Fentanyl patches do nothing for me. The only opioids I take for chronic pain syndrome are Roxicodone 30mg: 4hrs and Methadone 10mg : 8hrs. I add Clonidine 0.3mg: 8hrs to increase the effectiveness of the narcotic & added comfort. Fentanyl IV is not very good either & is more like speed compared to standard pain killers from morphine and thebaine.
The best combo for pain treatment for oral is Roxicodone & Methadone. Best IV is hydromorphone, oxymorphone, and demerol.
Mallinckrodt's brand name Roxicodone & generic Oxycodone can be dissolved under the tongue for a 4 times best first pass effect and lasts 3 times as long vs oral swallow. The RP 30's suck. The K9 30's also dissolve under the tongue but not as good as Mallinckrot. Many people have slept on this route. I have been prescribed the 30's for the past 14 years and recently had to dissolve them under the tongue for them to work at all.