Quote:
Originally Posted by kittycapucine1974
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.
|
hello there...
I am also on a fentanyl patch for rsd along with other pain problems that existed prior to the onset of the rsd. in the 11 years since I have been on the patch I have gone from using 150 mcgs to 400 mcgs. currently I am on a 72 hour change which I prefer. my previous dose to the current one was 350 mcgs every 48 hours. the doctor upped the dosage, so I could return to a 72 hour dosage as 48 hours comes too frequently for me. it is possible that the medicine is delivering at a faster rate than 72 hours due to various factors such as heat, humidity, sweating, exposure to hot water, etc. I guess it is different here in the U.S. wrt doctors changing dosages as we have private healthcare. I would recommend you either go up 25 mcgs on your patch or change your current dosage to every 48 hours, if possible. is there another doctor you can go to who has expertise in pain management and would be willing to work with you not at you?
I have never taken a medication holiday as the previous poster mentioned. with rsd, I could not imagine what that would do. furthermore, with rsd, in particular, the current theory of resetting the brain's tolerance is to use ketamine by coma or inpatient or outpatient infusion without coma. This is the ultimate treatment for rsd. I have not done it as I feel I am doing well enough with the fentanyl patch and the fentora (fentanyl) breakthrough pain meds as ketamine treatments are complex, involved, expensive, and not always well tolerated during and immediately after. You are not nearly as highly dosed as myself, and it sounds as though you have fairly good pain control notwithstanding the issues you present here. it does not seem like ketamine is the best choice for you right now. if things get drastically out of control from where you are now, perhaps you should think about ketamine in the future.
as for your question about the MSIR helping the withdrawal symptoms from the patch, yes, the MSIR should abate the symptoms; however, you may need to take more than your prescribed dosage for it to do so. you may want to ask your doctor for clonidine which can help the withdrawal symptoms. it is a heart medicine, but it helps with withdrawal symptoms quite well. I do not think the clonid one is the answer as ultimately, you are experiencing withdrawal due to your patch running out on you which occurs every few days. it is a band aid solutIon. ultimately, I think you will find you will feel best and experience less pain if you up the patch either in dosage or by changing it every other day or 48 hours...it works out to be the same either way.
as I mentioned, if you cannot discuss the issues with your doctor and get the results you need, you may have to see a specialist about it. many people change their patch one day earlier than the 72 hours with excellent results. I certainly have throughout the years. it is only nature rail that you develop a tolerance. the other thing I mentioned was to test the patch to see if it is not releasing too much medicine too quickly due to the factors I mentioned above. if you use a heating pad near the patch, that will do it. if you live in a warm environment that can do it. same is true with hot baths or hot tubs (whirlpools). perhaps yOu can try another fentanyl patch than the brand you are using. I do best using mylan generic brand which does not have gel in the patch. the medicine is in the adhesive. they work far superior to the other gel dispensed types that are the usual method of delivery. make sure you are applying the patches correctly according to the manufacturer's instructions. I had problems once due to that. frankly, fentanyl is known not to give any mental high to the patient unlike the MSIR. it does not seem like you are asking for much by needing the extra 25mcgs or one less day on the current dose. it is not to get high. if you wanted to increase the MSIR, I could see where a doctor would be more concerned from an addiction point of view. so, go talk with your doctor armed with the knowledge you gain here from other's experiences. I wish you the best of luck in getting a result that benefits you. take care and be well.
Sloane