Chronic Pain Support Group
Physicians and professionalsdefine pain as chronic if it lasts longer than three to six months and is persistent. It's distinct from acute pain that is a direct result of injury or trauma. This support group is dedicated to those suffering from chronic pain. Discuss treatments that have worked for you, find advice for your specific experience, and find support. You're not...
I suffer from chronic neck, back, shoulder pain. The doctors say I will have it the rest of my life. Tried surgery. After a year the doctor classified it as a failed surgery.
I am currently on Vicodin taking enough that my eyes should be bleeding.
I have been thinking about telling my doctor that I would like to try the fentanyl patches. What is the best way to approach my GP who is not a pain management specialist.
The reason for getting off the Vicodin is that I take 4 7.5's a day which is a lot of Tylenol to take every day. Even at this dose, I do not get continuous relief.
Any input would appreciated.
I am currently on Vicodin taking enough that my eyes should be bleeding.
I have been thinking about telling my doctor that I would like to try the fentanyl patches. What is the best way to approach my GP who is not a pain management specialist.
The reason for getting off the Vicodin is that I take 4 7.5's a day which is a lot of Tylenol to take every day. Even at this dose, I do not get continuous relief.
Any input would appreciated.
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I have been on fentanyl I live in extreme pain I take 300 mg of morphine a day and I would not go back to fentanyl , you cannot live a normallife with it. It makes you a zombie and it runsout before the 24 hours or 48 hours is up. It is not a cure all drug. I would hope your doctor would send you to a pain specialist and go on neutonin or gabepentin and ms contin or oxy or tramdol or toradol. Ask your doctor to refer you to a pain special instead. good luck. isabee
I'm sorry that you're suffering from neck/back/shoulder pain. Have not seen you around before, so I welcome you to the Chronic Pain board!
Do you see a pain management doctor? Most GP's will not prescribe medications that strong for long-term use like what's necessary for chronic pain. It would be a HUGE jump in dosage to go from hydrocodone to fentanyl; 50-100 times stronger ( http://en.wikipedia.org/wiki/Equianalgesic ) I would be hesitant to go into a doctors appointment asking for ANY medication by name; I've found it's always best to simply state what you're experiencing (ie, that the Vicodin isn't helping your pain to a sufficient level) and how it's effecting your life, and let the doctor try to work out what medications might help. It's important to know that you shouldn't expect total pain relief from medications, and instead should focus on a return to functionality. Most of us will never be pain free, only pain-managed.
I hope you're able to find a treatment protocol that works for you.
Hugs & God Bless
Lisa
Yes it is stronger than morphine which is why it is dosed in micrograms instead of milligrams. Fentanyl has equalanalgesic dosing just like all the other meds. People are started out on the lower 12.5 micrograms.
I went straight from hydrocodone to fentanyl because my doc wanted me on a long acting med. No matter which one we choose, it would have been an equalanalgesic dose.
ipf, I would just tell your doc you would like to try some of the long acting medications to get better pain coverage and to get away from the Tylenol. He then may or may not ask if you have a preference or he might recommend a different med altogether. It's not usually a good idea to ask for a med by name, but in my case for example my doc asked me if I had a preference to which LA med I would like to try. I told him I was not comfortable with Methadone but the others were fine. I told him I had read good things about the patch and he had no problems trying me out on one. I get great pain control with mine. I also do not get too much of the sweating that some people complain about, nor do I have an issue with heat. I am very careful to take my patch off if I am going into the hot tub, or to take a nice long hot bath. I will take one when it's time to change the patch.
Some people get a little(or big depending) skin irriation from the glue on the patch. Just have your doc prescribe something like Flonase which is an allergy spray. Spray it on the spot you are going to put the patch, let it dry, then put on the patch. No more skin irritation!
Good luck!
Before your just ask for what is pretty much the strongest "at home" use narcotic you might want to talk to your Dr. about trying a Long Acting med first. You've not even gotten into that category yet. Short term meds like Vicodin cause a constant series of peaks and valleys, they have a short half life, and your constantly chasing your pain. When you move into Long Acting meds. you then get into meds like Oxycontin, Morphine, Kadian, etc. which are dosed at 12 hr interim's so that your body's BPL (Blood Plasma Level) has time to build up a constant level of medication, so your not going through those valley's and peaks. Some patients also get Breakthru meds with their Long Acting meds so if they have bad flares they have a "booster" to take care of it. Not all Dr.'s do this because patients often start to use those Breakthru meds daily and they then become regular daily pain meds.
So, there's some info. for you. I wouldn't go straight into your Dr.'s office and say, "hey doc i'd like some Fentanyl patches" they generally don't like that. I'd go into the appt. and tell your Dr. you'd like to have a conversation about moving to a long acting med that gives you better coverage overall throughout the day, so that your quality of life is improved.
