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  #1  
Old 20-02-2012, 20:23
St Dismas Novitiate St Dismas Novitiate is offline
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BuTrans patch vs. Fentanyl patch for chronic pain?

So, BuTrans Vs Fentanyl, which one is better? Now, we already know that Bupe is about 1/2 the strength of Fentanyl and it is used either alone or in combination with other drugs for opiate detox procedures, but how does it work for chronic pain applications? Specifically, chronic back pain?

Currently, I am down to one 25 mcg/hr Fentanyl patch (from 2-100 mcg/hr patches!). My goal is to get off of Fentanyl completely. With this in mind, my plan is to drop one more time, to a 12 mcg/hr patch, for a period of 30 days. At that point, I am thinking about jumping over to a BuTrans patch. This should serve several purposes-first, it gets me off the fent! Secondly, I think that the BuTrans will help with the fent WD's, which is a big deal with me, as I do NOT want to go through fent WD's at all! I suspect that BuTrans may also help with any lingering addictive issues concerning break-thru meds-if the additional meds are blocked and don't work, then there is little incentive to take them for recreational purposes, right?

Some have said that it takes days for the BuTrans patch to become fully effective in controlling pain, while others have to remove it after just a few hours, because of its effects. I never experienced this in any way with the Fentanyl patch, but I went from Opana to Fent, and Bupe works differently, I guess.

So, Butrans or buprenorphine-containing patches-Do they work for chronic pain? If so, how well?
  #2  
Old 22-02-2012, 01:38
iceflame iceflame is offline
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Re: BuTrans patch vs. Fentanyl patch for chronic pain?

G'day my (former) Sparky mate!

WARNING Very long post, hopefully this can be of some help.

The following Buprenorphine experiences are based on my ex's, my own, and patients that I nurse weekly.

•My ex was given this patch, the 20 mcg because he had overused his prescription opiates. (7 day BUP TDS)
He would need to take this for 3+ months because he had overused 3 months worth within 3 weeks.

He at this time was 25 and suffers from severe chronic back pain (mostly lower but it's generally all over) caused by motor bike accidents amongst other things.
He is wheelchair bound/bed ridden, and unable to work without his medications.

Now he found the patches to be highly effective, after they began to take affect...around the 5th day.
He was able to help with minor activities around the house, nothing strenuous but helping me with our little one's, cooking and cleaning, etc.

The following weeks things improved immensely, he was able to finish painting some of the rooms (This is part of his trade).
He could also mow the lawns and start the retaining wall, completing 90% of it.

In the final month he was back at work, building homes (he's also a Master Builder(now)) and continue to paint what was required.
The Buprenorphine worked exceedingly well for him.
Obviously he couldn't obtain BT meds because of his abuse.

•My story comes in to this because he had also been using my medications.
Therefore I was close to running out, when the time came he gave me one.
I kept it on for a week to aid with withdrawals, and also because I would be picking up my prescriptions in 14 days.

The patches did absolutely nothing for my pain, but I have Crohns Disease and Bupe isn't indicated for Crohns or Collitis.
It did however help slightly with withdrawals, but I ended up in hospital with a flare up for 2 weeks. (So my problem was solved)

My ex had huge problems with the patches sticking, this is more common in younger patients who sweat alot or have a considerable amount of body hair.

•The older patients (50~86+) I work with at the hospital don't ever have this particular issue, (sweating/hair) the patches I've administered are Fentanyl and Buprenorphine.

My patients swear by the pain releiving properties of Bupe.
About 70% of these geriatrics would be bed-ridden without it.
Sometimes I change their patch every 4-5 days, maybe 6 as the Bupe doesn't always last the full seven days.
The patches control their back & knee pain, some report improvement with osteo & rheumatoid arthritis, and generalised pain.

Toxin, if I havn't explained this very well I apologise, as my lil' satan spawn keep requiring me to play 'The Mad Hatters Tea Party', needless to say I'm being distracted.
I'm very sorry, just let me know if I can elaborate on anything.

Last edited by iceflame; 14-03-2012 at 22:40. Reason: Tidying up & spelling due to rug-rats distraction/clarification of patch
  #3  
Old 22-02-2012, 03:17
St Dismas Novitiate St Dismas Novitiate is offline
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Re: BuTrans patch vs. Fentanyl patch for chronic pain?

Good additional news to have! The only part that is still somewhat of a concern to me is the excessively long-seeming time it takes for the patch to become effective and what I'll do between the time I end the Fentanyl and the time the BuTrans starts working.

