Problem with Longterm Use of Duragesic 100

[Shel53]

I've been on the Duragesic 100 for almost 18 years.  I've had 3 cervical fusions & 1 lumbar laminectomy.  The Duragesic 100 has controlled my constant, chronic pain & while I've never been pain free, the Duragesic certainty helped.  However in the last 2 months, its as if the patches are no longer working.  I've always had additional breakthrough meds, but now its as if I'm going through withdrawals.   I've tried changing to different boxes of Duragesic but that hasn't helped.  I was wondering if anyone else has recently had problems with their Duragesic 100?  Also has anyone been taking this same medicine as long as I have & if so, how well have they worked longterm for you?  I am afraid I have no further options. I'd appreciate any imput.

[femmy29]

Hi Shel and welcome to the pain management community.

You most certaintly have options.  While you are on the strongest medication there is on the market today, there are larger doses of fentanyl that can be taken.  

I am on the 50 mcg/hr patch and inside the prescription leaflet it shows morphine conversions to up to 300 mcg/hr of fentanyl, which is equal to three 100 mcg/hr patches.

Because you are on 100 mcg/hr of fentanyl, keep in mind that the other "newer" medications that weathergirl mentioned looking into, will require a large dose to equal the amount of fentanyl you are getting through your current dose.  Of course, there is cross tolerance but once you get that far up in strength via fentanyl, you are still more than likely going to require larger doses than normal of morphine, oxymorphone, oxycontin, etc.

There is also an option to ADD another long acting medication in with the fentanyl.  This has been done for other members here that have an extremely high opioid tolerance.  

So I would just discuss with your doctor the fact that the fentanyl is no longer working.  I have heard that fentanyl tends to work a lot longer than longer acting opioids in pill form before effectiveness begins to wane.  

The options that your doctor will most likely present to you are, an increase in fentanyl (which will require wearing a couple of patches versus just one), an increase or change in breakthrough pain medication and/or an addition of a long acting medication in pill form.  

Please let us know how things go at the doctors.

femmy

[Weathergirl21]

Wow...I am amazed that you have been able to stay on the same medication for 18 years...That is almost unheard of....

So it is not unusual at all for you to become tolerant and need to either go up in dosage or change your extended release medication...

Why do you say you have no further options? If you have been on this for 18 years, then it means you have not tried other medications that have come on the market in all those years...

So there are many other combinations that you can try if your Dr. does not want to increase the Fentanyl amount.

When is your next appt. with your Dr. to discuss this?