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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Ame Sans Vie on October 1, 2003, at 18:39:57
I'm getting rather frustrated here... I put the patch on five hours ago and pain relief is minimal (I'm not opioid-tolerant at all, btw -- been taking 400mg/day of Ultram for months, but that's said to be equivalent to 80mg oral morphine). The PI says the peak is around 24 hours, but I'm wondering if this is really the case... and if 24 hours is the peak, about how long does the onset take? Anyone with experience on this matter?
Posted by Ame Sans Vie on October 2, 2003, at 9:33:07
In reply to Just started Duragesic-50 -- how long till effect?, posted by Ame Sans Vie on October 1, 2003, at 18:39:57
Yesterday I was just a bit frustrated, but now I'm really scared -- about 20 hours now and the patch STILL hasn't done a thing. Anybody know what's going on? When I went to the doctor yesterday I was expecting maybe some Roxicodone or Demerol, not these things, though I assumed they'd be much better anyway. I mean from what the literature says, I should be getting the approximate pain relief equivalent of 180mg oral morphine/day.
Posted by Ame Sans Vie on October 2, 2003, at 14:36:13
In reply to Please, anybody!!, posted by Ame Sans Vie on October 2, 2003, at 9:33:07
Posted by Zenclearer on October 2, 2003, at 23:32:29
In reply to 25 hours now... still nothing--why why why?! (nm), posted by Ame Sans Vie on October 2, 2003, at 14:36:13
Someone in the pharm biz mentioned to me the other day that the current transdermal patch is known to sometimes be less-than-perfect in regard to delivery.
A new patch form is due out in about 9 months, with reportedly improved delivery.
Posted by jay on October 3, 2003, at 1:37:13
In reply to Please, anybody!!, posted by Ame Sans Vie on October 2, 2003, at 9:33:07
I don't know why you wouldn't respond..just tell your doc and get oral meds. Is this for an injury?
Best,
Jay
Posted by lesliekay on October 3, 2003, at 3:39:37
In reply to Re: Please, anybody!!..Go get oral meds.. » Ame Sans Vie, posted by jay on October 3, 2003, at 1:37:13
Fentanyl transdermals are really good for pain management, your doc should have kept you on your oral meds while waiting for it to kick in. The onset is actually 12 hours to reach a serum level, however most of my patients have to wait 1-2 days for efficacy. You still need an oral med for breakthrough pain...it doesn't sound to me that your doctor really has it all together if you know what I mean. It sounds like you have a chronic severe pain issue, and for that you need a specialist. Go see a pain management specialist
Posted by Ame Sans Vie on October 3, 2003, at 9:52:49
In reply to Re: Please, anybody!!..Go get oral meds.. » Ame Sans Vie, posted by jay on October 3, 2003, at 1:37:13
::posted by jay
> I don't know why you wouldn't respond..just tell your doc and get oral meds. Is this for an injury?Thanks for responding... I called and asked about calling in a script for Talwin, Stadol or something else not Schedule II (can't take Vicodin, Percodan, Vicoprofen... allergies to OTC pain meds). Anyway, she said, "We're not a pain clinic, you're just going to have to wait for your appointment with your pain-management specialist on the 20th."
No, not an injury -- fibromyalgia, depression, and OCD. Mostly fibro though, since the Ultram I take helps a lot with the other two.
::posted by lesliekay
>Fentanyl transdermals are really good for pain management, your doc should have kept you on your oral meds while waiting for it to kick in.Actually, I haven't been on oral opioids for the pain yet (I take Ultram 400mg/day, but for depression and OCD -- absolutely useless for my pain), which is why I found it quite strange that she prescribed Duragesic-50! But she really should have given me something to hold me over.
>The onset is actually 12 hours to reach a serum level, however most of my patients have to wait 1-2 days for efficacy. You still need an oral med for breakthrough pain...it doesn't sound to me that your doctor really has it all together if you know what I mean. It sounds like you have a chronic severe pain issue, and for that you need a specialist. Go see a pain management specialist
Well, luckily I woke up today with the patch working at what seems like full force, as the pain is *completely* gone -- I woke up and immediately started to cry just because I was so relieved. Am feeling a little bit loopy... well, okay, extremely high would be a better description, lol. Absolutely wonderful.
As I mentioned above, I do have an appt. with a pain-management doc -- I've only seen him once a couple weeks ago, and he ordered some MRIs and lab work. I go back on the 20th and he refuses to give me anything until he sees that the MRIs are negative. So this doctor I saw the other day is just a family practice clinic doc -- I assumed she didn't know what she was doing, but I certainly wasn't going to complain about a prescription for fentanyl, lol.
