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Fentanyl reduction, or pill?
  1. #1
    Certifried is offline New Member
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    Default Fentanyl reduction, or pill?

    I was on Fentanyl 50mcg/Hr for a few months for facet joint arthritis. I have very few side effects (occasional constipation is about it) and it just kills the pain completely. I also don't have any euphoria either, which I prefer so I can work without being high all the time.

    I just had a RFA (a.k.a rhizotomy) of the lumbar facet joint nerves, so my pain is greatly reduced. With that, I was considering whether to discuss with my doctor moving to the 25mcg/hr Fentanyl patch or going to an opiate. I'm leaning towards the fentanyl because I just have fewer side effects with it, and it's more effective. I'm torn, however, because of the strength of this drug. I figured I'd ask for some advice to mull over before I see my doctor. More effective, but stronger versus more side effects but a weaker drug?

    Luckily, my doctor and I have a very open dialogue. It's great because I can talk to him about concerns and be treated effectively. I just like going to see him with an informed opinion on my treatment.

  2. #2
    Certifried is offline New Member
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    I wanted to edit this, but don't see a way... odd.

    The title might be misleading. I'm wondering if I should have my fentanyl dosage reduced, or switch to a different medication (opiate, pill form).

  3. #3
    korbon is offline Member
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    I'd stay with what's been working for me and with the patches there will be less chance for you to start abusing them. If you start on pills and they aren't doing the job you may find yourself doing more than you're supposed to.

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    Certifried is offline New Member
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    Thanks for the reply. I'm not concerned about the abuse factor, it's just simply not an issue for me. I didn't want to really point that out because I know a lot of people here have that issue and I don't want to offend. Which is also why I posted in the "Drug Info" forum and not the addiction forum. I know that may sound offensive to some or evasive on my part, but it's just that simple.

  5. #5
    korbon is offline Member
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    I don't have a problem with it, I'm glad it's working for you. I only meant that it's pretty easy to take an extra pill when you're in pain.

  6. #6
    Certifried is offline New Member
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    Quote Originally Posted by korbon View Post
    I don't have a problem with it, I'm glad it's working for you. I only meant that it's pretty easy to take an extra pill when you're in pain.
    No argument there. That's one thing I like about the patch, it's much more consistent. When I get pills, they doctor usually writes them "as needed", with a maximum per day limit. I'd be lying if I said I haven't ever exceeded that, but I absolutely talk to my doctor about it. I think this is one reason it's just "simply not an issue". I was worried at one point, about 2 years after I moved from enough motrin to rot my stomach (3 duodenal ulcers) to opiates, and talked with my pain mgmt doc. He explained the difference between physical dependence, and addiction. I'm clearly dependent, but not addicted. It's something my doctor and I discuss from time to time. I think many of the issues I see people have with getting prescriptions would be solved if more took this approach (obviously).

    I stopped the fentanyl a week ago and have been taking Oxy CR instead. I just don't find them to be effective, thus why I'm considering going back to the fentanyl patch at a lower dose. I know a lot of people consider Oxy CR to be the devil, but it's just a pain reduction tool for me, not even that great of one. The fentanyl is scary, honestly. I ended up in the ER once. A hot shower caused the patch to release entirely too much med and ... scary. Fortunately, I just needed to be observed, went home in 2 hours, and saw my doc the next day.

    I guess I just needed to "vocalize" (textualize?) my concerns about the fentanyl. I'll ask my doctor to put me back on it, but the 25mcg instead of the 50 and see how it works. I was just hoping, as I always do that I could stop everything. That causes some people suggest alternative methods, been there and done that. I even saw a pain doctor who is non-opiate oriented. It didn't work for me, nothing against those who it does work for. It just doesn't work for me. Pain meds do, with very few side effects. OK, tl;dr, sorry, I communicate too much sometimes
    Last edited by Anonymous; 02-06-2012 at 05:35 PM.

  7. #7
    korbon is offline Member
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    I know a girl with a neck injury who has been on Oxycontin, then Methadone (for pain) and she said Fentanyl was the only thing that really helped her.
    Last edited by Anonymous; 02-06-2012 at 04:46 PM.

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    Certifried is offline New Member
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    Yes, absolutely the same for me. The Fentanyl isn't 100%, but I have BT pain just about only every 3 days. Why every 3 days? That's patch change day So the last 1/2 of that day and the first few hours after I put the new patch on, I'm in pain, but not a ton. I hardly even take any BT meds for it.

    I've been thinking about this all day. Actually, for a few days. I was wondering why, and why I posted. I realized why when you replied, and then replied again, Korbon. It's the pain that I have problems with, and no one to talk to about it. Even if it's only "every 3 days", it's still crushing. It used to only be L4/L5, then L3-L5, then L3-SI, now it's L2 all the way down to SI with occasional herniations thrown in for good measure (T7, T12, L1 have all herniated at some point). It's just getting worse. I'm going to try to find a pain support group of some kind. Thank you.

  9. #9
    korbon is offline Member
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    They had her on Vicodin for breakthrough pain too but it didn't seem to do much.

    I wouldn't trip on it if I were you. I don't see any stigma attached to not wanting to live in pain. It's not like you're eating or shooting up your patches or even doing them early.

    I wouldn't worry about being on a lower dose if you can't manage it either. If Vicodin would tide you over through the change of patches I wouldn't suffer because somebody else might not approve of it.

    It's quality of life thing and you're the one living it.
    Certifried likes this.

  10. #10
    Certifried is offline New Member
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    Vicodin never really did anything for me. I tried all the oxy/hydro/codone/morhpone combinations. Most made me nauseous. The only one that has been effective with minor (occasional constipation) side effects is the percocet. Even the CR has limited relief past a few hours, which is why my DR moved to fentanyl. That has been incredible, it just kills the pain and I have no negative side effects. It's just strong, which is a bit scary. (I mentioned the too hot shower issue).

    I saw my DR today, and we discussed everything. I mentioned my concerns over fentanyl, and he agreed that the 25mcg fentanyl was the best option given it's efficacy and lack of side effects for me. So that, and some 5/325 percocet for the BT pain is what I'm trying. I hope there is enough reduction in pain from the RFA so this works out. This was my 3rd RFA at the lumbar level, so historically I know it should be.

    I've had a total of about 10 RFA procedures. 3 on the left lumbar, 3 on the right. and 2 at the SI level (left and right). This procedure has been amazing for me, so if anyone has questions about it, I'm happy to answer them.

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