Opioid painkilling patches

What are painkilling patches and how are they used?

Painkilling patches are used to treat some types of long-term pain.

They are prescribed by a doctor when other types of pain relief have not been able to manage your pain.

These patches usually contain opioid (oh-pee-oyd) drugs. There are two types of opioids which are available as patches: buprenorphine (buu-pre-nor-feen) and fentanyl (fen-ta-nil). Both come in different strengths.

These patches come in two different designs: reservoir (re-zer-vwar) or matrix (may-tricks).

A reservoir patch has the liquid drug contained in the middle of the patch. Matrix patches have the drug spread evenly throughout the whole patch. Matrix patches are generally more popular.

Opioids can help some types of pain for some people, but not always and not for everyone. Before starting to use painkilling patches, you and your doctor should agree the goals of your treatment. This could include being able to carry out a particular activity.

The next step is to try a prescription for short-term opioids, such as low-dose oral morphine (more-feen), for a week or so. This will help you find out if opioids are likely to help you. If opioids such as morphine don’t achieve the goals you’ve set, then a higher dose, or switching to a patch, is unlikely to be any better.

If you’re taking opioids long term, then it’s important to have this regularly reviewed with your healthcare team. This is especially true if you’re also taking with other drugs like pregabalin (prey-gab-a-lin) or gabaptentin (gab-a-pen-tin).

You should talk to your doctor about gradually reducing your dose, and coming off treatments that aren’t helpful if:

  • you don’t feel that opioids are working for you
  • the side effects aren’t worth the benefits.

How do I put on a painkilling patch?

The skin you put the patch on must:

  • be clean
  • be dry
  • be free of any hair - if you can’t put the patch on an area without hair, the hairs should be cut with a pair of scissors. Do not shave them
  • be on your upper body - good places to stick patches are the upper back, upper outer arm, on your chest, or to the side of your chest.

You can wash the area you stick the patch with cold or lukewarm water. Do not use soap, cream, oil or lotions, as this may stop the patch from sticking to your skin.

If you’ve had a hot bath or shower, wait until your skin is completely dry and cool.

Don’t apply the patch to any area with large scars. Also try to put the patch in different places each time you use it, as using it on the same area of skin each time may cause a rash.

How long do painkilling patches last for?

Painkilling patches can last from three to seven days.

Each patch is different, so make sure you read the patient information leaflet, as this will tell you how long to leave it on for. After removing the patch, you may still feel the effects for a few hours.

Do not apply extra patches. It is important that only the prescribed amount is worn at any one time.

Should I be careful about using opioid patches?

You should be cautious of using painkilling patches if you:

  • have problems with your adrenal glands, bowels or biliary tract
  • have convulsions
  • are elderly
  • have low blood pressure
  • have an underactive thyroid (th-eye-royd)
  • have respiratory issues, such as chronic obstructive pulmonary disorder (COPD) or asthma
  • have myasthenia gravis (my-ass-thee-nee-er gra-viss)
  • have an enlarged prostate
  • have liver problems
  • a narrow urethra
  • any form of addiction, alcohol or substance abuse
  • are pregnant or breastfeeding.

Fentanyl patches should not be prescribed to patients who have not used opioid treatments before, such as morphine.

Certain drugs may interact with painkilling patches. You should tell your doctor what drugs you are taking before you are prescribed a painkilling patch. Also let your doctor know that you are using a patch when starting any new medication.

Can I use a hot-water bottle while wearing a painkilling patch?

Extreme heat will increase the absorption of the drug into your bloodstream, so sources of heat should not be placed near the patch.

This includes:

  • hot-water bottles
  • electric blankets
  • heat lamps
  • heated water beds
  • microwavable heat packs.

Can I take a bath, have a shower or swim with my painkilling patch on?

Yes. However, you must be careful about washing the area of your body where the patch is. It is also important not to bathe or shower in hot water.

Possible risks and side effects

Painkilling patches are safe, and most people who use them don’t have any side effects. Some people do experience mild side effects, which can include:

  • having an irregular heartbeat
  • feeling confused
  • feeling dizzy
  • having a dry mouth
  • high mood
  • flushed skin on your face
  • hallucinations (seeing things that aren’t there)
  • sweating more than usual
  • eye problems
  • skin problems
  • vertigo
  • itching
  • feeling sick
  • being sick
  • lower blood pressure
  • difficulty having a wee
  • constipation.

Opioid medication, including painkilling patches, can carry a risk of addiction. This is unlikely to happen, but if you are worried, speak to your doctor.

Can I take other medicines while using painkilling patches?

Painkilling patches can interact with some medicines. If you’re taking other medication or using complementary treatments, speak to your doctor to find out how this many affect you.

Vaccinations

You can have vaccinations while using painkilling patches.

Alcohol

You shouldn’t drink alcohol when using painkilling patches, as using both together can make you feel drowsy.

Fertility, pregnancy and breastfeeding

It is not known whether painkilling patches affect fertility.

Painkilling patches should not be used during pregnancy unless necessary. The risk to pregnant women using painkilling patches is not known, although fentanyl used as an anaesthetic (an-ass-thet-ic) has been shown to cross the placenta.

Newborn babies whose mothers used painkilling patches during pregnancy have been seen to have withdrawal symptoms.

It is recommended that you do not breastfeed while using painkilling patches and for three days after taking the patch off. This is because the opioid drugs can pass in to your breastmilk.

Driving

It is illegal in England and Wales to drive when taking prescription drugs if this affects your ability to drive.

Talk to your doctor about whether you should drive if you’ve been prescribed any of the following:

  • amphetamine
  • clonazepam
  • diazepam
  • flunitrazepam
  • lorazepam
  • methadone
  • morphine or opiate and opioid-based drugs – such as codeine, tramadol or fentanyl
  • oxazepam
  • temazepam.

You can drive after taking these drugs if:

  • you’ve been prescribed them and followed advice on how to take them
  • they aren’t causing you to be unfit to drive, even if you’re above the specified limits.

The law doesn’t cover Northern Ireland and Scotland, but you can still be arrested if you’re unfit to drive.