What to Know About Prescription Pain Patches

A pain patch is a transdermal medication used to manage acute (short-term) and chronic (long-term) pain. Common prescription pain patches include:

• Flector (diclofenac epolamine): A nonsteroidal anti-inflammatory drug (NSAID)
• Lidoderm (lidocaine): A local anesthetic
• Duragesic (fentanyl): An opioid pain medication

The patch has an adhesive back that sticks to the skin. It slowly releases the medication into the bloodstream.

This article discusses pain patches, how they work and what they are used to treat. It also explains how to use a pain patch, doses, and side effects.

Pain Patch Uses

Pain patches are prescribed by healthcare providers for patients with various medical conditions. They are commonly used to treat back pain, knee pain, nerve pain, and other types of pain.

Diclofenac Epolamine

For minor injuries, such as muscle sprains and strains, a healthcare provider may prescribe a patch with diclofenac epolamine, an NSAID in the same group of medicines as aspirin and ibuprofen. Also known by the brand name Flector, it can be applied near the area of pain if there’s no broken or damaged skin.

In 2010, a study found that the diclofenac pain patch was associated with significant pain relief for soft-tissue injuries like strains, sprains, and bruises with few adverse effects.

Lidocaine

Lidocaine, also known by the brand name Lidoderm, is available in a prescription pain-relief patch. It’s often prescribed for patients suffering from the pain of shingles (postherpetic neuralgia), which can last for months or years after an infection.

Lidocaine is a local anesthetic that works by stopping nerves from sending pain signals. The topical lidocaine 5% patch starts acting quickly, usually in less than four hours, and is generally well-tolerated, other than mild skin reactions at the application site.

Fentanyl

Healthcare providers may prescribe fentanyl patches for severe, chronic pain, also known by the brand name Duragesic. Fentanyl patches should be used only by patients who can tolerate opioids and those with long-term, severe pain who can’t be treated with other medications.

A 2018 study found that fentanyl patches were as effective as oral morphine in managing moderate to severe cancer pain with fewer side effects, such as nausea and vomiting.

Before Using Pain Patches

Prescription pain-relief patches may be prescribed for patients who are unable to take drugs orally because of stomach irritation or other conditions.

Precautions and Contraindications

Before using a prescription pain-relief patch, talk with your healthcare provider about any allergies you have and if you’re taking any other medications or supplements. Also tell your healthcare provider if you’re pregnant, plan to become pregnant, or are breastfeeding. 

Some drugs may be safer for you to use than others depending on your medical history and the cause of your pain. Your healthcare provider can help you weigh the pros and cons of a medication, including its ability to manage pain and the risk of side effects.

Because fentanyl is a strong opioid, it can be addictive. As such, tell your healthcare provider if you or anyone in your family has abused alcohol, street drugs, or prescription medications, or if you have ever had depression or another mental illness.

Fentanyl patches should only be used by patients who have previously taken and tolerated opioid medications.

Tell your healthcare provider if you have asthma or any condition with slowed breathing, as you may be advised not to use fentanyl patches. Also tell your healthcare provider if you’ve ever had lung disease, a head injury, or any condition that increases pressure in your brain.

Pain Patch Dosage

All listed dosages are according to the drug manufacturers. Check your prescription and talk to your healthcare provider to make sure you’re taking the right dose for you. 

For the Flector patch with 1.3% diclofenac epolamine, the manufacturer’s recommended dose is one patch applied to the most painful area twice a day.

The Lidoderm patch with 5% lidocaine is applied once a day to the painful area for up to 12 hours. Check with your healthcare provider on the number of patches that can be used at once.

The fentanyl patch is typically applied to the skin once every 72 hours. Your healthcare provider may start you on a low dose of fentanyl and gradually increase it, if needed.

How to Take and Store

The adhesive side of the transdermal patch is placed firmly on the skin per label and healthcare provider instructions. Never place a patch in an area for which it is not prescribed, and never use more than one patch at a time unless approved by your healthcare provider.

Patients should wash their hands before and after touching a patch to avoid contaminating the drug and to keep the drug from being applied to an unsafe area such as the eyes or mouth.

Pain-relief patches should only be used on skin that is not broken, cut, or scraped. Do not use a pain-relief patch that has been cut, torn, or damaged unless directed to do so by your healthcare provider.

Store all pain patches at room temperature and away from excess heat. Like all medicines, pain-relief patches should also be stored away from children and pets. The best way to dispose of a patch is to fold it in half, so the adhesive side sticks to itself. A used patch should be thrown away where children and pets won’t come into contact with it.

