Hi, DVORA:

I have severe chronic pain caused by generalized internal chronic RSD since August 2001. The orthopedic surgeons would give me Vicodin again and again, even though I complained about this medication's ineffectiveness to them. An Emergency Room doctor added Valium to my Vicodin treatment. It helped for some time but, in the end, this combination also stopped working. I asked one primary care doctor to prescribe something stronger than Vicodin, that is, Oxycontin. He accepted. Later, when I had to change doctors, another primary care physician switched me to two kinds of patches, which I think work extremely well for me.

The first kind of patches was the fentanyl patches, used at a dosage of 125 mcg (one 100 mcg patch and one 25 mcg patch every 72 hours). However, for effectiveness reason and to avoid side effects like very strong nausea and vomiting (so strong I would throw up blood), I only accept brand name fentanyl patches (Duragesic). I noticed that, for me, the generic fentanyl patches are not as effective as and cause more side effects (see above) than brand name fentanyl patches. When I go back to the brand name fentanyl patches, the effectiveness comes back and the side effects go away. Of course, everyone is different. What happened to me with the side effects might not happen to other people (even though I have indeed seen many people in other forums, American and foreign, complain about the same things as me). Only you and your doctor can make the decision on which fentanyl patches to use.

The second kind of patches was the lidocaine patches (Lidoderm 5%). These patches are very effective for electrical discharge type of pain, but I have to cover them with very large tape (the kind usually used by surgeons) so they would not come off when I sky dive, water ski, rock climb, or simply walk... I found something more convenient that has the same good effects as the lidocaine patches. It was the Tambocor (flecainide) sustained release capsules. They are considered by some pain management doctors to be an oral anesthetic. Tambocor is normally a heart medication, but it is used off-label as an oral anesthetic. I checked this in some doctors' chronic pain encyclopedias.

There are also Icy Hot patches, which I do not need to use because my other painkillers work well and I am very satisfied with them.

Talk to your doctor. If you do not have a pain management doctor, find a good one, capable of understanding your needs and help you instead of fearing the insurance companies (fentanyl patches are very expensive), the AMA, the State Medical Board, and the DEA. I fought for one year to get my fentanyl patches. I have been using them since September 2002, so they feel like friends to me, because they are sooo, sooo helpful to me. Thanks to these fentanyl patches, I can do my favorite activities, sky diving and horseback riding.