Durogesic DTrans patches!

[stratts]

Hi,

My pain levels have been really bad lately, with some really bad episodes of severe pain.

My GP has given me some Durogesic DTrans patches. The type which look like a piece of sticky tape.

I am only on 12mcg/hr at the moment. I started using them last night and had a few funny side effects. I woke up in the night with a little bit of breathing problems. I felt like somebody was pushing on my chest a little! I got up and got some fresh air and had a drink and settled myself down.

This has seemed to settle down now and i just seem to have a bit of a headache and feel a little spaced out. I think or hope this was just the reaction of my body to them.

My GP was putting me on 25mcg/hr, but when i went to pharmacy to collect them the pharmacist seemed very concerned and asked me if i had used them before. I hadn't so he contacted my GP and advised that i start on 12mcg!! My doctor agreed!! I could not believe it!!

After my reaction to the 12mcg i am glad i didn't jump straight on the 25mcg!!

I have done a little research on these patches and frightened myself to death!! I don't like taking meds at the best of times, but after reading about these patches and their potential danger, i now understand why the pharmacist was concerned.

Another concern is that you have to keep the patches away from heat sources such as hot water bottles and even the sun, because this can alter the amount of drug released into your body. I am a little worried because i do try to exercise occasionally and of course sweat? Do you think this is a problem?

They have seemed to ease the pain slightly.

Does any body on here use these patches. My concern is the long term effects this drug has on your body? I presume it will cause some problems with your kidneys and liver long term? Maybe i am just been paranoid but i am always sceptical with tablets, medication and chemicals and have always tried to stay away from them.

Does anybody know anything about these patches?

[mesquite]

I will ask Dr. Hibner about this patch when I see him next week. I use the Flector patch which has NSAID within in and put a large square/rectangle directly on the square at night. It lasts for 12 hours. It gives me some relief. Just started reusing the B & O suppositories, also. Good luck to you

[JeanieC]

I tried fentanyl patches for a few weeks, and I felt just exactly like you do, Stratts. I was scared that the patch would release too much narcotic if I got hot from exercise or just from being outside in summer. Also I could not soak in a warm bath which is one of my chief comfort measures. I don't remember what dose I was on, but it did nothing for my pain and the pain doctor's plan dose was to gradually increase the dosage. The patch just was too life restricting in my case and I went back to taking oxycodone for pain, which is only a little help, but I do feel more in control of how much narcotic gets in to my system.

[Violet M]

Stratt, here's the link to one of my favorite drug sites:

http://www.rxlist.com/duragesic-drug.htm

The warning is that this drug should not be used on a patient who is not already on a comparable dose of opioid and that it may cause hypoventilation. So, yes, I think you have reason for concern here. Also, it says that increasing your core temperature with exertion can be dangerous.

As far as liver and kidney damage, I don't see any warnings about that but I didn't read the entire webpage closely. From what I have read, opioids have been around for a long time and are considered safe with not too many long-term side effects on the liver and kidneys when used as prescribed. There is actually more concern with tylenol and liver damage.

In order to avoid developing a tolerance and an addiction to opioids, I used oxycodone (not the time-released form called oxycontin) and I only took them in the evening, and when the pain was unbearable. (Although I think I may have toughed it out a little more than I should have). Mostly opioids took the edge of the pain but didn't take it away completely.

[stratts]

Hi,

I can,t believe it!! I actually woke up on the first night with breathing difficulties!! It could have been serious. Luckily the pharmacist refused to give me the 25mgc saying it could be dangerous. He then contacted my doctor to reduce the dose to 12mgc. My GP then agreed with him, so why didn't he prescribe me with 12mgc in the first place?

I have no tolerance to Opiods at all, therefore, surely my GP should not have prescribed me the higher dose. I honestly believe if i had jumped straight on 25mgc it could have been fatal. I woke up at 3am with breathing difficulties, like somebody was sitting on my chest and slow breathing!!

I am so angry with my GP! Thank god the Pharmacist stepped in and stopped me getting the higher dose.

I am very nervous about these patches now after what i have read!!

[stratts]

Do you think i will be better on Oxycodone.

Are these in tablet form?

I hate taking tablet meds. My father had heart disease and was taking lots of tablets every day. The tablets eventually caused his kidneys to fail. He collapsed and died last Monday morning.

This is why i am nervous about tablets.

Is Oxcodone safe?

I just do not trust doctors today. They only seem interested in pumping you full of meds. I think it is a cop out. If tablets don't help they don't know what to do?

I hate this!! It takes the emphasis off trying to get rid of the cause of the pain.