Pain Patch Side Effects

Prescription pain patches may have side effects depending on the type used. Check with your healthcare provider or pharmacist about what symptoms should warrant discontinuing the medication or seeking medical attention. If you are using a fentanyl patch, your healthcare provider will closely monitor you during treatment to check for any serious side effects. 

Common Side Effects

In some cases, a patch can cause minor irritation, redness, blisters, or a burning sensation where it is applied. These symptoms are usually minor and go away within a few hours. Check with your healthcare provider if symptoms are severe or don’t go away.

Severe Side Effects

Severe side effects are associated with the different types of patches.

NSAID Patches

NSAIDs can increase the risk of heart attack, stroke, and bleeding in the stomach or elsewhere in the gastrointestinal tract. Seek medical attention if you have shortness of breath, slurred speech, nausea, weakness, diarrhea, yellow skin or eyes, indigestion, stomach pain, vomiting blood, blood in bowel movement, or swelling.

Lidocaine Patches

Side effects from the lidocaine patch may include allergic reactions, such as hives, skin rash, itching, difficulty breathing, difficulty swallowing, swelling, hoarseness, fast pulse, fast breathing, unusual thirst, nausea, vomiting, confusion, weakness, dizziness, or fainting.

Symptoms of an overdose can include lightheadedness, nervousness, blurred vision, ringing in the ears, twitching or shaking, seizures, slow heartbeat, or loss of consciousness.

Fentanyl Patches

The fentanyl patch can cause severe side effects such as changes in heartbeat, agitation, hallucinations, fever, sweating, confusion, severe muscle stiffness or twitching, seizures, hives, swelling, hoarseness, or difficulty breathing or swallowing.

While you are using fentanyl patches, you may be told to have a rescue medication called naloxone available in case of overdose. Symptoms of an overdose include difficulty breathing, extreme sleepiness, difficulty talking, trouble with walking, small eye pupils, faintness, dizziness, confusion, and coma (loss of consciousness).

Warnings and Interactions

Be sure your healthcare provider is aware of any other medical conditions you have, including liver or kidney problems and high blood pressure, and any medications and supplements you’re taking. 

Diclofenac Epolamine Patch

The diclofenac epolamine patch can interfere with the effects of other medications or cause drug interactions. Let your healthcare provider know if you’re using anticoagulants, aspirin, ACE inhibitors, angiotensin receptor blockers (ARB), beta-blockers, diuretics, or digoxin.

Lidocaine Patch

Tell your healthcare provider if you are using any medications, including Norpac (disopyramide), Tambocor (flecainide), medications applied to the skin or mouth to treat pain, Mexitil (mexiletine), Ethmozine (moricizine), Procanabid, Pronestyl (procainamide), Rhythmol (propafenone), Quinidex (quinidine), and Tonocard (tocainide).

Fentanyl Patch

When using a fentanyl patch, do not drink alcohol or take street drugs, as it can increase the risk of severe side effects or death. Tell your healthcare provider about any other medications you’re using to avoid life-threatening interactions.

Drugs that can cause a serious interaction include benzodiazepines such as Xanax (alprazolam), Klonopin (clonazepam), Valium (diazepam), and Ativan (lorazepam); medications for mental illness, depression, and nausea; other medications for pain; muscle relaxants; sedatives; sleeping pills; and tranquilizers.

Not all drug interactions are listed here, so always let your healthcare provider know about any medicines or supplements you're taking before you start using a fentanyl patch.

Fentanyl patches can be dangerous in the wrong hands or if applied improperly. The U.S. Food and Drug Administration (FDA) has issued warnings about fentanyl patch safety after a number of accidental overdoses were reported.

Overdoses have occurred when more than one patch is used at a time when a patient applies heat to the patch and when a non-patient—such as a child—accidentally comes into contact with a patch. According to the FDA, young children have died from accidental exposure when putting it in their mouth or applying it to their skin.

In 2013, the FDA required color changes on the writing of Duragesic (fentanyl) patches. The change was made so patients could more easily see the patches and notice when they fall off to avoid accidental exposure to kids and pets.

The FDA also reminded that fentanyl patches are dangerous even after being used because they still contain high amounts of opioids. Used fentanyl patches should be folded with the sticky sides together and flushed down the toilet.

A Word From Verywell

If you have any questions about pain patches' use, efficacy, or safety, please discuss these concerns with your healthcare provider. Although pain patches can be effective, they need to be used safely, properly, and under the guidance of your healthcare provider. Take safety warnings seriously to protect both yourself and others.