[anniedan]

Because of chronic pains I'm on MS Contin and have been for over 2 years now. Now I'm at 100mg, twice a day. I went up to 300mg a day (150mg, twice a day), but the only difference I could see was the side effects, so I went back to only 200.

I really want to try Duragesic/Fentanyl because of the side effects of MS Contin, because of the fact a patch would be easier to deal with and because I'm hoping it could work better (the MS Contin only makes the pain easier to deal with, about 50-60% better, and in "crisis" I can only take Tylenol and/or Advil which help a little but never completely remove the pain... but which in the long run, have side effects too!).

I'd like to try something else, anything!, but my doctor doesn't seem to know of anything else... Or so he says.
I'm hoping the Duragesic/Fentanyl patch could be it.

I'd like to know if someone here have done that switch, and from a comparable dose of MS Contin... because my doc just refused to give me the patch! He said it was too high a dose for me, that there was nothing in the patch comparable to where I was at in the MS Contin, nothing even close.
Of course I wouldn't like something too "hard" for me... I wouldn't care trying something a little higher-dosed, though... since the MS Contin is not 100% effective at the does I'm at!
But since the doc doesn't seem to really try and help me lately, I've been wondering if what he said was true...
(The doc even said the side effects were as bad, while I read the contrary in here!)

When he got me at 300mg/day, he had told me I was almost at the highest dose I could get... and I've heard of people switching from MS Contin to the patch... so either he lied then, either he is now!

I searched around and learned the lowest dose of Duragesic was 12mcg/hour.
It's hard for me to see if it's comparable to 300mg a day of MS Contin... Of course, the active agents are certainly not the same (codeine and morphine are both opioids, but are not the same)... but they must be close...
Are 300mg in 24hrs that far from 12mcg in one hour? I may be doing it wrong, but it gives me 12.5mg/hour of MS Contin, or 288mcg/day of Duragesic... Now I'm trying to compare apples and oranges, or miligrams and micrograms, but still... It makes me wonder.

I'd like to know, because if it's not that far from one another, and it was just another episode of that doctor not even trying to help, I may be able to ask my GP at my next visit... until I find myself a new specialist...

Thanks!

[Tapering]

Originally Posted by anniedan

Because of chronic pains I'm on MS Contin and have been for over 2 years now. Now I'm at 100mg, twice a day. I went up to 300mg a day (150mg, twice a day), but the only difference I could see was the side effects, so I went back to only 200.

I really want to try Duragesic/Fentanyl because of the side effects of MS Contin, because of the fact a patch would be easier to deal with and because I'm hoping it could work better (the MS Contin only makes the pain easier to deal with, about 50-60% better, and in "crisis" I can only take Tylenol and/or Advil which help a little but never completely remove the pain... but which in the long run, have side effects too!).

I'd like to try something else, anything!, but my doctor doesn't seem to know of anything else... Or so he says.
I'm hoping the Duragesic/Fentanyl patch could be it.

I'd like to know if someone here have done that switch, and from a comparable dose of MS Contin... because my doc just refused to give me the patch! He said it was too high a dose for me, that there was nothing in the patch comparable to where I was at in the MS Contin, nothing even close.
Of course I wouldn't like something too "hard" for me... I wouldn't care trying something a little higher-dosed, though... since the MS Contin is not 100% effective at the does I'm at!
But since the doc doesn't seem to really try and help me lately, I've been wondering if what he said was true...
(The doc even said the side effects were as bad, while I read the contrary in here!)

When he got me at 300mg/day, he had told me I was almost at the highest dose I could get... and I've heard of people switching from MS Contin to the patch... so either he lied then, either he is now!

I searched around and learned the lowest dose of Duragesic was 12mcg/hour.
It's hard for me to see if it's comparable to 300mg a day of MS Contin... Of course, the active agents are certainly not the same (codeine and morphine are both opioids, but are not the same)... but they must be close...
Are 300mg in 24hrs that far from 12mcg in one hour? I may be doing it wrong, but it gives me 12.5mg/hour of MS Contin, or 288mcg/day of Duragesic... Now I'm trying to compare apples and oranges, or miligrams and micrograms, but still... It makes me wonder.

