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Lyme pain and vicodin+extended release Tramadol. Think I need to make a change.

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Chronic Pain
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Posted 10/24/2012 11:14 PM (GMT -5)
 

Hi,

I've never posted here. I usually post over on the Lyme Forum. However, I am looking for a different view of how I might manage the pain which I live with daily to determine whether there is an alternate approach than the one I am taking now.

I suffer across just about every nerve in my body due to having Lyme for the past 7 years. I have had a steady presecription for Vicodin for the past 4 years and until about 6 month's ago was able to manage interchanging extended release (200 mg) Tramadol with perhaps 3-4 vicodins per week. Over the past 4-6 month's I have started moving up to approximately 2 - 7.5 mg Hydrocodones per day, so about 15 mgs a day. I know that is not much, but I am starting to feel the effects more acutely when it starts to wear off which has me worrying about taking more. I'm not inclined to do that, but I also need to find a way to manage my pain appropriately.

I was just wondering if anybody has any experience with any other pain medicine which might be more appropriate to try before moving up the dosage scale with Hydrocodone? I've tried many anti-inflammatories such as Mobic etc., they just don't help. Would a patch be a more reasonable approach which might maintain the minimum amount of medicine in my system to be effective instead of me deciding that I need to take another Hydrocodone? I'd like to avoid going to three a day since I am pretty sure I know it would go up from there. So I feel like I am at a point here where a change to a different medicine might be appropriate. Does anybody have any experience with the patches?

Thanks!      

Posted 10/25/2012 4:30 AM (GMT -5)
Hi Lymebean, I had a little bit of experience with the Butrans patch, only one month though, I'm on work comp, and they only covered it once, then decided it was too expensive, there's no generic for it yet. I found it to be about as effective as a round the clock Norco regiment, which sounds like what you're looking for, though it did have a few set backs.

The patches were surprisingly easy to keep on, I had been told to cover them with tagaderm, but found that the patches adhered better than the tagaderm. I just kept it covered on my upper arm with an elastic knee brace that was small enough for that purpose, snug, but not restrictive. It's downside for me was three things, 1, I got the itchies from it, but not every one will, I get the itchies from most pain meds, they're just easier to tolerate than my back pain. 2, around the 4th or 5th day on each patch, I started to get horrible muscle cramping like pain, right around the outside of my chest and shoulders, I found out that can be normal for the first few months on it. 3, they were temperature activated, and I had them around June/july, so there were a few random moments where the patch suddenly made me very sleepy for a few minutes, and the doc said that's probably because the patch got too warm.

I had the 20mcg per hour patch, which is the strongest one, and as I said, offered about the relief of Norco, but no down time from it. I don't know how much they cost, but I've heard they're not cheap. I hope you find the relief you're looking for. One suggestion I have, is there are other long acting meds, besides the patch, that you might be able to try. Ms-contin, also Oxycontin, tramadol ER, or Nucynta ER, just to name a few, I've taken Nucynta, and found it to be a great medication, but its brand new with no generic, and very expensive.

I'm sure there are other medications as well, and there are also Nerve pain meds like Lyrica, or Neurontin, that can also offer some relief. Take care, and I hope you find the relief you're looking for. Good luck, and God bless.
Posted 10/26/2012 9:12 PM (GMT -5)
Thanks for the response 2y4t.
I've heard of the duragesic patches with Fentanyl which is what my dr. has mentioned to me before. Are these the same type of patches you took? How long do you think I could benefit from the minimum dosage on those and after how long do you think I would hit the maximum dosage on the patches? I know everyone is different. I'm just looking to get an idea if whether it is a long term solution or not.
Thanks for any additional thoughts anyone has about these patches.
Posted 10/26/2012 9:47 PM (GMT -5)
Hi again lymebean, no the Butrans and duragesic are two different types of patches, the duragesic is fentynol, as you know, and is supposed to be a lot more potent than the Butrans, which is Buprenorphine, a different narcotic medication. Someone told me a few months ago that they had used both, and thought the weakest duragesic patch was at least 3Xs stronger than the strongest Butrans patch, obviously, that's their opinion, but I've heard from more than one nurse that the fentynol is probably the most powerful drug out there, in widespread use.

I honestly think, with your current meds, it wouldn't be responsible for your doctor to switch you straight over to fentynol without trying some of the other medications, it sounds like you haven't been on any stonger extended release medications, and its possible you might get great pain coverage from something as simple as 10mg oxicodone ER, which is a lot stronger than what you are on, depending on how your body absorbs it, but it's a slow release tablet that should last 8-12 hours. I think the Butrans, from what you've written about your meds, might also give you great pain coverage, but again, these, to my knowledge, are not near the strength of the fentynol.

I've had two PMs now, who both said that they reserve fentynol for cancer patients, or for patients who have tried everything else, and everything else isn't working, and that people who go on it need to already be titrated on to a certain degree of opioids, they told me it's not a last resort med, but close to it, the last resort being an interthecal pump.

I'm curious if you've been referred to a pain management specialist at all? It's something you should probably talk to your doctor about, if you haven't seen one yet. There are a lot of other medications besides these, and also, it seems to me that an addition of a nerve pain medication might be one route you need to go, since you say that most of your pain involves the nerves. Hopefully someone with more knowledge will pop in and give some input as well, I'm a novice compared to a number of the members, and they have more first hand experience with some of these meds than I do.

I hope you're able to get your pain under control, and get this resolved, take care, and God bless.
Posted 10/26/2012 11:33 PM (GMT -5)
Lymebean,

Welcome to the CP board.

Re: the patches - I've used them off/on over the years. Fetanyl is an excellent pain medication for some people. My problem is keeping the patch on... and it causes rashes on my fair skin, etc. So, I now take the oral form of fentanyl...

Anyway, they now make the patch in a 12.5mcg strength. I would definitely think that if you were going from what you are on now.... to the patch.... you would start at this lowest amount. Making the jump from what you are using now (essentially 15mg of hydrocodone) to the fentanyl patches is a pretty big jump. Has your doctor talked to you about first trying something like Percocet? Or a low dose of long-acting morphine?

But, in answer to your other fentanyl questions:

There's no way of telling how long a certain strength of a med will last - as you said, everyone is different. But, as Matt shared, Fentanyl is one of the strongest narcotics out there.... so, hopefully, the lowest possible dose would work for you.

There's really no "maximum" for the patch. Typically, though, a chronic pain patient wouldn't exceed 150mcg - and that's a pretty high dose. But I have read reports of end-of-life patients being on 300, 400mcgs and more. But the "average" dose is usually around 50 to 75mcg.

The positives to a long lasting medication - is that you always have something on board, and don't go through the "peaks and valleys" of pain. And, as stated, fentanyl is an excellent pain medication for many people.

The negatives to the fentanyl patches, in my opinion - some people have issues keeping them on... and sometimes the medication doesn't last the full 3 days (patches are typically changed every 72 hours) - which sometimes require your doc to script it to change every 48 hours...

As Matt mentioned - are you seeing a pain management doctor? Have you tried any nerve medication - like neurontin, etc? A muscle relaxer? These are important components to my own pain management - so I just mention them as food for thought.

Anyway, those are the basics of the fentanyl patch. I'm not a doctor.... just a very experienced patient :( I personally think that there are a few other "hoops" I'd jump through before I'd go on the patch.... such as trying a stronger short acting med (like Percocet or oxycodone)... or a low dose of a long-acting medication (like morphine, oxycontin, etc).

Good luck figuring all of this out.... the goal is to get proper relief - and I wish that for you, and for everyone here. Take good care! --Tina
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