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Thursday, August 16, 2012 C-roc, Community Member, asks

Q: What is stronger than Fentanyl?

I have been suffering a severe knee injury for the last 10 months. They have me on 100mcg patches every 48 hours, and 4 percocet 10-325 a day. Nothing is even touching the pain! I put the patch on before bed and I MIGHT get 6 hours of relief the next day, that's it. From what I understand this is pretty strong stuff. What can my PM doc try next, what is stronger than the fentanyl?

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Answers (1)
Cort, Health Guide
8/19/12 8:53pm

There's not much stronger than Fentanyl. According to an opioid comparison chart on Wikipedia a drug called sufentanyl, etorphine and carfentanil are all much stronger than fentanyl. Sufentanyl is used almost exclusively during operations, etorphine is used to immobolize elephants and is for veterinary use only, and carfentanil is the same. 


Some people just don't respond well to opioids; my girlfriend in one of them. There are other possibilities; they include antidepressants such as cymbalta which turn out to be able to reduce pain in people without depression and anti-convulsants such as Lyrica and neurontin. 


Since anxiety is a great pain enhancer and it's hard not to be anxious when you're in alot of pain you might also try stress reduction courses. MBSR (mindfulness based stress reduction) was developed to help pain patients who did not respond to narcotic drugs. Courses can be found across the US.


Good luck in your search! 


C-roc, Community Member
8/19/12 10:04pm
Thank you for your ansewer. I acually have had cymbalta, lyrica, Neurontin, and many, many other antidepressant type, and nerve type medication. I do find that Xanax helps slightly with the pain, and anxiety that comes along with it. I've even considered amputation. My surgeon seems to think that that is the next step. It gets VERY fruserating at times to say the least. I'm sure 99.99% of the people here can relate. Thanks again. Reply
Karen Lee Richards, Health Guide
8/22/12 10:42am

You might consider asking your doctor whether an intrathecal pain pump would be an option for you.  It's an implanted device that delivers opioid medication directly into the spine.  Because it doesn't have to go through the digestive system, greater pain relief can be accomplished with much smaller doses of medication.  Here is some more information:  Intrathecal Pain Pumps


Before you seriously consider amputation, I'd like to suggest you do some research on phantom limb pain and discuss what you find with your doctor.  Although it seems like cutting off the body part that is causing your pain should get rid of the pain, that's not always the case.  Pain signals actually come from the brain.  Once a pain path has been established, sometimes the brain will keep sending pain signals even though the original source of the pain is gone.  It would also be a good idea to get a second opinion before taking such a drastic step.  Perhaps talk to a pain specialist who has experience with phantom limb pain. 


I wish you the best and hope you find a way to get your pain under control.

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By C-roc, Community Member— Last Modified: 03/12/14, First Published: 08/16/12