Good luck with your appt.
Kat
Some food for thought: if you have breakthrough pain, there is nothing stronger in the ER/hospital they can give you fentanyl. Fentanyl is about as strong as it gets for oral and IV routes. If you want to try going off your meds for awhile, the withdrawals from fentanyl will be stronger and longer than other types of pain meds.
It sounds like you have the history and relationship with your doctor to justifiably ask for it, but this medication can be game changing. I have to disagree with Boxerlover, as a former healthcare worker we rarely got patients whom took Fentayl as a home medication. Those who did take at home, and did not have cancer, long time usually didn't do too well. It is a medication that truly needs a team to successfully manage at home, and personally I wouldn't write for it as a GP.
Actually Fentanyl patches are quite well known for patients with severe Chronic Pain for long periods of time, meaning years. I've known many Long Term Chronic Pain pts that have used Fent patches successfully. I've used it, a few years ago, stayed on it for 2 years and used a breakthru med with it, Percocet. I chose to change because I've had 30 operations and my skin is extremely sensitive to any kind of adhesive substance or latex product, so after awhile I just couldn't use the patches without my skin blistering under them. As for the withdrawals, I went from Fentanyl back to an Oxycontin/Percocet mix and didn't have any withdrawals. Generally if you've taken narcotics for long periods of times and you switch from one equivalent to another you don't have many withdrawal problems. I've taken oral narcotics daily for over 10 years now and on and off for the last 27...
For the last 10 years my Dr. switches them up every couple of years so that my brain/pain receptors can get a little bit of a chance to reset. I'm now on a Morphine/Oxycodone mix and had no withdrawal problems when I switched to it. The only time I've had withdrawal issues is when I take my pain med holidays every few years for a total brain reset.
But as you said, and as I mentioned in my post going from a Hydrocodone product to Fentanyl is just not what a good Pain Dr. or any Dr. would do....there are too many stages in between that need to be tried.
Take care,
Kat
The second thing is going from vicodin to fentanyl. The object of our pursuit is always to maximize the amount of relief we get, right? The lowest starting dosage of fentanyl patches is a joke but it's where you will begin. As for the dosage of vicodin you are on, it's childs play to me. A PM doc once told me the doage another PC had me on should have been increased by 6 pills a day, which would have had me at the max dose of Tylenol considered to be safe (although there are discrepancies on that, depending on who you ask). For instance, I have taken ten 10/325 vic's a day before in two doses. When it made no dent in my pain I requested to be switched to Oxycontin and was given it.
I think docs are pretty much aware patients are more educated nowadays because of the internet and have only had one actually yell at me for quoting what I read online. He had the god complex and informed me he had studied in med school for twelve years to learn what he was doing. Never went back to him again. I had studied in the school of being in pain constantly for 20 years (at that time). You have to take ownership of your issue and become your own advocate. Too many people walk on egg shells with docs and I see no useful purpose in that.
You've made a mention many, many times about how you and your Dr. are so very close, how your basically friends, how he tells you you never cross the line, etc. and he's been your Dr. for a long time.
My point is, realistically you've been out of the Pain Management game for quite a while. You don't even see a real Pain Management Dr. 97% of them do not like being asked for particular narcotics...especially when you've only been on Vicoden and now you want Fentanyl. About 30% of them are not chummy and friendly and caring...they can't afford to be anymore, they spend their days weeding out drug seekers and addicts, wasting their time so they can actually take care of the few real patients. Most are not very trusting of new patients for that very reason....they don't take you word on anything, they want reports, scans, images, films and any other information you can bring from a referring Dr. so they don't have to go on just your word...because it's not always easy to figure out who's really good at faking pain for drugs and who's really in pain.
Then there's the fact that GP's won't RX Fentanyl Patches. With changing laws only a PM Dr. can RX those Schedule of meds for any length of time, unless the GP/PCP has had specific Pain Management Specialty Continuing Ed. Certification each year (can't remember the # of hours), and even with that I'm not sure Fentanyl is even allowed on a Chronic Pain level.
As for going from Vicodin to Fentanyl being no big deal....do you even consider the fact that when you jump to the Strongest "use at home" narcotic without trying any of the normal steps in between...there's nowhere to go if that doesn't work. Build yourself up a nice tolerance to Fentanyl and it doesn't work....well if you've never tried anything else except Vicodin, then where are you going to go from there??? This man has a long road to hoe, playing it smart and trying to conservatively find something that works before playing every card in his hand is a lot smarter way to do it.
There's a reason that PM Dr.'s do Narcotic pain meds in certain orders and it has nothing to do with the DEA or the Feds. PM Dr.'s know that if you play the big guns too soon, then there isn't anything else they can try for your pain and your screwed, you've got no where else to go, nothing to try. There is a reason they try the lesser narcotic meds first.
Kat