Hi, Sloane:

I do not know how you were able to convince your doctor (pain management doctor, primary care doctor...) to prescribe for you a dosage of 400 mcg of fentanyl patches. On the one hand, I would like to stay on my 125 mcg fentanyl patches dosage to prevent the return of the nausea and vomiting caused by my fentanyl patches, nausea and vomiting which no medications could control. On the other hand, I would like to increase my fentanyl patches dosage to 150 mcg to control my increased pain and prevent my withdrawal symptoms, but I am afraid the doctor will refuse this increase and I fear the return of the nausea and vomiting caused by a higher dosage of fentanyl patches.

Quote: "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 do think my fentanyl could really be delivered to my body at a faster rate than 72 hours because, where I live, it is very hot and humid, so I sweat almost daily, even late at night.

Quote: "I would recommend you either go up 25 mcgs on your patch or change your current dosage to every 48 hours, if possible."

I will try to convince my present primary care doctor or try to find a new one. There is only one pain management doctor in French Polynesia and he is no good. According to him:
1) my pain is in my mind even though I have proof I have RSD and
2) he believes only cancer patients have pain strong enough to deserve the use of fentanyl patches.

Even though it happened (rarely) to me to forget changing my fentanyl patches, I have never yet taken a "drug vacation". Like you, I do not know what a fentanyl holiday would do to my RSD, epilepsy, and asthma. Maybe some of my doctors or other people and doctors from the Internet would have the response.

Quote: "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."

My public health insurance does not pay for it. It is my dream to try the inpatient RSD ketamine coma procedure, if only I had the at least U.S. $ 50,000 it takes, plus the costs linked to the complications this treatment might cause. I must admit I envy the rich people who can afford this treatment. I am not one of them, but the woman who injured me and caused my RSD and epilepsy is; she even owns a store and two houses. Unfortunately, my lawyer, very likely a "scheister lawyer", lost my case. Who knows!?!? Maybe the woman's insurance company "bought" him. I do not think this impossible.

What is Fentora? Is it the fentanyl lollypops? I never heard of Fentora.

Quote: "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."

I will try this technique the next time fentanyl withdrawal happens to me. It cannot hurt; it can only help.

The other medications I take for pain are Tambocor extended release 200 mg (one capsule per day) and Inderal immediate release 40 mg (one tablet twice daily). I do not know if Tambocor and Inderal are similar to clonidine.

Quote: "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."

I will try to convince a doctor about this, but with doctors being afraid of insurance companies' doctors, it will be quite hard.

Quote: "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."

How to do these tests? As mentioned earlier in this post, where I live, it is very hot and humid, so I sweat almost daily, even late at night. I do not see a way to prevent this because the electricity in French Polynesia is the most expensive in the world. If the electricity was cheaper, I could have air conditioning.

Quote: "I do best using mylan generic brand which does not have gel in the patch. The medicine is in the adhesive."

I seem to be different. Fentanyl patches containing a reservoir of gel seem to stick better to my skin than non-reservoir types of fentanyl patches.

Quote: "Make sure you are applying the patches correctly according to the manufacturer's instructions."

I use tape (not waterproof tape, which cannot be found where I live) all around the edges of my fentanyl patches. Sometimes the tape sticks; sometimes it does not.

Quote: "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 25 mcgs 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."

I totally agree with you. I never got high with my fentanyl patches whereas I sometimes (rarely) get high with my MSIR capsules.

Thank you for sharing all your information and ideas.