Geri,
Many of us here wouldn't have survived without the miracle of the Fentanyl patch. It takes 24 hours to reach it's full therapuetic dose in the blood - that is for the first patch. There will be enough residual effect that you will not notice when subequently replacing patches every 24-72 hours, whatever your doctor prescribes. The patch should knock the pain threshhold down to a "3" or less. In instances where there is breakthrough pain, then that's where the morphine comes in. It is the fastest acting narcotic on the market today. 1/2 hour in tablet form and almost instantaneously in liquid form. If you find yourself taking too many morphine pills or liquid morphine each day (like the maximum allowable amount) then the strength of the Fentanyl patch must be increased. The doctors have a specific method for this called a titration formula. Never adjust the meds yourself -always seek clearance from the prescribing physician first. Breakthrough pain may occur while doing simple activities such as attempting to eat or drink water. I also took breakthrough meds when I knew I was going to have a procedure, such as an exam that day. I always took them in advance of the exam to insure they were at full potentcy during the procedure. There is no need to suffer when you don't have to and proper pain management is a basic patient right! You should also have "pink magic" swish & spit topical pain killer on hand, especially for eating and drinking.

Some might say "why bother - I have a PEG tube" well the fact is if you don't use it you lose it. Every effort should be made to continue to swallow food (even liquid, like Carnation VHC) and water orally to keep the muscle groups functioning. By all means use the PEG for the heavy lifting, if you have one, but don't stop attempting to swallow normally (even if it is just sipping water). You may end up with swallowing issues, post Tx, that can take a long time to rectify. A few of us here went without a PEG (myself included and I safely say that out of the 5,800+ members, I can count that number on ONE HAND)) and in and many foreign countries this is the norm. The truth is that many here simply would not have survived without one and there has been plenty of discussion about this in other areas of the forum. This is a controversial topic so to those of you thinking about it - don't hijack this thread with a debate on to PEG or not. I merely mention it in the context of pain mitigation for swallowing orally.

Caution: Follow the directions for use, to the letter, when using Fentanyl patches. NEVER use a damaged or torn patch. It is the most potent synthetic narcotic ever invented.

Always report, daily, to the doctors what the pain threshold is. My CCC asked me every day but some don't. Use the numbering system 0-10 with "10" being unbearable pain.

Keep a log of all medicines, food, and water ingested.

It can take a short perioed of time to adjust to some narcotics and there have been a very rare few instances, on the forum, of individuals having an unusual adverse effect so they may have to fiddle with different drugs to find the correct ones for you. There is also a morphine time release patch available as well. Some patients will get Oxycontin and even Methadone. The latter we see less often here, but is is listed in the NCCN Oncology Practice guidelines for adult cancer pain management. If you explore the resources setion of the main site there is a link to the NCCN guidelines. I am no longer providing the link because there is a wealth of information on the home site and I wish to encourage every person coming here to explore the main information pages. Many questions, frequently seen on the forum, are answered there.

To avoid side effects from narcotics, mainly constipation, which will also cause nausea due to the interuption of homeostasis, be sure to stay hydrated and speak with the nutritionist about methods of mitigation. Constipation is a nasty side effect and can make the cancer adventure a very miserable experience indeed. Trust me on this - I know from first hand experience.

When the pain has passewd then you will need a medically crafted phase out plan to avoid severe withdrawal symptoms and possibly even convulsions and death. NEVER stop taking "long term" narcotics abruptly.

Some here have mentioned fear from addiction problems. This RARELY happens when people NEED pain management (I wish I COULD have gotten high!). Addiction occurs when people take narcotics when they DON"T need them.