I think the amount of fentanyl must be different with the matrix/non matrix patches. Prehaps you could ask your doctor for the matrix-type patches (could say something like "I heard they stick better" or "I'm afraid of the gel leaking out" - whatever) if they aren't much more expensive or unavailable. Another benefit of the matrix-type patches is that they can be divided into non standard doses, you can cut them in half if your doctor wishes it, without any gel leaking out/loss of adhesive.
I've been on chronic pain medication for "only" ~3years so I understand to a certain degree what you are talking about, both concerning tolerance and concerning doctors. Regarding tolerance, prehaps you could try certain inpatient procedures like lingocain or ketamine infusions. Again the availability of treatments varies depending on geographical location (I'm in Australia), but the lingocaine may help because it can reduce pain and therefore the amount of opiates you use for up to a fortnight, which in turn may reduce your tolerance thereafter. The ketamine (either infusion or take home doses, depending on availability of routes of administration, I receive it in sublingal lozenge form) works by reducing pain and working to potentiate the effects of the opiates, but some people (including myself) feel that it also reduces tolerance to opiates.
Your relationships with your doctors is very important, because as you know if it is poor they will mistake your search for pain relief as a search for drugs, this has also happened to me. If they say you are exhibiting drug seeking behaviour to your face, tell them that they should know that the same behaviour is also exhibited by pain patients with inadequate pain relief. Also prehaps ask them questions, such as why they think you aren't in pain etc.
My advice is also to find one pain management specialist that you can forge a good working relationship with and try to receive all of your scripts from him. Not only will this save you time seeing multiple doctors, but it will also reduce the chances that you will be accussed of doctor-shopping or drug seeking behaviour because you will only be receiving medication from one doctor.
Glad to try and help
I appreciate the advice. I have thought about all of this for quite a while. As I said Ive been having problems for over 15 years. To start with I had a great doctor and everything was fine for a few years. Eventually he retired though and I moved to a different state where I was able to find another good doctor. Since I have moved back to Louisiana thought I havent had very good luck. I have a primary care physician which made me go to pain management, which I didnt mind at all. The pain doctor had me on a pretty good regimend, though it still wasnt as effective as past experiences, Im assuming because my tolerance has become so high over the years. Unfortunately the pain doctor has now moved away and Im stuck going back to my primary care physician, which say straight out they are not pain management and will not deal with pain management needs. The only reason she is doing anything for me is because I am disabled and receive Medicaid (government medical insurance) and physicians who accept Medicaid are limited (Medicaid actually gives you a doctor in your area for you to go to). I have to admit I have seen many many MANY people in that clinic who are there just to try to get pain meds or xanax or something else for a buzz, and it does hurt people like me. I wont lie and say I dont like a buzz, but Id rather not hurt at all than have a buzz. When I moved back here from Texas I was on 6x10mg hydrocodone a day, which worked fairly well, although sometimes it didnt do the job either. Once back here I was immediately dropped down to 3x10mg hydrocodone a day, which needless to say was pointless. The pain doc then added a 10mg methadone a day to be taken in the morning. It helped but didnt last throughout the day, so she then added another to be taken in the evening, which put me taking 3x10mg hydrocodone and 2x10mg methadone a day. Honestly I didnt like the methadone though. I knew I was getting very addicted and so I told the doctor I have now about my feelings and she took me off of it, giving me 4x10mg hydrocodone a day. If I lay in bed and do absolutely nothing all day this might be sufficient (though I doubt it), but I do try to work and do things to keep from becoming just a blob, and doing so increases my pain. I told my doctor of this recently, told her that I understood there are people with drug seeking behavior and some people just want more. I actually told them Id like to switch to something completely different because Id been taking the hydrocodone for so many years and I didnt want to take the methadone, so thats when she told me about the fent patches. She only gave me a weeks supply (I went last week, will be going back tomorrow) and wanted me to come back in a week to see how things are doing. When she gave me the patches she cut the hydrocodone down from 4 to 3 a day though, which kinda defeats the purpose in my opinion. Add something and take away, when something just needs to be added. She talks all the time about how addictive opiates/oids/narcotics are though and she doesnt like writing them and she wants me off of them and blah blah blah. I just want to not hurt. If Flintstone vitamins made me not hurt Id be addicted as hell to them. I personally thought doctors had to have some knowledge of psychology too. For them just to point a finger and say "druggy" is just way wrong in my opinion. Yeah I know theres people just looking for a high, but some people just want to stop hurting. I was actually told "Everyone hurts sometimes, you just need to deal with it". I mean what the hell?! Deal with it? I have lymphedema in my left leg which makes it as swollen as a normal persons body, Ive ripped my left knee out of place 4 times which hurts like hell if Im up on it doing anything (if Im sitting or laying I have to change position every couple of minutes), I have disk disease of some sort in my back and spondelosis (sp?) in my lower back. Cant sleep on my back at all, cant sleep on my left side due to my leg, cant sleep on my stomach because it also hurts my back, so that leaves the right side, which causes my legs to burn down my thighs and starts hurting like hell after a few minutes. Ive been over this numerous times with them and they act like its something I need to just live with or it will go away or something. I have a friend that was in a very bad wreck some years ago and he was on all types of pain meds, including 80mg oxycontins for a while. His doctor is now giving him Subutex/Suboxone and says its the greatest thing ever invented. He said where he was taking SO much pain meds he can take one of these 2 or 3 times a day (8mg each I think) and he is good to go.
Anyway, I realize Im rambling again, just wanted to give everyone an idea of exactly what my problems are. I will certainly write these meds down that you have advised me on and talk to her about them. Also, do you really think the other patches are better than the gel ones? Ive been reading a lot on this stuff the last few days and some people say they are better, some say they arent. I know these arent doing anything that I can notice. No pain reduction, no high or buzz of any kind, nothing but irritated skin where I have the patch. Maybe a higher dosage also? Anyway, thanks for the help/advice. Maybe with everything people have been telling me I can get something worked out with my doc and not have her calling me a doper.
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Of course overdosing scares me a little but I do know I have a very high tolerance and I know my limit, so I really dont see me doing anything TOO stupid. I just want the stuff to work. 
