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Suggest pain management for arthritis after knee and reverse shoulder replacement

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Posted on Sat, 14 Nov 2015
Question: I have been on a fentanyl 100 MCG/hr for about 10 years. I also take Percocet 10mg for breakthrough pain. About a year ago my doctor (Pain Management) added OxyContin 2, three times a day. A month ago he decided to decrease the fentanyl to 75 mcg/Hr. At the same time my pharmacy changed brands of the patches because of decreased insurance reimbursement and the Mylan patches cost the pharmacy a lot more than other generic brands. With the decrease in strength of the patches, and I believe, the change in brand, I found that the patches did not last nearly as long as they had previously. I had been changing patches every 48 hours, but began having the patches wear off in 36 hours or so. The symptoms were bad enough that I had to change the patches before 40 hours. I had suggested that my doctor begin decreasing the OxyContin 2 and leave the fentanyl alone. Have you found that some generic brands are not equal to other brands of fentanyl patches? Which medication do you think should be decreased? Thank you.

This is additional information for the doctor. I started Pain Management September, 2004. Besides prescription medication I periodically get injections of a steroid in my lower back or mid back. I have had 4 cervical disk removal-fusions, 6 back surgeries with fusions from S1 up to and including a couple dorsal vertebrae, with 2 titanium rods. I have also had right knee replacement and almost two years ago I had a reverse right shoulder replacement. I've had a few other surgeries and have arthritis in a number of joints. The most painful arthritis is in both wrists and shoulders. There is a lot of scar tissue in my neck and back. I don't want any more surgery.
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Answered by Dr. Ivo Ditah (2 hours later)
Brief Answer:
Let your doctor stick to the 100mcg/hr that has shown to work well!

Detailed Answer:
Hi and thank you so much for this query.

I am so sorry to hear about these changes that have led to poor pain management. True doctors will always try to reduce the dosages of pain medications for the good of the patient. However, this should only hold if it doesn't compromise the quality of pain management. Let your doctor get you back on what has worked and so for many years because these changes are not making life any better.

All pain medications are not the same. Though expected to be equally effective, branded pain medications are often better than generics. This shouldn't be the case but unfortunately it is the general observations.

In all, back to your regular 100mcg/hr. All changes should be reversed such that you can get better pain management.

I hope this helps. I wish you well. Thanks for using our services and do feel free to ask for more information and clarifications if need be.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Ivo Ditah

Internal Medicine Specialist

Practicing since :2002

Answered : 3989 Questions

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Suggest pain management for arthritis after knee and reverse shoulder replacement

Brief Answer: Let your doctor stick to the 100mcg/hr that has shown to work well! Detailed Answer: Hi and thank you so much for this query. I am so sorry to hear about these changes that have led to poor pain management. True doctors will always try to reduce the dosages of pain medications for the good of the patient. However, this should only hold if it doesn't compromise the quality of pain management. Let your doctor get you back on what has worked and so for many years because these changes are not making life any better. All pain medications are not the same. Though expected to be equally effective, branded pain medications are often better than generics. This shouldn't be the case but unfortunately it is the general observations. In all, back to your regular 100mcg/hr. All changes should be reversed such that you can get better pain management. I hope this helps. I wish you well. Thanks for using our services and do feel free to ask for more information and clarifications if need be.