For some reason, I am still having trouble wrapping my head around how you can take other opiates for breakthrough pain with Buprenorphine entering your system via the patch, or by any other means for that matter. If I understand correctly, Bupe blocks the effects of opiates at higher dosages, but not at lower ones? So as long as the total amount in your system does not get above a certain level, you can take other opiates for pain and not have a problem.

That leads us to the question of: what is that amount? I recall both Kailey_Elise and I were discussing a similar issue in a different thread, and we came up with a number of I believe .48 mg of buprenorphine is what should be the max amount available from a correctly placed 20 mcg/hr BuTrans patch and when averaged over the 7 day span of the patch. So, call it 1/2 a mg. will be good for pain, but where does the point come in which it moves from agonist to antagonist? 1 mg.? 1 1/2? 2 mg. is used for detox purposes, so obviously not a dose that high. Is that line razor-edged or fuzzy? If 1/2 mg works good for pain, would 1 mg work better, but still allow the use of breakthrough pain meds?

It seems questions beget questions! My knowledge in this area IS moving forward however, and I would like to thank all of you who are helping.
  #4  
Old 23-02-2012, 11:33
iceflame iceflame is offline
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Re: BuTrans patch vs. Fentanyl patch for chronic pain?

Toxin,
Do you have access to the 3 day patch for the change over?
According to an article I just read this may really help when you jump.

The 3 day patches reach dose effectiveness within 12 -24hrs. (constant control for 96 hours)

Can I post a PubMed link here, or pm you maybe.?
Anyway it discusses Equipotency and Equianalgesics regarding fentanyl and buprenorphine patches. (FEN TDS & BUP TDS respectively)

The article is called ~ 'Transdermal buprenorphine - a critical appraisal of its role in pain management'
Specifically from citation points 60 -64.

It's well worth a read, even just for reference sake.

I'm still looking for more info on breakthrough meds, but this isn't too useless (I hope).


EDIT: Link provided further down this thread.

Post Quality Evaluations:
outstanding article reference and extra effort!

Last edited by iceflame; 14-03-2012 at 22:42. Reason: Info on link.
  #5  
Old 23-02-2012, 19:09
St Dismas Novitiate St Dismas Novitiate is offline
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Re: BuTrans patch vs. Fentanyl patch for chronic pain?

I was not aware of a 3 day patch. Do you have a name for this? And yes, you can always PM me, my friend! I'll try to Google the name of the article and see what I can come up with.

toxinreleased added 11 Minutes and 18 Seconds later...

OK, I found it. Outstanding article! I can only understand about 85% of it, and can piece together another 5% or so, but it has answered all of my questions so far. I will have to read it more in depth when I have time, but I can understand what I need to understand so far. I did not know about the Transtec patch either, so I will have to run that one by my doctor, but I like the sound of it already. Unfortunately, I also checked with my insurance, and they do NOT cover it, so I will have to jump through hoops to get it, but I think it will be worthwhile. Assuming that it is available in this country, and I saw no reason why it would not be.

To anyone who may be interested in this thread, I would highly recommend that you read this article before you make a decision or as an aid in helping you make that decision. I just Googled the entire title and choose the article by Guy Hans and Dominque Robert, if the link does not get posted.

Thank you, Iceflame! Good job.

Last edited by St Dismas Novitiate; 23-02-2012 at 19:09. Reason: Automerged Doublepost
  #6  
Old 23-02-2012, 21:28
iceflame iceflame is offline
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Re: BuTrans patch vs. Fentanyl patch for chronic pain?

I'm so glad the article was helpful, it's alot of info but you can find the gems within.
It's an interesting find, very thorough.
This is the link...

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004620/
(I'll post the article when I work out how, I've only just worked out how to post links )

Hopefully it's allowed.
Let me know if it shouldn't be here, please.

I'm currently sifting through some more, will let you know if I find anything.
I also beleive Transtec sounds very promising, I guess if you're successful you can then jump to the BuTrans?

I noticed they mentioned Tramadol in one section as 'resuce medication', I guess dosage wise I found this interesting...a reference point atleast.

Anyhow let me know how you go.

Last edited by iceflame; 24-02-2012 at 00:17. Reason: Adding more after validating link.
  #7  
Old 24-02-2012, 03:24
St Dismas Novitiate St Dismas Novitiate is offline
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Re: BuTrans patch vs. Fentanyl patch for chronic pain?

Yeah, now I'm trying to find out if the Transtec is available in the U.S. So for, it doesn't look good. While I can't find anything that says it isn't, I also can't find anything that says it is. I'm sure that because I want to try it, it won't be available!
  #8  
Old 01-12-2012, 19:12
Bandhor Bandhor is offline
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Re: BuTrans patch vs. Fentanyl patch for chronic pain?

