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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 shelliR on April 5, 2002, at 20:23:19
Have just started with a fentanyl patch. I was doing well on buprenorphine but last package seems to be confiscated (at customs for ten days now), and supply is out at the overseas companies that generally sell it.
The one thing that I hated about bupe was that I woke up with depression and pain. The pain is inflation in my chest. Anyway, so far it's 24 hours-25mg fentanyl hasn't hit (if it will). Am getting a little scared that it won't work. Raised to fifty this morning and still not a lot of benefit but I am trying to remain hopeful.
Question: did you find the patch helpful for depression? My pain is real but I can't completely separate it from depression. Buprenorphine made both the pain and depression subside.
You talked about postpartum depression. Are you back on opiates? If so, are they not working this time or did you decide to go it without them for a while?
Shelli
A hug to the new baby girl. Do you find she helps ground you?
Posted by jay on April 5, 2002, at 21:31:53
In reply to Use of the Fentanyl Patch: Judy, Anyone, posted by shelliR on April 5, 2002, at 20:23:19
Shelli:There are some studies that show many of the antidepressants that affect norepinephrine help work with the pain meds. Besides some of the old tricyclics, there is also Effexor at higher doses.
I have also heard of Tegretol (and I imagine it's new cousin, Trileptal(sp??) helps with pain.
I've been trying to explore this area for a long time, because codiene is an excellent a.d. for me, and is available OTC here in Canada. I've also been on a few other pain meds since I had a nasty motorbike accident a few years ago, and I didn't go on fentanyl, but was on a few other opiates. That's how I discovered I could use codiene for "breakthrough" depression.
Not much new info, just some of my personal experience I hope can help.
Best wishes..
Jay
> Have just started with a fentanyl patch. I was doing well on buprenorphine but last package seems to be confiscated (at customs for ten days now), and supply is out at the overseas companies that generally sell it.
>
> The one thing that I hated about bupe was that I woke up with depression and pain. The pain is inflation in my chest. Anyway, so far it's 24 hours-25mg fentanyl hasn't hit (if it will). Am getting a little scared that it won't work. Raised to fifty this morning and still not a lot of benefit but I am trying to remain hopeful.
>
> Question: did you find the patch helpful for depression? My pain is real but I can't completely separate it from depression. Buprenorphine made both the pain and depression subside.
>
> You talked about postpartum depression. Are you back on opiates? If so, are they not working this time or did you decide to go it without them for a while?
>
> Shelli
>
>
> A hug to the new baby girl. Do you find she helps ground you?
Posted by judy1 on April 6, 2002, at 1:15:56
In reply to Use of the Fentanyl Patch: Judy, Anyone, posted by shelliR on April 5, 2002, at 20:23:19
Hi Shelli,
I noticed a definite AD effect with fentanyl at 50ug after about 24 hours. The doc also gave me actiq for immediate relief (it's in the form of a lollipop). I had to stop nursing after a month because I was falling into a psychotic mixed episode- I was fortunate it was caught early but only because I had about half a dozen docs/pdocs/therps waiting for it. I'm doing much better, thank you. I decided to go back to ms contin for depression/pain (just got tired of the adhesive) and take 60mg tid and the 15mg ir as needed. That feels comparable to the fentanyl dose I was on (75-100ug every 72 hours) but the pain doc said it's different for everyone. I hope you begin to notice a difference soon, please let me know.
My baby does help keep me grounded but I have to be careful with my sleeping patterns, since I no longer nurse my husband helps at night. I also did a contract with my therapist (I was pretty bad there for a while) and that helps with my impulsiveness. I hope this med helps you as much as it did for me. Take care, judy
Posted by IsoM on April 6, 2002, at 1:41:14
In reply to Re: Use of the Fentanyl Patch: Judy, Anyone » shelliR, posted by jay on April 5, 2002, at 21:31:53
Jay, I live in Canada too & the only way I know of codeine being able to be gotten OTC is by the acetaminophen (325 mg)/codeine (8 mg)/caffeine tablets. If this is where your codeine comes from, please be careful of acetaminophen poisoning. The amount of codeine is fairly low & to get what you need, you may be risking permanent liver damage from ingesting too much acetaminophen. I'm concerned how much you may get.
Posted by shelliR on April 6, 2002, at 18:38:41
In reply to Re: Use of the Fentanyl Patch: Judy, Anyone » shelliR, posted by jay on April 5, 2002, at 21:31:53
>
> Shelli:
>
> There are some studies that show many of the antidepressants that affect norepinephrine help work with the pain meds. Besides some of the old tricyclics, there is also Effexor at higher doses.I don't think I have a pdoc at the moment, but as soon as I do (better be soon), I want to look at either a retry of nardil or effexor. I found when I was a lot younger that I couldn't adjust to any tricyclic, so don't want to go back there.
