It is possible to be prescribed fentanyl in a fast acting form for breakthrough pain. Tramadol is not considered to be a particularly ideal drug to prescribe with fentanyl because it has a more complicated method of acting in the body than many other opioids and this can give rise to more complications and adverse interactions. It is best to try and use a simpler opiod for breakthrough pain if you aren't able to just sit out the flare up periods.

Fentanyl patches come in 2 forms - reservoir and matrix. These are very different methods of delivering the drug through the skin and you can't switch from one type to another. I'm assuming you are using the matrix patches so it's a matter of trying to get the most effective brand that you can and sticking with it. The issues you have had with different brands not being so effective, may come down to needing a slightly stronger patch of the one you don't think irks so well. If you have problems with the patches not sticking to your skin, ask to be prescribed something like Tegaderm or opsite film dressings to stick over the top. These are excellent at keeping the patches stuck on very securely even with repeated wetting from washing or swimming.

It is better to be taking the least complicated cocktail of pain medication possible. For neuropathic pain, anti-depressants and anti-seizure drugs are often far more effective than opioids or they are prescribed along with an opioid for pain management purposes. It is pretty old fashioned to prescribe only an opiod for neuropathic pain. There are many anti-depressants of varying types which are effective for neuropathic pain so it is a matter of starting with one and then working your way through the options to see which ones and which doses work best for you. There are fewer anti-seizure medications but the main ones, neurontin and pregabalin are the normal place to start.

If you are taking an opioid, it is advisable to take a daily dose of acetaminophen at the same time. Although you probably won't notice any direct pain relief from it, it makes the opioids more potent in your system thereby making them more effective. Provided you have no other underlying health conditions which prohibit it and you are careful not to exceed the maximum dose, it is actually very safe. There is a lot of rubbish and swarming wring written about acetaminophen but it has a valuable and safe role as a potentiator.