Paul has recently commenced fentanyl with a 50mcg Durogesic DTrans patch, after having been on 90mg MST BD and becoming distressed with repeated bouts of constipation.

After 2 weeks at this dose Paul notices that at the end of the second day following each patch change his pain recurs and gradually worsens into the 3rd day.

He has no other symptoms.

The pain disappears 6-12 hours after application of the next Durogesic DTrans patch.

This is a recurring feature of his pain control.

Action –

Paul's Durogesic DTrans patch strength is increased to 75mcg per hour patch and his pain is controlled.

Conclusion

Paul is suffering pain on the 2nd to 3rd day after patch application because his fentanyl dosage is too low.

Peter has been using a 50mcg per hour Durogesic DTrans patch for 3 to 4 weeks.

He complains of feeling agitated, sweaty, develops goose pimples, and has abdominal cramps and diarrhoea towards the end of the 2nd day or early into his third day after patch application.

If he takes Morphine breakthrough medication his symptoms settle for a few hours but then recur.

Action –

Following advice from a specialist palliative care team it was suggested that Peter change his patch every 48 hours. His opioid withdrawal symptoms settle.

Conclusion

Peter is one of the few patients who after using the Durogesic DTrans patch for several weeks develops fentanyl withdrawal on day 2 /3rd day