I have been on the Butrans 10mg patch for 48 hours and I do not need my Norco 10/325's as much. I have better around the clock pain management with the patch already! I was taking 3 Norco 10's a day. But now I find that when I do need them for BT pain I get no relief anymore. I wake up in the morning and do not feel as much pain now thankfully since on the 10 mg patch but I still have BT pain and the Norco does not seem to work anymore. Why does the Norco not bring my pain down while on the patch? I see so many conflicting things on here and I need a professional's answer! Please help..
I am a Registered Nurse. I feel that with the Patch you don't need the Norco/Lortab. Unless you're Dr has prescribed that you need to take them. It really depends on how long you've been on Norco because if you've been on the same dosage for say, 3 years you're body gets so immune to them you probably should request an increase to 10/325 Every 6 Hours.
Please forgive me if this question has already been answered for you, but I thought I'd go ahead and do it in case you were still at a loss. I am a registered nurse and have some experience with butrans in the patch form for patients in chronic pain. First, a caveat. When educating my patients, I have found in my many years of experience that it is very helpful to them to use real world, concrete examples to help them better understand and grasp what can, at times, be very complex ideas. Especially pharmacodynamics. If I have dumbed it down too much, please forgive me. It is in no way a reflection on your intelligence.
The reason that you feel that your Norco does not work quite as well is that, in fact, they don't. Norco plugs in to your pain receptors like a key plugs in to a lock. In this way, the key blocks pain signals from reaching your receptor to tell your brain you are in pain. Butrans is more like honey covering a spoon in how it interacts with your receptors. It sort of coats them to prevent the pain signal from reaching the receptors. Butrans also has a far greater affinity for receptors. Meaning that if your receptor is given the choice of a "key" or "honey," the sticky substance almost always wins. It also has a very long half life. This is basically the time that it takes your body to use up and eliminate the drug after you stop taking it. Your Norco is a few hours I believe, whereas butrans is something in the range of 24-36 hours. Sometimes longer.
I have seen several patients placed on a long acting med like butrans or a continuous release or long acting pill, with an immediate release drug like Norco or oxycodone prescribed for breakthrough pain. The butrans covers most of your receptors and the patch provides a continuous release of medication over it's seven day life span. Norco can then be taken in addition to the butrans when having an increase in pain to target those receptors that have not already been targeted by the butrans by plugging in to them. It will still work, but because it is targeting fewer receptors, the effects you feel from it will not be as great. And it is my understanding that brutrans will not be knocked off the receptors by the Norco, but I am not sure the opposite is true.
In truth, many pain specialists prescribe both an oral med and the patch together. You may notice a little bump in your pain relief by taking a Norco, but it will not be identical to the pain relief you experience when just taking Norco. Many patients I have encountered swear by the butrans because it gives them continuous relief without taking pills around the clock and is not associated with the euphoric feelings that can be caused by other narcotics. This allows a higher level of functioning in activites of daily living for a lot of people. But everyone is a little different and some patients do not report well controlled pain with the patch. There is certainly nothing wrong with taking the Norco with the butrans if that's what your doctor prescribed and you are doing it under their direction. On the whole, controlling chronic pain is a very personal and individualized treatment course and if this course is not working for you, discuss it with your physician. You know what you need better than anyone, and treating chronic pain is not an exact science. Sometimes it takes a lot of trial and error before arriving at a course that works for you.
I hope this is helpful and I wish you success in your continued treatment.
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