I'd like to know, because if it's not that far from one another, and it was just another episode of that doctor not even trying to help, I may be able to ask my GP at my next visit... until I find myself a new specialist...

Thanks!

The following is a crude dosing conversion. http://www.eperc.mcw.edu/fastFact/ff_002.htm However, I would warn against beginning the patch. First, there is little control on your part to take less. Second, beginning at such a high dose with the patch leaves you little room to increase to a reasonable dose. Third, when the time comes to discontinue the patch, you have to drop down no less than 12.5 mcg per step, which right now may not seem like much to you, but believe me, the drop will be noticeable.

I discontinued the patch at 87.5 mcg /48 hours 33 days ago and is was quite difficult.

While it is certainly not my place to tell you how or what you should decide as far as your medications are concerned, I would think twice regarding the patch.

Another consideration is the availability of the patches. Many of the manufacturers of the generic and brand patches have issued recalls for one reason or another and it became quite difficult to find a pharmacy that had them in stock. All fentanyl transdermal patches are not made the same. Some are more effective than others. There are many factors that play into the dispensement of the drug as well; placement on the body, body temp, sweating, showering, bathing. It is not as easy as it may seem. The adhesives have been to known to cause skin reactions.

Also, after reading many of the testimonials of persons discontinuing fentanyl, it seems that the withdrawal symptoms are considered to be worse that those experienced with other "time-released" or constant dosing medications. While I can not attest to that fact, since this is the only medication I used after hydrocodone, it sure seems to be the general consensus.

So, I would certainly think long and hard regarding this switch.

For what it is worth.

[Robert_325]

Originally Posted by Tapering

http://www.eperc.mcw.edu/fastFact/ff_002.htm

So, I would certainly think long and hard regarding this switch.
For what it is worth.

You made some good points in your post. I have not seen the above link that you referenced here before. It has some good information. There is also some really good information available on the links at this page. If you follow the links through it shows several opiate conversions, includes methadone information, has a lot of good stuff. I saved this page. Thanks.

[Tapering]

Originally Posted by Robert_325

You made some good points in your post. I have not seen the above link that you referenced here before. It has some good information. There is also some really good information available on the links at this page. If you follow the links through it shows several opiate conversions, includes methadone information, has a lot of good stuff. I saved this page. Thanks.

No problem! After experiencing the advantages and definite disadvantages of using the fentanyl patch, it would most certainly be one of my last choices in pain control. There seem to be just too many variables. I have personally come to the conclusion, that you can not control pain at a 100% level and I don't think that the goal should be as such. If that is your goal, you are doomed to a road that leads to escalating opioid use.

As stated before, getting the body back to a somewhat opioid naive state has its advantages. Lower doses can be taken to control pain, if controlling pain is your true motive. I think this has to be approached with a well balanced plan in mind. One of the most beneficial activities I have found at controlling pain is activity itself. One can fall into an either or situation making neither work. That is why it is so important to find a physician who uses a multi-disciplined approach; you don't want to get caught in a vicious cycle. You have to control pain so you can remain active and take a pro-active and responsible approach for yourself. The doc can't to it all.

[gristd]

I was on oxy contin 80 mg 3x a day + 40mg 3x a day as needed for break through pain....more on that in a minute. I ultimately switched to the durgesic patch. While I have had pretty good results with it, it's not the miracle drug it's cracked up to be. The 3rd day jitters are ridiculous. When I first switched, my doc placed me on 100mcg every 3 days. I tried that for the first 2 weeks with very minimal pain relief, especially on the 2nd night and the 3rd day. I told my doc this and he upped me to 2 - 100 mcg patches every 3 days. That was almost 4 years ago. I am still on the same dose. The first and second day are OK, the 3rd day is an absolute nightmare. I have almost no pain relief from the patch. My stomach is in a constant state nausea. I get the cold sweats. This happens more in the summer months than the winter months. Also the patch really screws up your summer, because you can't expose the patch to the direct sunlight, which I understand, but they also leave you very limited application locations. Mine are on my upper arms. Unfortunately for me I can't wear any thing shorter than a short sleeve shirt. I've also found that when I go swimming the chlorinated water dissolves the glue on the patch, ultimately causing them to fall off, so that means no swimming. To say the least, there are definitely a few life syle changes that you would have to make, if you decided to try the patch. Be careful if you use the generic patch, they use a different glue base, which cause alot of skin irritation. I only use the brand name, unless I am forced to use the generic. In regards to my opening comment, before anyone blogs that you can't take oxycontin for break through pain, your wrong. It is probably the best break through pain med on the market to take if you are on oxycontin.....Look at this way, your already taking oxy contin. The break through pain is usually caused by a sudden drop in your med levels, rather than use a totally different drug for the break through pain and have to wonder if it is going to work, why not just take a 1/2 dose of the medication you are already taking and increase your levels. It work wonderful for me. Finally, I'm not trying to scare you away from switching to the patch, I'm just trying to give an honest opinion on the patch. Would I switch back to Oxy contin if I had the chance? Probably not, but that doesn't mean that I am singing praise for the patch either. They both have their negatives, you have to decide which set of negatives are easier for you to deal with. Best of luck in your search for pain relief.