Based on the info I have gleaned from here seems to be two things, bup seems to be better with chronic back pain and most important is much safer than fent. These two things alone make me consider switching if I cannot be drug free. My back will never heal, surgery is 30/30/30 and new procedures are years away before becoming mainstream. I also am not a candidate for an electric stimulator. Pain pumps scare me. So there ya go. the road continues. I do as tox said want say I am grateful for what I do have in options, a home and family. I was alone for the first 20 years or so and know what it's like not knowing where the next meal is coming from, but too many suffer worse and that pisses me off every day. Right here is the true war on drugs, not laws, but fighting the pain of dependence and addiction, rambling off topic stopping now.
  #9  
Old 09-07-2013, 22:34
foreverfriends1 foreverfriends1 is offline
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Re: BuTrans patch vs. Fentanyl patch for chronic pain?

Toxic. foreverfriends1 was prescribed Fentanyl for severe pain.
After 5 years she went 100mcg then 82mcg in a week. Then to
50 mcg b4 jumping off at 25mcg onto BuTrans5. Is now taking
BuTrans 10. Fentanyl and BuTrans CANNOT be compared. Forever
Friends has WDs from HELL & is still wondering when they will
Leave. She once had a Great Relationship with Fent.now HATES it.
USA can get 3 day stronger BuTrans. Forever friends does not
Want anyone to suffer severe WDs. Even pharmacy asked her to
Take other meds. Foreverfriends kept a diary. Forever is still sweating
Aching and wants the withdrawals to go away. She also wishes you all
The best!
  #10  
Old 19-07-2013, 19:51
fuzelogic fuzelogic is offline
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Re: BuTrans patch vs. Fentanyl patch for chronic pain?

My friend Jim is using the Butrans 10 mcg patch and has had pretty good success with them, he said he's been able to swim in the ocean for 45 minutes and take showers without the patch being covered and never had one luckily fall off yet other than when he stuck one on his rib cage which was a bad location.

Until the BuTrans patch, Jim was always having to constantly take hydrocodone, oxycodone, tramadol consistently every 6 hours. These medications were prescribed at various times and never all at the same time, but it didn't matter they would all wear off around 5 hours.

Now Jim doesn't get the lovely opiate headache every morning, he still has to take tramadol short acting and aleve consistently everyday, but it's not like he's watching the clock to take the next dose.

Jim is unsure how to tell others on how to approach the doctor if you are in a similar situation, but it was due to insurance issues that Jim was able to move to the patch since insurance didn't want to pay for the extended release tramadol with the short acting tramadol every month.

Jim said it has improved his life and feels much better with less sciatica pain down both legs.

My insurance wanted to switch Jim to Duragesic, but the doctor wasn't interested in moving him to the new drug just to save my friend Jim money, so he can't comment on fentanyl

Last edited by fuzelogic; 19-07-2013 at 20:56.
  #11  
Old 02-09-2013, 14:50
EtrophineM99 EtrophineM99 is offline
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Re: BuTrans patch vs. Fentanyl patch for chronic pain?

The Buprenorphine patch has no blocker in it. They use it for pain, not for opiate abuse. So it they never thought to put a blocker in it. I'm on the 10mcg/hr, it doesn't really help, but when I use other opiates, it stops withdrawl.
  #12  
Old 15-01-2014, 12:02
Ntense Ntense is offline
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Re: BuTrans patch vs. Fentanyl patch for chronic pain?

Buprenorphine itself is a partial agonist,meaning it it does block.You could take a breakthrough med you would just have to quadruple the amount ,buprenorphine itself binds to receptors so tightly other opioids literally bounce off depending on how hi dose and it builds up in your system over years its far better than suboxone who ever came up with idea of people taking naloxone daily is retarded say you take suboxone for 2 years then get in a bad accident and your arm got cut off all that naloxone in a person could not be treated for the pain. Buprenorphine by itself isnt near as bad but does build up.
  #13  
Old 24-03-2014, 23:47
jagman48 jagman48 is offline
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Re: BuTrans patch vs. Fentanyl patch for chronic pain?

For chronic pain I have been on Buprenorphine 5mcg/h for 5 years. Due to botched surgery and post polio pain It was lifted to 30mcg/h. I an now also on 75mg of Lyrica morning and 125mg at night.

Due to sensitive skin and very nasty skin reaction. The doctor has now put me on Temgesic Sublingual equivalent to 200mg of buprenorphine and wants me to take up to 6 a day.

I have been having terrible problems establishing a dose that makes me pain free but not spaced out.

My question to the group is just how many of the temgesic do I need to cover the 30mg/h patch. What frequency should I take them. ie 2X3 or 3X2. I just can't seem to get it right.

Can anyone help me to sort out this problem.

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