree that his options are limited at this point...he really likes NOT taking a pill. I wish there were other meds (like hydrocodone) available in patch form...*I* would take a hydrocodone patch if they made one. I just didn't know if there were too many other ER options...thank you for all your advice :-).

My neuro is back in the office today and they're going to sort it out by tonight I think, but yeah it's been a little tough with being sick because my headaches are always worse when I'm sick.

[namnam46]

Ash - meant to add to BE SURE that his Doctor tapers him off SLOWLY - 12 mcg's a month so that he will have MINIMAL w/d's.  He can fill in with LOW doses of whatever med he is going to switch him to.  

Good Luck........Sherry  :)

[Ashelen]

OH!now that I think of it, I DO Have a big update about myself...my SI joint has been acting up again, to the point where the days after Christmas I was stuck in bed with the pain (my SI joint has almost no cartilege from a combination of genetic DDD and injuries from 14 years of horseback riding- several years of which I was riding professionally for) and they want me to consider some sort of surgery involving injecting cartilege or SOMEthing into the joint? I don't know any details, but does anyone know what they might be talking about?

[namnam46]

Hi Ashelen,

I think you probably already know that he needs to let his Doctor make the decision on his meds.  Of course there will be NOTHING that is as strong as the Fentanyl BUT there have been many that have been weened successfully and started on another long acting med such as oxycontin and a break through med.  :)

I'm so sorry that he's faced with this problem!! :{  But as I said BE SURE that he DOESN'T go in asking for something in particular let his Doctor lead the way. :)  

Are you going to be able to go with him?  That would be of GREAT help IF you are able.  I KNOW with your BEAUTIFUL children that might be VERY difficult!  :{

I wish him the VERY best.  OH, one other thing, BE SURE that he TELLS the Doctor about about the morphine and the fact that he doesn't like oxy is REALLY going to limit the Doctor's options.  There's ALWAYS Methadone as that is supposed to be a GREAT pain reliever also - unfortunately is carries a BIG stigma with the name of it.  :{  I REALLY feel for him as I KNOW how upset I'd be if I had to give up my patches!!!

Ash, I'm SO sorry that you have had to go without your meds because of the mis-up with the script!!!  Bless your heart.  I KNEW your weren't feeling well but I'm SO sorry about this!!!  I HOPE that you get it straightened out SOON.  How long before he will be back in the office?  I'm SO glad that your Hubby was home and you COULD curl up in bed!!!  

Thinking of you AND your Dad and sending you GENTLE {{{{HUGS}}}}...Mama Sherry