P.S. If the patch is not tightly attached to your skin, it is not working well. If this happens on a regular basis, you will be undertreated and have more pain. Fentanyl will only transfer into your bloodstream when each part of the patch is tightly pressed into your skin.View Thread
Ask you doctor to write a new Rx for a different type of patch.
The large Fentanyl patches do not seem to stick as well as smaller patches. Ask your doctor if you can try the Mylan brand patches. They have the same Fentanyl content as the larger patches, but they are much smaller and they seem to remain in place better and longer.
One other interesting factor. Almost everyone using the patch that I've chatted with agrees that it works well for up to 48 hours - but NOT FOR 72 HOURS. I've chatted with dozens of people using the patch and NONE OF THEM felt any pain relief after 48 hours. Ironically, that might be the most common time when patches tend to fall off the skin.
If you feel that the medicine in your Fentanyl patch is not effective after 48 hours, tell your doctor and ask if you can change the patches at 48 hours, rather than at 72 hours. Some patients change the patches daily.
This might kill two birds with one stone. Your patches will stay on better and longer and you will avoid those lapses in pain relief that occur after your patch has been exhausted of Fentanyl (at 48 hours).
Doctors are frightened about the DEA oversight of opioid Rx's. However, there are many physicians who will prescribe the most potent pain medications. Trust is the major issue. I wish that we could give you the names of physicians, but WebMD prohibits that - and for some good reasons. But keep trying. Eventually, you'll find a physician for your husband who has empathy and compassion - one who is more motivated by the Hippocratic Oath than by fear of the DEA. There are many such physicians available in every state; "bleseedlady" take notice... Unfortunately, it might take some time to locate one. But they do exist. Keep in mind that your family doctor, who knows and trusts you might be willing to provide the medications that you require much more easily than would a pain management physician. Best of luck to you.View Thread
CAT-scans are safe and effective. The amount of radiation you receive is hardly what you've alleged. I've had many of CAT-scans and never even worried about it at all. Your information might not exactly be accurate. And it's Hiroshima, not "Hiroshimo."
However, I feel your angst about being 15 minutes late for an appointment. If that's true, you should have been worked in as possible some time that day.View Thread
New research only serves to confirm older research that steroid injections for spine-related pain do not work. Furthermore, repeated injections become a nerve-root impingement risk. They can also contribute to fibrosis, which can also impinge a nerve root.
This no doubt comes as bad news to the plethora of "injection mills" that exist everywhere. Those unfortunate millionaire physicians will have to find another way to supplement their bloated incomes. Some of these physicians have the nerve (no pun intended) to call themselves a "Pain Management Clinic," even though they only offer injections.View Thread
Duragesic is available in various generic alternatives. Consider, for example, Mylan brand Fentanyl patches. While Duragesic (DAW) can cost up to $2,000 for a 90-day supply, one of the generic alternatives (ex. Mylan) costs $10 for that same $2,000 90-day supply and it is at least as efficacious. I kid you not! Duragesic = $2,000 for 90-days. Mylan (same formula) is $10 for a 90-day supply.
Even with a less generous insurance plan, you could save thousands of dollars annually by using a generic alternative (which works at least as well).
Is there a reason why you are not using one of the generic alternatives to Duragesic?View Thread
You are experiencing tolerance; but you are not on the most potent pain medication. Fentanyl is 80 times more powerful than morphine and more powerful than Oxycodone. Typically, when a patient becomes tolerant to the highest safe dosage of a pain medication, the physician will rotate the drugs.
Second, your oxycodone is not a long-acting pain medication. Research clearly shows that chronic pain patients respond much better to a long-acting pain medication (Kadian, Oxycontin, Fentanyl Transdermal, etc.). You can then use the oxycodone for breakthrough pain. This has been standard practice for a long time.
Perhaps you should ask your doctor about using a long-acting pain medication. When I first tried Fentanyl Transdermal, it wiped out at least 80% of my pain. One caveat though, the patches never last more than 48 hours. In fact, I've never heard of anyone who obtained benefit from a Fentanyl patch after 48 hours. But it is by far the most powerful pain medication available.
