Originally Posted by Dave ARNP Where are you folks at that patients do so well with Duragesic?
I've found them virtually useless for chronic non-malignant pain.
Cancer pain does fairly well with them, especially Lung.
I write fewer Duragesic patches than any other schedule II out there.
Now the Actiq trans-mucosals... THEY'RE AWESOME!
-Dave
I have the unfortunate pleasure of being an RN who has to personally use both Duragesic and Actiq. I'll keep the dosage to myself; suffice to say it would put you to sleep for weeks.
I had ulcerative colitis which went to toxic megacolon, and had the J-pouch surgery, then had some complications, and almost before I knew it I had undergone five laparotomies in 23 months, all through the same vertical incision. The best explanation they can give me for 'why does it still hurt?' is that the muscle and fascia are stretched and sutured in such a way to irritate the nerves. I went to a pain mgmt specialist who put me on OxyContin; we got up to 120mg a day of it before I figured out I wasn't digesting the stuff. It was coming out whole in the toilet. I changed MDs and now I use the above meds, both of which bypass the upper gastric tract (except, of course, for the mucous membranes of the mouth).
I had problems with the patches sticking at first, too. I've learned that I have to put them on my back, preferably my lower back, away from my waist. I can't put them on my chest or my arms because the movement loosens them up too much. I also rub the edges and press them down all around for at least 90 seconds. I also got under-dosed at first, and I change my patches q48 instead of q72; I think my skin is warmer than most and the change to q48 actually helped quite a bit. Maybe you could consider that.
The Actiq are indeed wonderful, but they are simply out of most people's price range. If you don't know how much the things cost, you really should find out. If I were not on an insurance plan that paid for them -- and I had to get a special waiver for it -- the Actiq I take would cost $2800 a month, and I think I'm underestimating it. Cephalon does have a program to send it at no cost to patients with malignant pain, but they won't talk to you if you're non-malignant. You can check the retail price at walgreens.com, although the last time I looked it was out of date with the new quantities per box. There's only one pharmacy in my part of the state that will carry Actiq, and they absolutely refuse to dispense single units -- boxes only.
Please feel free to email me privately if you'd like to discuss more. I'm just now coming out of the dark and starting to function again, and it's helpful to me to talk about my good and bad experiences with pain management. And for everybody else, I know there are drug seekers out there, but many of us just hurt and want some relief. Good luck to all of us!!
Shelties
Yesterday is the past, tomorrow is the future, and today is a gift THE PRESENT. Use it wisely.
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