I would be surprised if she has prescriptions for all of those meds to take at the same time from the same doctor. That would be "out of the box" from the NCCN Adult Cancer Pain Management Guidelines from the Oncology Practices Guidance document. Pain meds should be coordinated by one doctor. The guidelines typically only list a combination of 2 drugs - one for "long term" (like Fentanyl) and one for "short term" (or "breakthrough" pain - like Morphine). Magic mouthwash being an exception to the 2 drug rule.

Many institutions have pain management specialists. I would start be trying to get a referal to them. My second choice would be the MO since they specialize in body dhemistry. Even her PCP should be able to help. RO and ENT's are typically the most reluctanct to prescribe adequate pain meds.

Remember that Fentanyl takes 24 hours for changes in the therapeutic dose to be noticed so a little patience is required. 100 mcg is not a large dose, by the way, they can prescribe up to 500 mcg, but that is rare for H&N cancer patients. Fentanyl is typically increased in 25 mcg increments. I had 175 mcg at my worst point and others here have had as high as 250 mcg. Read and follow the directions for use with the patch explicitly.

When using the magic mouthwash - do not swallow it - it is a "swish and spit" medication. Swallowing it may numb the gag reflex and result in aspiration into the lungs, which could result in pnuemonia.

Gary, I am told and the instructions are on the bottle to take 2 teaspoons before meals and at bedtime. swish around the mouth gargle then swallow. I have the bottle sitting on my desk here.

It has been two months since my surgery and I still have a burning sensation in my tongue. It gets worse if I eat anything, and will start to go numb, and then the burning sensation comes back.