> I have also heard of Tegretol (and I imagine it's new cousin, Trileptal(sp??) helps with pain.<
My doctor said he wanted to work with something for immediate relief (although I don't look at 48 hours so far as immediate). I think since I was off of buprenorphine (self-medicated) for almost a week, he wanted to keep me clean to see what strength patch I really needed without overdosing me. Then, my understanding is that we will talk about other pain remedies that are slower, like neurotin, and perhaps tegrital.>
> I've been trying to explore this area for a long time, because codiene is an excellent a.d. for me, and is available OTC here in Canada. I've also been on a few other pain meds since I had a nasty motorbike accident a few years ago, and I didn't go on fentanyl, but was on a few other opiates. That's how I discovered I could use codiene for "breakthrough" depression.I didn't find that regular codiene even touched my depression even when a lower dose of vicodin did.
You are lucky that such a small amount of narcotic helps (especially after being on heavier opiates). I wouldn't worry so much about ACH, unless you are taking huge doses. At least that's what I was told by the guy who did the bupe study. When I was taking a small amount of vicodin and wondering whether I should switch to buprenorphine, he didn't think it was worth the bother since I wasn't going up. I asked about ACH and he was the one who told me not to overreact to it, that it told a really high dose to be affected by it.Thanks for your info.
>Shelli
Posted by jay on April 7, 2002, at 13:09:08
In reply to Codeine Use » jay, posted by IsoM on April 6, 2002, at 1:41:14
> Jay, I live in Canada too & the only way I know of codeine being able to be gotten OTC is by the acetaminophen (325 mg)/codeine (8 mg)/caffeine tablets. If this is where your codeine comes from, please be careful of acetaminophen poisoning. The amount of codeine is fairly low & to get what you need, you may be risking permanent liver damage from ingesting too much acetaminophen. I'm concerned how much you may get.
Thanks IsoM. I have been able to use it without cranking up the dose, and I may even switch to the Aspirin/Codiene combo one of the major chains here carries. In honesty, I don't just use the med for psychological reasons, because I happen to have very bad sinus problems and the pain that follows. Short of surgery, I have tried everything else over a 15-20 year span, and this keeps the pain at bay.Thanks again for your concern..:-)
Your fellow Canuck,
Jay
Posted by IsoM on April 7, 2002, at 13:39:09
In reply to Re: Codeine Use » IsoM, posted by jay on April 7, 2002, at 13:09:08
Jay, do you have a doctor who's willing to just prescribe you codeine without anything added? That may be the best if you can get it. Then you can add ibuprofen, Aspirin, or acetaminophen as needed or wanted. When my doctor found out that I used acet/codeine combo for pain, he was willing to prescribe codeine for me but I told him I didn't use it that much.
Posted by Elizabeth on April 8, 2002, at 0:13:25
In reply to Use of the Fentanyl Patch: Judy, Anyone, posted by shelliR on April 5, 2002, at 20:23:19
> Have just started with a fentanyl patch. I was doing well on buprenorphine but last package seems to be confiscated (at customs for ten days now), and supply is out at the overseas companies that generally sell it.
So now you're substituting fentanyl? Dude.
> The one thing that I hated about bupe was that I woke up with depression and pain. The pain is inflation in my chest. Anyway, so far it's 24 hours-25mg fentanyl hasn't hit (if it will).
It's actually 25 mcg -- 0.025 mg. That's the amount that gets released per hour. So you're getting a total of 0.6 mg/day. Potent stuff, that fentanyl. (When I was on an IV drip in the hospital last year, at one point I was getting something like 120 mg/day of Ativan. Woah!)
TCAs and Tegretol are mainly good for neuropathic pain. I didn't find TCAs helpful for my back pain, and Trileptal isn't doing anything either. (The things that have worked for me are opioids, Soma, benzos, and Nardil.)
The Duragesic PI should have directions for calculating the dose you need. You should be able to find the PI at www.rxlist.com. I think there's a good chance that you might need 75 or even 100 mcg. So don't despair!
What was your most recent total daily dose of buprenorphine, BTW?
I still can't believe you're taking fentanyl. But I admire your initiative. :-)
As always, you're welcome to email me if you'd like to chat, exchange stories, etc. I haven't been very good about checking my mail lately, but I promise I will if you mention here that you've written. :-}
-elizabeth
Posted by Elizabeth on April 8, 2002, at 0:29:21
In reply to Re: Use of the Fentanyl Patch: Judy, Anyone » shelliR, posted by jay on April 5, 2002, at 21:31:53
Jay --
The TCAs and Tegretol really are not general pain medications/analgesics. They're for certain specific kinds of pain, and I don't know if they'd work for Shelli's.