[DMcPershing]

I have just recently started the Fentanyl Patch. I had been taking Vicodin ES 7.5/750 for several months. It got to the point where I was taking 7-8 tabs daily so, my doctor was concerned of acetaminophen levels. I started the patch at 25mcg for 3 days and had no relief for a week so, I was taking the Vicodin for breakthrough pain regularly. She upped the patch to 50mcg per 3 days and I am on 5th day now and it still isn't working. I dont want to keep having my doctor up the dosage but, this is not working at all. I was told it would be a much better option than Contin. I don't know what to do at this point. Please advise if you can. Thanks.

[Robert_325]

Originally Posted by DMcPershing

I have just recently started the Fentanyl Patch. I had been taking Vicodin ES 7.5/750 for several months. It got to the point where I was taking 7-8 tabs daily so, my doctor was concerned of acetaminophen levels. I started the patch at 25mcg for 3 days and had no relief for a week so, I was taking the Vicodin for breakthrough pain regularly. She upped the patch to 50mcg per 3 days and I am on 5th day now and it still isn't working. I dont want to keep having my doctor up the dosage but, this is not working at all. I was told it would be a much better option than Contin. I don't know what to do at this point. Please advise if you can. Thanks.

You are not taking much Fentanyl considering you were taking 8 Vicodin ES per day. She had you taking the Fentenyl plus the Vics so you were still getting the apap. What is the cause of your pain??? If this will be a longterm treatment then I would recommend that you see a pain management specialist. They would be best suited to help you. You need to do something different than what you are doing now but we don't even know what is wrong with you. If this is only a short term problem then I contend the Fentanyl/Vic combo is probably worse than the high dose of acetaminophen. The Fentanyl will be very tough when it comes time to stop if you are given a dose that is sufficient to adequately deal with your current pain. Good luck.

[DMcPershing]

This is for a long term condition. It was a specialist who put me on the patch. I am still on the Vicodin for breakthrough pain which we expected
to be 2 or 3 tabs a day. So the plan was to greatly reduce the Vicodins which would decrease the acetaminophen intake. My concern is that Fentanyl is supposed to be more effective and give me better control but as of yet I have not gotten any relief. If this keeps up I may ask them to switch me to Oxycontin. For the time being I would rather not mention my medical conditions. I do however appreciate any advice.

[Robert_325]

Originally Posted by DMcPershing

This is for a long term condition. It was a specialist who put me on the patch. I am still on the Vicodin for breakthrough pain which we expected
to be 2 or 3 tabs a day. So the plan was to greatly reduce the Vicodins which would decrease the acetaminophen intake. My concern is that Fentanyl is supposed to be more effective and give me better control but as of yet I have not gotten any relief. If this keeps up I may ask them to switch me to Oxycontin. For the time being I would rather not mention my medical conditions. I do however appreciate any advice.

If it's a permanent condition or very longterm then I would ask for OC, more fentanyl or methadone. Lots of people who use the patch for serious conditions take 100mcg every two days. Your current dose is not anywhere close to that. I am not promoting high dose fentanyl understand. You can see how I feel about it by the posts above. But if you are going to take it then you should take enough to work. I would rather take methadone for longterm therapy than fentanyl. At least a methadone dose is easier to control than a patch.