The patch is kind of a pain though... I have to plaster it down with about 20 strips of medical tape. I think I'll opt for something oral and long acting when I see the pain doc... probably MS-Contin, methadone, or OxyContin, all of which he already mentioned to me as options.
Posted by Ame Sans Vie on October 3, 2003, at 11:52:06
In reply to Re: 25 hours now... still nothing--why why why?! » Ame Sans Vie, posted by Zenclearer on October 2, 2003, at 23:32:29
Hmmm, thanks for the info... though I'll only use it if they also improve the adhesive, lol. I'd rather not spend $30 a month on medical tape. Come the 20th, it's gonna be either methadone, MS-Contin, or OxyContin. I'll probably switch to that extended-release Dilaudid when it's available though -- fewer side effects. What's it called... HydromorphoContin, HydroContin...?
Posted by femlite on October 4, 2003, at 22:38:36
In reply to Re: 25 hours now... still nothing--why why why?! » Zenclearer, posted by Ame Sans Vie on October 3, 2003, at 11:52:06
Keep us posted, okay?
Just wanted to add my recent pain management update (fibro related)
Neurontin seems effective so far
Ive only been able to tolerate 600 mg total.(300mg am & pm) I know thats nothing, but like others, I must be sensitve. Im also on WB xl which I think is resp. for leg weakness, but when i bumped Neurontin to 900 gross motor skill suffered, too much stumbling.
I really didnt expect to have this much relief. Lower back is still flaring up a bit, but I can live with that, if I can manage the fibro flares.
Ame, I think the weather is aggravating it. I know you were really suffering this last month.
Good luck on the new pain meds. I dint have much luck with pain managment specialist. They wanted to inject my spine with cortisol, which really hypes me up. The GP was more help for me. (But that was the back issue, not the fibro)
Posted by fachad on October 7, 2003, at 21:55:18
In reply to Re: Please, anybody!!..Go get oral meds.. » jay, posted by Ame Sans Vie on October 3, 2003, at 9:52:49
Did I miss something here or did someone RX fentanyl for fibromyalgia?
Where I come from, most docs won't RX anything controlled, much less fentanyl, for fibro or anything that is not correlated with a conditon that shows up on some sort of objective diagnostic test.
I'm not saying fibro is'nt real - just that it can't be tested for and positively confirmed, i.e., an opiate seeker could feign fibro to obtain opiates.
My GP will begrudgingly give me 20 Vicodin every once in a while, and I have an MRI confirmed herniated disk.
He just says, "you need to do PT, opiates are not an appropriate long term pain management strategy at your level of injury...further, if your injury becomes more severe, (the disk ruptures), then laminectomy surgery is the fix, followed by short term opiates for post-surgical pain, but remember, opiates are not an appropriate long term pain management strategy etc...."
Posted by femlite on October 8, 2003, at 0:19:10
In reply to fentanyl for fibromyalgia?? » Ame Sans Vie, posted by fachad on October 7, 2003, at 21:55:18
I think it depends on individual patient condition.
By the time I got to my doc, I was unable to move with out tears.
I had eliminated bone injury, but I was on soma just to eliminate severe mucle cramping.
When the condition worsened he prescribed oxycodone and I was on complete bed rest for a month. Some fibro conditions are that bad. Its obviously a judgement call, because as you say there is no test.
I have since had an MRI, one torn and one herniated disc.
But they neither one are related to my extreame mucle and joint pain.
As there is no test there is also no cure for fibro. All that can be done is manage symptoms.
I know of fibro patients with such extreme and dibilitating symptoms, they have recieved goverment disability.
Every case is unique.
Im thankful to have had a doctor that was compassionate and open minded enough to treat me on the basis on my need at the time and my response.
Posted by EscherDementian on October 10, 2003, at 1:40:02
In reply to fentanyl for fibromyalgia?? » Ame Sans Vie, posted by fachad on October 7, 2003, at 21:55:18
I don't have fibromyalgia, but i've been given fentanyl in place of morphine for severe pain. Was not allowed to take any home, though. Was given Stadol for that. Fentanyl was dreamy. Stadol was a HORROR.
One month in the early 80's, half the heroin addicts in SanFrancisco OD'd because fentanyl had been stolen from the U MedCentr and was being sold as heroin.Don't know why i put that in. Random ADD thinking, i guess.
Bedtime for Bozo,
Escher
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