Butrans Pain Management System for RA


I wanted to write a specific post about the Butrans pain patch for control of chronic pain that is moderate to severe because it has changed my life, but I’ve found in talking to other RA patients and them in turn asking their physicians about it, that there is some confusion with this newer pain medication system and the pain patches used by cancer patients. Because of lack of knowledge about this patch, patients are having to educate their physicians. So, I wanted to give you the scoop because I find it senseless for RA patients to suffer the way we do day in and day out with pain eroding our hopes and dreams.

Butrans is a patch worn on the skin for 7 days at a time that contains buprenorphine, an opioid pain medication, which is a narcotic. The Butrans skin patch is used to treat moderate to severe chronic pain around the clock so it is not ordered for those with bursts of intermittent pain or for those needing pain control for a short time. It comes in several different strengths: 5mcg, 10mcg, 15mcg, and 20mcg. I am on the 10mcg patch. Because Butrans was made for the chronic pain sufferer, it makes it perfect for those of us with moderate to severe forms of autoimmune disease experiencing chronic pain. The patch is small, about 2 1/2″ wide and 2″ tall, and is flesh colored and easy to wear. It looks like a large band-aid. The material on the patch is breathable, but waterproof so you can shower with it on without fear of it coming off. You do have to be careful with the storage and disposal of this medication, especially if you have children who can get into your medications as the patch could be fatal to a child. As a nurse, I recommend any patient taking narcotics keep their medications in a lock box with a combination lock for the safety of others and for safe keeping.

Butrans has kept my pain levels controlled to “background noise” when my body is at rest.  Prior to Butrans I was on a low dose oral pain pill but it was not enough to adequately control my pain. In adding the Butrans pain patch to my regimen, my pain has been significantly better. Disclaimer: Butrans is not a cure all! I’ve had S-RA and other autoimmune disease for 5 years that has gone unchecked by biological agents so I have permanent damage and active disease. I still have pain every day, hour, and minute but the pain no longer makes me want to stop breathing to escape it. I continue to have flares because I have active disease, but the pain isn’t so severe I walk the floor crying or have to go to the ER to determine if I’m having a heart attack or just  a nasty round of costochondritis. When this happens now, I am able to take a low dose pain pill (the one I was on pre-patch) and a low dose muscle relaxer.  When the pain breaks through the control of the patch this is called breakthrough pain and it will require treatment plan because it is inevitable. This is why I warn that you can’t just get on this patch and expect to have no pain and it does not treat fatigue, inflammation, or other symptoms of RA. I want to be clear about that as not to mislead anyone.

For the last year I’ve heard many stories like mine from moderate to severe chronic pain sufferers, but few have known about Butrans. There was such a huge gap in adequate pain medication coverage when Darvocet was removed from the market. Many people, like me, are allergic to the first line choice of most doctors which is Lortab. Finding a oral pain medication that worked was difficult and I struggled through needless months and years of pain because there was nothing for me. I either took the lower dose medication that was inadequate or I was facing skipping over the level of coverage that Darvocet provided and going on up the narcotic ladder to morphine or stronger. I did not want to do that. I’m very cautious about taking pain medications. When I learned about Butrans through a brochure given to me by my doctor, it seemed like the answer that was appropriate for me.

What have found in trying to educate others about this new patch, is that a lot of doctors don’t know about it and when their patients ask for it, they make the wrong assumption that they are asking for the pain patch known as Duragesic (fentanyl in generic form) that is worn by cancer patients 3 days at a time, that comes in different mcg doses,and is clear in color. Docs are afraid to prescribe this very strong narcotic for fear of non-cancer patients dying in their sleep from the overdose! So, when the patient asks for a “pain patch” because they can’t remember the name “Butrans” the doctor either freaks thinking you are drug seeking for this stronger patch or they simply haven’t heard of the Butrans patch because it is a newer drug and assume you are talking about the stronger patches worn by cancer patients.

If you decide you would like to know more about the Butrans patch this link has the best comprehensive information in laymen’s terms that I’ve found: http://www.drugs.com/butrans.html. You may also wish to visit the drug website at  http://www.butrans.com to print prescribing information for your physician if you are interested in trying this form of pain management. I do strongly recommend that you print the information and take it to your primary care physician so they can learn about Butrans and together, you can see if it is right for you. Most likely your rheumatologist will not prescribe this medication for you as they rarely treat pain. I’m providing this information as another alternative to those who suffer with debilitating pain who have not responded well to low dose prescription pain medication.

4 responses »

  1. I’d just like to share that I, too, wear the Butrans patch. When I first asked about it, the doctor I was seeing at the time simply said, “We don’t prescribe patches.” I changed PCP’s and my new doc actually suggested the Butrans patch. It has made such a positive difference in my life. I don’t get up every morning feeling as though a train ran over me in my sleep. Thank you, Mischelle, for telling me about this patch. It has greatly improved my quality of life!

  2. I wore Butrans patches for 2 years. Then my insurance changed and my Medicare Plan-D does not cover Butrans. I would LOVE to go back to it! Hydrocodone is totally inadequate on most days. {Start whine]:I HATE not being active – going places, doing things, learning to garden, learning to knit. I’m terribly tired of being told our income is too high for assistance. If we bought all the medications we are supposed to, our monthly bill would exceed our income. Give me a break! [OK, whine over].

    • I’ve been researching Part D plans as I’m eligible for Medicare in April. Since Butrans is a brand name, there aren’t very many plans that will help cover the cost at all. It is difficult knowing which part D plan to choose because I take so many medications per day. If you find a plan that covers one of your most expensive drugs, it may not cover the second most expensive drug. I can see why many people living on a fixed income do without. Thank you for replying to Facets of Living with RA. God bless you!

  3. Hi, my name is Jeanette. Bless you Mischelle for passing this info along. I will check with my yet another, RA doctor when I see her 6/19. I have had severe RA for over 10 yrs with no relief from anything, (Methotrexate, Arava, Remicade, Actemra, Xeljanz etc). Sometimes I feel as I have not been accurately diagnosed. Every year I am more crippled and with no relief from pain as I cannot tolerate narcotics. I would feel so blessed just to receive some pain relief. I am almost entirely housebound now. For all of you who suffer with RA, I identify and have so much compassion for you.
    I would love to find a natural cure for us. The meds for RA have such serious side-effects. I will stay in touch Mischelle.

    With love and kind of spirit to kindest of spirits.

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