Fentanyl

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Pain-n-TnLady
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Hey everyone. It's been a while and I apologize.  I did find a new pain management doctor and I like him a lot. We did a lot of digital xrays and had a long discussion about what he can do to help me with my pain other than just handing out pills.

As most of you know, I struggled with heel spurs for years from installing floors with my feet bent back behind me and then working on bare concrete for 7 yrs.  My primary care doctor sent me to a podiatrist. If only I had known. Long story short, the podiatrist cut my plantar fascia. His reasoning was that my pain was coming from the spurs rubbing against ths tendon and that if you simply remove the spurs they usually grow back. 

Unbeknownst to me, once the Plantar Fascia was cut, my feet had no support tendon-wise whatsover. After 7 years my feet are not only completely flat but my toes don't even touch the floor when  I step. My feet almost seem to be trying to curl upward. The ensuing arthritis is a sight to behold on xray. The doc says my feet look as if  I'm in my 70's after having flat feet my entire life. The pain is indescibable at times.

With nothing to be done surgically and my other pain management doc simply writing my scripts. I'm hopeful in that this new doc is trying some new things. I had a cortisone injection in my left foot and will be doing the rt one in 2 weeks. It seemed to help somewhat. If I don't get enough significant pain relief with just the cortisone, we're going to try a nerve block. Any experiences anyone?

My biggest question today is that I'm still not on a long acting med.. Most of you know that I'm allergic to Morphine and Sulfa and my old insurance simply would not cover any ER med. My allergies limit my options when it comes to an ER med. My new doc wants to try Fentanyl and I know a lot of you folks have tried it or are still using it.

I'm wondering about a good starting dose. I could not find the conversion chart that I KNOW is here on Pharmer. Six months ago I was taking 150mg Oxy IR one day and 180mg Oxy IR the next day. With some truly inhumane dose cuts and now a new doctor, I'm getting by on 4-20 mg Oxy IR per day. I feel like I would be pretty comfortable at about 120mg OxyIR a day or the equivalet in Oxycodone and Fentanyl.

I will definitely let the dr be the dr when it comes to my new RX. I'm just curious as to what my fellow Pharmers think would be a good starting point with the Fentanyl.

Thanks in advance everybody. Linda

 

quincy
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Fentanyl vs Oxycodone

Hiya Linda,

things have been kind of slow here on the pharm lately, its great to hear from you! I have extensive experience with Oxy, Fentanyl, and Fentora . . . the IR version of Fentanyl. I was on 100-125 mcg of Fen. with 120-240 mg of Oxy for BTP for 4 or so years. This heavy (to me) dose is for relief from heavy duty OA which is aggravated by my cancer treatment. My feet and hands are the worst, sometimes walking is impossible. The Fen. really helped me but I had problems driving on it . . . I eventually quit driving completely. Most people don't have this prob but its something to watch out for.

From the oxy dose level you are at, 120-180 mg p/d, the chart would place you at 75-100 mcg p/d for equivalence. You might find that you will need something for BTP like 4 10 mcg percocets  prn. A lot of folks have complained here that their Fen. wears off at 48-60 hrs., leaving them in pain and sometimes the beginnings of WDs. while I've never been troubled that way I did seem to need an extra perc  towards the end of the 3 day cycle. Hope this info helps you . . . Q

Pain-n-TnLady
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Thanks for replying Quincy.

It's good to hear from you also. Things have been slow here on Pharmer. Everytime I check in, I don't see many new posts or any at all so I kind of got out of the habit of checking in. I'll check in more often and hopefully things will get going again. I hate to see so many long-timers having a hard time getting their meds. Hang in there Goat. I know when your meds are screwed up, nothing else matters. Especially if withdrawal has time to set in. Things seem to just keep getting harder and harder for us pain patients. As if living in chronic pain wasn't enough, we have to deal with the pharmacies and all the other folfs who have no clue what its like to live in our shoes for just a few hours much less every day. My thoughts are with you guys,

portlandia
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All Fentnyl is pretty

All Fentnyl is pretty expensive compared to oxycodone IR's. If you are taking 120mg of oxy IR I would imagine you would be comfortable on 60mcg fentnyl that is with the patches wich are 3 -day patches with the actiq or fentnyl lollipops the dosing would be a bit lower. I might think about dilauded 8mg tabs those are cheap and a 8mg tab is pretty much like taking 20mg oxy IR.I think if you switch your oxys IR's out you still will not be happy with the new medication right away. I would try to stay on the oxy Ir as long as you can,or taper down before you switch drugs. 

fentnyl and dilauded are more in the moriphine park-IMO as far as pain relief  and euphoria goes.I know euphoria is not what most people are looking to get out of their medication but your brain gets addicted to those kind of meds. Fentnyl lollipops would be your best bet but expensive and hard to get prescribed at least here but probably the best type of fentnyl as far as a fentnyl IR version goes.The lollypops def work better then the patches-IMO. As far as charts goes fentnyl is 100 times stronger then moriphine mg to mg, about twice as strong as oxy mg to mg but real world use charts don't always mean much.

quincy
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Oxy vs Fent

hey port, the equivalence chart that comes with Fentanyl shows that 180 MG of Oxy is equivalent to 100 MCG of Fent., not  90 MG of Oxy. A microgram, mcg, is one millionth of a gram while a milligram,mg,is only one thousandth of a gram. Math can really trip you up, it does me!

Herrball
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Once a Mathmatician?

Always a Mathmatician.  Did I even spell that right?

quincy
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Well let's see . . .

Mathematician seems to be the correct spelling old buddy . . . Q

portlandia
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Yeah I didn't won't to

Yeah I didn't won't to overstate how weak I think fentnyl is because I don;t want anybody taking more fentnyl and having a bad reaction but as far as real world experience and not charts I have 100mg oxy pretty much the same effectiveness as a 100mcg of fentnyl. I know fentnyl is measured in MCG but when I was on the 100mg fentnyl patches they did not work as good as taking 100mg of oxycocodone IR , but if I come on here and say if your taking 120mg of oxy IR a day it would probably be fine to take 100mcg-120mcg daily of fentnyl that might be bad advice to somebody who has no experiene to fentnyl use. 

I just really prefer the OXY IR's. I have no idea why doctors are making a big deal about prescribing Oxy IR especially if the patient is cash pay. Oxy IR are so effective and cheap. The climate up here is not good when it comes to getting prescribed Oxy IR 30mg tabs anymore. I only get them because that is what I have using since My insurance claim got settled and I couldn't get my oxycontin paid for in full anymore so I had to switch to the Oxy 30mg IR. I was on 240mg-270mg at one point and in the last 2 years have been tapered done to 180 tabs a month. 

I was kind of upset on the fentnyl patches. I was getting the 100mcg patches but like i said even though it is considered to be so potent in real life experience it was not as good as Oxy Ir's 1oxy mg to 1fentnyl mcg, but some people react diffrent so I would tell anybody new to fentnyl to take it easy at first. For some reason some people have more respitory problems on fentnyl. 

quincy
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I hear ya . . .

I switched to Oxy #240 p/d along with Fentora #150p/d.That cuts my pain down to a 2 level . . . sweet!

t-bone
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Well you won't get the

Well you won't get the euphoric feeling that you probably experienced with Oxycodone IR with the patch, but I love Fentanyl as it kills the pain for an extended time. I use a 75 mcg/hr patch every 48 hours. As some others noted that 3rd day can be tough for some folks, including me, but me dr had no problem upping the script to 15 patches per month. Again, don't expect some euphoric feeling with the patch, but it's highly effective in pain management IMO, and that's why we're on this forum (at least most of us).