> I've been trying to explore this area for a long time, because codiene is an excellent a.d. for me, and is available OTC here in Canada.
Codeine and fentanyl are pretty much the opposite ends of the opioid spectrum! :-)
I did try using buprenorphine on an as-needed basis, but I found that I really need it all the time. The side effects suck, though.
How much codeine do you typically take? I wouldn't be concerned about liver damage unless you go over 1000 mg of APAP or so. If you're doing that, you can add N-acetylcysteine (available at your local health-food store). My understanding (I've never actually done this) is that you take 1 mg NAC for each mg of APAP.
Curiously, in the USA it's very hard to get a script for plain codeine, with no other crap added. The reason is that unadulterated codeine is Schedule II, the same controlled substance category as morphine and fentanyl and oxymorphone and so forth. All plain, full-agonist opioids are, as is Percocet (oxycodone with APAP). Codeine and hydrocodone with other stuff added are Schedule III, though. So the docs figure that if you're hurting enough that you "deserve" a Schedule II drug, you probably need something stronger than codeine. Just silliness at usual here in the south. :-}
-elizabeth
Posted by shelliR on April 11, 2002, at 9:48:10
In reply to Duragesic » shelliR, posted by Elizabeth on April 8, 2002, at 0:13:25
> So now you're substituting fentanyl? Dude.Definitely was not my idea. It was the "pain doctor's" choice, although no objection on my part.
> It's actually 25 mcg -- 0.025 mg. That's the amount that gets released per hour. So you're getting a total of 0.6 mg/day. Potent stuff, that fentanyl.It's supposed to be potent, but for some reason it doesn't hit me as well as the buprenorphine.
>
> The Duragesic PI should have directions for calculating the dose you need. You should be able to find the PI at www.rxlist.com. I think there's a good chance that you might need 75 or even 100 mcg. So don't despair!
I've gone up to 75 mcg. I'm definitely better than I was a week ago, but still not feeling good as with oxycontin or bupe.
> What was your most recent total daily dose of buprenorphine, BTW?0.8, twice a day. And bad rebound depression in the morning.
> I still can't believe you're taking fentanyl. But I admire your initiative. :-)
Hey, I was just trying to stay alive. And this doc says "this is what I want to do", so didn't exactly take much initiative. :0)
Shelli
Posted by shelliR on April 11, 2002, at 9:55:56
In reply to codeine + paracetamol/acetaminophen » jay, posted by Elizabeth on April 8, 2002, at 0:29:21
I just got my hospital records from my detox off oxycontin. I am in total shock to report that the doctor pulled me off of 240 mg oxy using .1 mcg (yes, POINT ONE) of buprenorphine. There was a reason that I was on the floor screaming.
Shelli
Posted by Elizabeth on April 16, 2002, at 21:20:00
In reply to Re: Duragesic » Elizabeth, posted by shelliR on April 11, 2002, at 9:48:10
> It's supposed to be potent, but for some reason it doesn't hit me as well as the buprenorphine.
It's not supposed to "hit" -- it's a patch, it releases a little bit at a time. But anyway, did you find out what the equivalence ratio is between buprenorphine and transdermal fentanyl?
> I've gone up to 75 mcg. I'm definitely better than I was a week ago, but still not feeling good as with oxycontin or bupe.
Huh. I wonder if there's something more going on here than just trouble finding the right dose. Absorption problems, maybe? I don't know. (BTW, speaking of things that can go wrong with Duragesic, I hope you were warned not to use a waterbed!)
> > What was your most recent total daily dose of buprenorphine, BTW?
>
> 0.8, twice a day. And bad rebound depression in the morning.Yeah, I think t.i.d. dosing is preferable. I'd want to take a fourth dose at bedtime if it weren't so activating.
> Hey, I was just trying to stay alive. And this doc says "this is what I want to do", so didn't exactly take much initiative. :0)
Goodness gracious. Well, good luck with it! I hope you find a dose that does the trick for you.
> I just got my hospital records from my detox off oxycontin. I am in total shock to report that the doctor pulled me off of 240 mg oxy using .1 mcg (yes, POINT ONE) of buprenorphine. There was a reason that I was on the floor screaming.
0.1 mcg? Are you sure? Might it have been 0.1 mg? That seems more reasonable; 0.1 mg (always put the 0 before the decimal, good practice) is one-third of a cc, while 0.1 mcg is one three-*thousandth* of a cc. One-third cc is a pretty modest amount, but it's not outrageously low.
-elizabeth
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