Hi, everybody:

I use Duragesic (fentanyl patches) 125 mcg (one 100 mcg patch and one 25 mcg patch every 72 hours) for intense chronic pain caused by generalized internal chronic RSD and I take MSIR (morphine sulfate immediate release capsules) 30 mg (one capsule once or twice daily as needed) for breakthrough pain.

I have been using Duragesic, starting first with the 25 mcg dosage and then going all the way up to the 125 mcg dosage, since September 2002. I have been taking MSIR since May 2007.

I would like to know when physical tolerance (not dependence) will occur, because I guess it is only a matter of time before it happens, unless there are cases when it never happened.

Are there medications to help reverse this tolerance? What about other techniques?

For example, my fentanyl patches (dosage of 125 mcg every 72 hours since August 2010) are supposed to last 72 hours, but they seem to last only about 48 hours. Between hour 48 and hour 72, I sometimes have withdrawal symptoms but I always have my pain come back. My primary care doctor, who is the only one willing to prescribe strong opiates for me, will not prescribe fentanyl patches in a higher dosage for me (even though it is advised by Janssen Pharmaceutica in their doctor's medication notice, before switching to a change every 48 hours.) Anyway, knowing my doctor so well (he has been my doctor for about six years), I know for sure he will refuse a change of my fentanyl patches every 48 hours. Maybe he just does not like or want to do it; maybe it is not legal in France and in its overseas territories to change fentanyl patches other than every 72 hours; maybe he is afraid of the public health insurance company harassing him because me changing the fentanyl patches every 48 hours would cost them more than me changing the fentanyl patches every 72 hours (because they would have to pay for 15 patches of 100 and 25 mcg instead of 10 patches of each). They already harass me and my doctor now, so what would it be if the fentanyl patches were changed every 48 hours instead of every 72 hours, like now.

By the way, do you know if a MSIR capsule can stop fentanyl patches withdrawal besides stopping pain?

Thanks a lot for all the information you could give me.