AboutNigel Simmons Expertise I am happy to answer general questions on medicines and hospital care. If possible, please use approved / chemical names rather than brands which are not internationally recognised.
Like all health professionals I am bound by a duty of care which prevents me giving detailed information about medication or treatment of people other than the questioner.
I will endeavour to help wherever possible or point towards more appropriate advice. If however your question crosses too far into patient confidentiality, I hope you will understand why I cannot answer your question.
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Experience Registered as a UK pharmacist in 1982 and have worked in a number of hospital and health management posts around the UK. Formerly Chief Pharmacist for a 440 bed general hospital in Cambridgeshire.
Past/Present clients Previously Sysop on CompuServe UK Professionals forum.
Question Hi,
I had a Spinal Fusion in September 2003 relating to L3 & L4 (I was missing L5), due to a birth defect that was detected in March of that year. I have now been diagnosed as a Chronic Pain sufferer and have been on Fentanyl 50 micrograms per hour patches for about 18 months now. I have tried the 75 mg/hr but had to stop as I couldn't cope with how ill they made me feel. I have had 3 lots of Facet injections over the last year or so which help the pain and a Fact Joint denervation in February of this year which made things alot worse! The last bout of Facet injections were done on 14 June along with an L2 root block. As the pain has subsided (and I am not sure how long I should be on these patches for)I decided to try and stop the patches and so removed it on Sunday at 1.00pm. I gave up at midnight last night and put another one on as not only did I feel awful (leaden, jellified legs, irritable, hot, cold and generally like I had flu along with a really woolly feeling in my head) but the pain was unbearable. I am not sure if this was because I had just stopped the medication or a combination of that and the pain. If I were to try and stop the medication how would you suggest I go about it and how long would you expect it to take. In my current position would you say it is something that I can consider? I have been told by my Pain Clinic specialist that other than the Facet injections there is nothing else they can do (which I find hard to believe) and my consultant is near useless, basically telling me that if I think positively I can manage the pain (I do think positively and it has no effect!!). I understand that this only gives you a broad view but any advice would be much appreciated as I am only 31 and getting desperate!
yours sincerely,
Louise Williams
Answer Louise
I'm afraid I am on the limits of my knoweldge and experience with your question, and by and large I think your pain specialist is correct.
I would suspect the symptoms you experienced are indeed a result of opiate withdrawal and the lack of pain control from your nerve damage. This does not mean you are an "addict" in th popular use of the name, but you have developed a dependence as part of the pain management. For the time being at least, you do need to continue with the fentanyl, in time and with the fine adjustment of other drugs then you may be able to reduce the dosage.
Regrettably, treatment of nerve injury or damage can be unpredictable, and as you have found treatments sometimes give benefit and on other occasions they do not.
Regarding other possible treatments, there are some non-opiate options that may be possible and your pain specialist can advise and where appropriate initiate a trial. These drugs include amitriptyline, nortriptyline, gabapentin and pregabalin.
Use of a TENS machine and physiotherapy may also be worth considering.
Breakthrough pain can usually be treated with simple analgesics such as paracetamol or non-steroidal drugs such as ibuprofen. However if pain persists, then the overall management strategy should be reviewed. If you are regularly taking non-steroidals, then it would probably also be worth adding in something to protect your stomach from ulceration, as ulcers are in effect a factor of dose, potency and duration.