[janetm2]

Stratts,
Sincerely sorry to hear about your Dad and my thoughts go out to you and your family. Not sure how to answer if oxycodone is safe especially given what you dad experienced. I can just provide my experience but havee no idea what lies ahead. I have been taking oxycodone for some twenty years mostly only a few pills a week for my chronic ffoot pain. I fought for these so I could continue to work as the flare ups would keep me out of work for days and if I took a pill it could lower the pain enough to allow me to work. Like Violet I took it at night because it was giving me some very minor instability/dizziness and laying down at night I could not feel that. Since then I have taken more regular oxy right after my PNE surgery and before PT but are starting to return to my couple pills a week. I have a pain specialist monitoring my intale and so far I am not above a pain management level. My hairdresser takes more regular oxy all day long because she has gone past a point of the lower amounts working for her and again she probably wants less pain and still have a quality of life. So far she has not mentioned other problems but we both are probably not you dad's age and so not sure how the long term affects will be. Another tablet but non-narcotic that helps me with PN pain is tramadol. I hope you can find something because I think lowering the pain is essential wgile you get to the root of the problem and treatment. Best to you.
Janet

[Violet M]

Stratts, I'm sorry about your dad. You must be going through a lot of stress right now.

Here is one study on the safety of opioids that you might find interesting:

http://www.ncbi.nlm.nih.gov/pubmed/20808965

Pain Res Manag. 2010 Jul-Aug;15(4):213-7.
The long-term safety and efficacy of opioids: a survey of 84 selected patients with intractable chronic noncancer pain.
Watson CP, Watt-Watson J, Chipman M.
Source

Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. peter.watson@utoronto.ca
Abstract
BACKGROUND:

The use of opioids for chronic noncancer pain (CNCP) remains controversial. Despite a number of randomized controlled trials showing efficacy and safety in the short term, long-term data are limited.
OBJECTIVE:

To survey a selected cohort of patients with intractable CNCP with regard to long-term efficacy and safety of opioids.
METHODS:

The present study reports long-term results from a survey of 84 patients with CNCP. The majority of patients had neuropathic pain, were treated with opioids and were followed every three months for a median of 8.4 years. Outcomes examined were pain severity, adverse effects, pain relief, satisfaction, mood, problematic opioid use, tolerance, physical dependency, functional status, health-related quality of life, immune status, sexual function, morbidity and mortality. Measures included a numerical rating scale, the Hospital Anxiety and Depression Scale, Brief Pain Inventory interference scale, Pain Disability Index and Short-Form Health Survey 12, version 2.
RESULTS AND CONCLUSIONS:

Both long- and short-acting opioids were reported to be effective, with few significant long-term adverse effects in many subjects in the present selected cohort. The majority of patients reported at least 50% or greater pain relief and a moderate improvement in disability. Functional status and health-related quality of life scores were not severely affected. Problematic opioid use, tolerance and serious adverse effects, including constipation, were not major issues. The authors emphasize that the results obtained in the present selected group may not be generalizable to all CNCP patients in whom opioids are being initiated.

Oxycodone is not considered as strong as fentanyl but you could start out with a very low dose and see how you do with it. Or you could start out with something like hydrocodone, an even weaker opioid, or tramadol, a synthetic opioid. I would not look at opioids as a long-term solution to your problem unless all the other non-opioid therapies have failed and that's all you have left. Opioids are helpful in getting you through the PN journey while you are searching for a more long-term solution and they can help prevent your nervous system from becoming hypersensitive.

Studies have shown that chronic pain can lead to permanent changes in the brain and spinal cord so it's important to keep your pain under control if you can. Here is a link to a report on one of those studies but there are more if you google them.

http://news.bbc.co.uk/2/hi/health/4031825.stm
http://tinyurl.com/m3pxu6

So, I'm sure no one knows which is harder on your body -- the chronic pain or the drugs, but it's important to keep in mind that chronic pain could be just as bad if not worse than the drugs.

[deBBieW]

thanks Violet for all of this helpful information..

Stratts, I'm so sorry to hear of your father's passing. It's very difficult to loose a parent.
I do take hydrocodone when I can't stand the centralization burning, that bothers me more than the PN pain. I must say my script says I can take two, but i take one, and it usually takes the edge off.
When I take two, I usually get nausea, and very light headed. (5mg/500mg each)

I must remember to drink a full glass of water, and eat something too. Everyone is so different in tolerance. I find the hydrocodone only takes the edge off, (with one pill), but that's enough for me to forget about it, at least right now.
I'm always trying not to take them, but I see that I should probably just take it, and not fight it. I already have CS burning in both legs, so I'm probably not doing myself a favor by not taking it - at least from a nervous system point of view.
Tramadol did not work for me.

I am back from my visit from Hibner, so I will be posting soon under updates. He is such a nice doctor!!!

Debbie