Try to keep the "nice years" rolling along by rotating your pain medications to long-acting and more powerful options. Your doctor should be able to help you with this. Good luck.
P.S. The success rate for spine surgery today is still about 60%. That's very low, especially compared with other types of surgery. Be certain that you have tried all of the dozens of various treatment options available with a comprehensive pain management program before going under the knife.View Thread
First of all, 16 tablets of 15 mg. Oxycodone in itself would seem very dangerous of prescribe. Add to that the morphine and Fentanyl and it makes no sense. So, I must ask for an honest answer. Does all of this come from one physician?
Admittedly, a person in chronic severe pain can gradually work up to large dosages of opioids. Thus 8 tables of 15 mg. Oxycodone per day could be achieved without dangerous respiratory depression. But you mentioned twice that dosage. I find it hard to believe a physician would prescribe it in addition to a 100 mcg. Fentanyl patch and morphine.
Most people with that much opioids in her or his bloodstream would stop breathing.
Could you be wrong about the medications or dosages?View Thread
OK. This helps. I'm guessing that your breakthrough dosage (Oxycodone) is a typo. When you typed "60," was that the amount you receive in an Rx? 60 mgs per dose might produce dangerous respiratory depression. What is the strength of each Oxycodone tablet? Most patients start at 5mg and work up to 10mg (plus Acetaminophen or aspirin). How is it directed every four hours? One tablet? Two?
Have you tried other long-acting opioids? For example, one person can eat morphine like candy, yet Fentanyl is a wonder drug for him or her. We're all different. One person's wonder drug fails to help someone else at all. One of the primary purposes of comprehensive pain management is to try a wide variety of long and short-acting pain drugs in order to determine which combination works best for your unique body chemistry.
So... have you tried other combinations of long and short-acting opioids? If so, which ones? At which dosages?
Have you been through a comprehensive pain management program? I'm referring one that includes a variety of treatments, like spinal decompression, a corset, brace, TENS, traction, acupuncture, biofeedback, physical therapy, kinesiotherapy, rhyzotomy (radio frequency denervation), spinal cord stimulator, intrathecal infusion pump, off-label medications (anti-depressants, anti-convulsants), counseling, hypnosis, meditation, etc. For example, I can drop my pain by up to 20% with biofeedback alone. Some people rave about acupuncture. Others like hypnosis. Until you try most of these, you are cheating yourself. Of course, they don't replace medications. But they enhance medication pain management via alternative options. Ask your doctor for a referral.
One caveat about pain management programs. Today they so fear raising red flags with the DEA as a "pill mill," that PM physicians can be reluctant to provide powerful medications, or at least the one's you're using now. Starting from scratch again can be very painful.
If you've already tried a pain management clinic, then medication might be all that's left. Rotating and alternating medications can help you and your doctor discover the best combination. Also, some of us have a very high tolerance for opioids. Just like someone people can drink you under the table and look sober, some people can take high dosages of opioids and notice little pain relief. Under a physician's direction, you can gradually increase opioid dosages to fairly high levels without danger or risk of respiratory depression. The key is gradually and under a doctor's supervision.
When all of these fail, there are two options. One is the spinal cord stimulator, which can help patients who have referent pain (pain that travels from the spine into a neck, shoulder, arm, hip or leg). This is a mechanical device surgically implanted that exerts an electrical impulse upon the effected spinal nerve roots.
The other is called the intrathecal infusion pump, which is a mechanical pump surgically implanted with a catheter that drips an anesthetic fluid upon your effected spinal nerve roots.
These two items are last resort because surgery is required to implant and to remove. All surgery entails morbidity. So... it's a last resort for pain patients who cannot benefit from medications and other treatment milieu. If you decide to try either of these, know that there is a trial device worn outside the body with catheters and leads that go into your spine. If the trail effort does not help, then the surgical implantation is not worth the risk. The success rates vary from about 40% to about 60%, depending how much spinal damage, and especially spinal nerve root damage, has occurred.