Originally Posted by Neurochic

Hana
I don't know the details of your medication other than what is in your post above. I wanted to just throw in a thought or two on the fentanyl and bowle management for what its worth.

You are on a fairly low dose of fentanyl. It is a medication that has no upper dose limit. I'm obviously not advocating endless dose increases but if you don't feel that it is doing much in terms of pain relief then you should be speaking to your doctor about increasing the dose to an effective therapeutic level. For CRPS pain, it would be quite normal to be on a dose of double your current dose, or more. At least try the drug at a more potentially therapeutic level before you write it off as insufficiently effective.

It would be very odd to be changing the fentanyl patch every day - I am assuming that what you say "alternating every day"? Have I misunderstood you? The patches are designed to release the drug at a constant rate over 36 hours. They can be prescribed on a 48 hour change cycle but if it is being changed ever 24 then something isn't right and, again, the dose needs to be reviewed.

You may find that a change of patch type would be more effective for you. Fentanyl patches use 2 different drug delivery approaches - reservoir or lattice. The reservoir patch has a pool of liquid drug and the lattice patch looks just like a piece of sticky scotch tape or Sellotape with no liquid. The two types are not interchangeable so whichever type you are prescribed, is the type you need to keep being prescribed. However, you could have a "one off" physician managed swap to the other type to see if it works better for you. If I have misunderstood what you mean about alternating, then sorry.

Fentanyl is potentiated by concurrently taking paracetamol (acetaminophen in the USA). In other words its painkilling effect is made greater and it is more effective if it is taken with acetaminophen. Unfortunately, a lot of doctors, especially those who aren't pain management specialists, aren't sufficiently aware of this so patients don't always get the best advice. Of course, not everyone can take acetaminophen but in order to maximise the effect of your fentanyl a good doctor would prescribe the maximum daily acetaminophen dose of 4 grams per day. Of itself, acetaminophen is unlikely to give you any noticeable pain relief from the extreme pain of CRPS but that's not the point of taking it in these circumstances.

Opioid induced constipation is a side effect that your body will not get used to in time. Everyone has to decide what is right for them but my personal view is that if the opioids are helping, then even severe constipation is a price worth paying. I will not get CRPS remission so I know that I will have to take opioids for the rest of my life to manage my pain. That's just how it is and it means I need to take powerful laxatives - the gentle types are a waste of time so there is no point. I assume Bisacodyl is available in the US? It is a more powerful laxative and its effect can be increased by increasing the dose and/or using Bisacodyl suppositories. None of it is pleasant but its a matter of finding and ensuring you regularly and continuously use a sufficient quantity of strong enough laxatives. Trying to just use them intermittently or use low doses might seem better for your body but it actually creates more problems.

There is another option if you can't get an acceptable routine with diet, hydration, laxatives and softners and that is an irrigation system like Coloplast's Peristeen system. It is very effective for chronic constipation. Its clean and simple once you get the hang of using a bowel irrigation system. It is NOT the same as colonic irrigation - that is completely different from these medical bowel management systems. They have to be prescribed by a physician after a proper medical assessment. Again, CRPS is for the long haul so the bowel management routines are for the long haul too, a mindset that its something that will go away will only lead to frustration and misery.

Just my thoughts for what they are worth.