First post--neuropathy/stenosis/hernation treatments
 

Hi everyone, this is my first post here, as this forum keep coming un in my quest for info about fentanyl patches and which ones are "best".

A little background--I have had neuropathy (not necessarily diabetic) in both lower legs and complete foot drop (right) since 2007. At first I searched for doctors who could help, went thru all of the medications, and ultimately gave up. Only relying on a single pain med to get me thru my days.

My life changed DRAMATICALLY, but I managed to get by. for the past two years, the pain in my legs and associated neuropathy symptoms (heat, burning, tingling, freezing, standing in a puddle constantly, etc.--all at the same time) worsened. My PC doc finally ordered another MRI on my back. So, then came the news, now I have two herniations--the L4 and L5 along with moderate/severe spinal stenosis. Also, very possible psoriatic (history of autoimmune problems) or rheumatoid arthritis.

Well, life as I know it has come to a screeching halt. it's hard just typing this. I feel dead. Except for the constant, non-stop screaming pain.

I saw a (supposed to be, "excellent") neurosurgeon and a ortho surgeon both who said my back is inoperable--after I did something I swore I never would do--BEGGED for a back operation.

So my PC was giving me (he is acting as my Pain Doc too--long story, long drives every month, etc. to get to one) just oxycodone 15mg 3x a day. Naturally, that wasn't enough!!!!!!

I was given the idea of a fentanyl patch by a friend who had used them. So I talked to my PC two months ago, and he switched me over--50mcg fentanyl patches (10 per month) with, ughhhhh, only tramadol for breakthrough.

The pharmacy only carried Apotex patches--and I didn't know the difference anyway--wow, now after a friend game me a Duragesic one--I KNOW the difference between bad, and good!!!

So my questions are two-fold... a rheumatologist said my PC should NEVER have stopped the oxy 15 3x even with the fentanyl pathes, and that I need a different generic manufacturer. so my monthly appointment is this coming Friday, and I intend to lay it on the line with my PC.

I researched area pharmacies--the only alternatives to crappy Apotex are Mallincrodt (SP??) and Mylan. By the looks of it, Mylan is the way i'm going to go--and my PC will write "brand necessary" on my script supposedly. (this doesn't mean my insurance would cover duragesic, no way).

I am also praying that he restores the oxy 3x 15mg. Praying.

Even with the Apotex only--I had a glimmer of hope as to what life can be like again. WOWWWWW!!!!!!!!!!!!! The relief I had when they weren't getting all bent up and twisted (the foil), etc. etc. was amazing--it was LIFE CHANGING. I felt human again!!!!

I'm sure many can relate--but my main question is for right now--what do YOU get for BT pain??? and is MYLAN worth fighting for in the 50mcg form????

Thank you so much, i'm hoping for much guidance and insight with this forum

Willy Be Hurtin

Welcome willy be hurtin. :Wave-Hello:

thank you Kitt. :)

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.

Opioids etc.
 

It may be a good thing, but opioids make me ill. As I have said, ambient soothes me at night and helps me shift into sleep, however it is a highly regulated drug in the U.S. The stigma here is very great, and as someone who works in addiction psychology, the culture is ironic. Kids are dying in an epidemic of opioid overdoses and heroin. Adults like me who are suffering with neuropathic paint and not prone to drug abuse have often don't get treatment unless they have a longterm and trusting relationship with an M.D.

I have had 3 or 4 years of chiropractic, PT, acupuncture, CBT, and cortisone shots. This is not what I want my life to be like, but, it is what it is for now.