Suboxone- Pain management

I don't know.  I know that the target dose for withdrawl is 8-16 mg per day.  This is supposed to be equivalent to 60mg of Methadone.  You can use up to 32 mg per day.  It comes in 2mg, 4mg, and 8mg sublingual tablets.  My one patient had tried isuboxone before.  He was given 2mg then 4mg, but this did not help his pain. 

Not to dog you or anything, but could hoarding pills for later use and not following your doctor's instructions be part of the reason you got into trouble with opiates in the first place?

"We have met the enemy and he is us"

 Facedown- those methadone patients who take benzos and get messed up don't necessarily represent all methadone users. Of course the media picks the most sensational cases to report. I saw a program on cable called "Methadonia" and it was obvious they picked all the people that weren't seriously trying to get it together (in plain lingo, they picked the %?#$$-ups). Ask the original poster- he'll tell probably tell you methadone is a life-saver.

  Yes, the withdrawals are horrible...you have to know going in that if you decide to get off, it will be slow going.

 End of speech. :-)

 Best to all.

 "The first casualty of war is the truth"

"We have met the enemy and he is us"

 Can someone cite the study or literature that says sub is the most common drug for pain management in Europe? I find it hard to beleive. Thanks.

Roberts, DM, et al, Anesthesia Intensive Care 2005;33(1):17-25

"Buprenorphine has unique pharmacological properties making it well suited for use as a maintenance therapy in opioid dependence. However, these same properties may cause difficulty in the perioperative management of pain. Buprenorphine is a partial opioid agonist, attenuating the effects of supplemental illicit or therapeutic opioid agonists. As a result of its high receptor affinity, supplemental opioids do not readily displace buprenorphine from the opioid receptor in standard doses. High-dose buprenorphine has an extended duration of action that prolongs both of these effects. The perioperative management of patients stabilized on high-dose buprenorphine and undergoing surgery requires consideration of the likely analgesic requirements. Where possible the buprenorphine should be continued. Pain management should focus on maximizing non-opioid analgesia, local anaesthesia and non-pharmacological techniques. Where pain may not be adequately relieved by these methods, the addition of a full opioid agonist such as fentanyl or morphine at appropriate doses should be considered, accompanied by close monitoring in a high dependency unit. In situations where this regimen is unlikely to be effective, preoperative conversion to morphine or methadone may be an option."

I am glad you had such success.  Are you still taking Suboxone or Subutex for pain relief?  How does it compare to the straight agonists for pain relief?  It does seem to be a terrific drug for narcotic withdrawl, and I think the DEA restrictions on it's use for withdrawl by specially licensed doctors and for limited numbers of patients is stupid.  In my experience, most people who have used it for withdrawl started out as chronic pain patients.   

I put a couple of posts earlier in this thread about acute pain management for people on suboxone.  My problem is it does not seem to be working for chronic pain for my suboxone patient.  He went from 75mcg/hour of fentanyl TD to Suboxone.  Titrated him up to 32 mg/day with only about half the relief he was getting from the fentanyl.  On the other hand he worked 40 hours in the past four days and is working for the first time in about a year.  Tramadol was inadequate for breakthrough.   I tried him on Dilaudid 8-16mg every 6 hours as needed for breakthrough pain.  He had no withdrawl symptoms and did report pain relief.

As you noted, it is hard to separate pain relief from the euphoria some people feel on narcotics.  I am not 100% sure which one my patient is responding to.

Suboxone is usually only prescribed to recovering heroin addicts trying to clean up their lives. You will only be prescribe this drug if u A) was on methadone and lowered you levels downs to 25MG. Methadone as well gets a bad wrap of course if you go into using this drug with bad intentions and do not want to get help well that's what will happen. Tricking a doctor into giving you a dose that is above what you need will only punish you in the long run. I was on methadone, stared at 50 then went up to 100 gradually mind you. Since then over the past six months i have been lowering my dose. Now i am at 35mg. It has taking some time but i find it that is much better then the cold turkey method. You have a much much higher percentage of never using drugs again. If u were on method a Doctor will only prescribe you suboxone at 20MG or lower. Doing that would defeat the whole purpose of the progress you had made up to that point. Methadone is an opiate blocker. Suboxone with still allow you to have opiates in your system. There is no easy answer but with the right will power and support from loved ones you can do ANYTHING. Removing you body from opiates forever is not a snap of you fingers it takes time and will power/ We all dug this hole for ourselves we all got to get out of it

Mike

Good luck Mike on fighting for your health and your family.  I hope Methadone works for you.  I don't think you have your facts right about Suboxone though, and talking to your doctor might be helpful.  Using Suboxone is a lot easier than going to methadone clinic every day once you are in a stable phase of recovery. 

I am addicted and need oxy 40mg and roxi 30mg, but I am not worried about it unless I run out because all in all it takes care of my pain and that works for me if I can get up and feel like doing something I am straight.... If I run out I am screwed.... But Good Luck To You...

Steph

I think it is worth a try if I see an appropriate patient, someone with chronic pain and a history of substance abuse or at risk for substance abuse.

My chronic pain guy was in yesterday and requested to go back on suboxone.  He had lost his job, so he wasn't sore from working ten hours a day, and was back up to 100mcg/hour of fentanyl.  I suggested he cut back on the fentanyl and see if his pain was controlled on 25-50mcg/hour and then switch to suboxone. 

I am still unclear about why he wanted to go back on Suboxone, but I think it may have had to do with the temptation to go back on heroin, but he did not say anything like this to me.

Ask your doctor about a  higher dosage of suboxone (8 mg 4x per day), ultram, or stadol which is also a mixed agonist/antagonist.  Pain in people with a history of addiction is really tough. 

stadol is not buprenorphine, it is butorphanol not sure what the main difference is but when i used stadol it really did absolutely nothing for me. peace baby bye

I wonder if people who say suboxone is not helpful for pain, are actually finding it does not give them the mood elevation that they get from narcotics, or because they "can't feel it working" because they associate being a little high or buzzed with getting pain relief.  Any comments? 

Hey there Gtrplayer, and others. I just posted a few comments and later a few questions on the "Suboxone gave me back and saved my life" forum topic. Please jump in with your thoughts if you would.Same topic as here.  Thanks

'My one patient'...Where did you get your degree?

I've never known ANYONE to take 32 mg of Subutex! That's outrageous. What Dr says ' Dog you'??

I don't believe for one minute that you're a physician and if you are I would love to know where you work.

People should NOT give advise about things they know nothing about. Period.  I'm from England and that is how we spell ADVISE, so don't bother correcting me. I guess you attended the school that didn't require grammar as a pre req..

People please talk with your primary care physician and not depend on message boards for medical advise. These are fine for discussing the medications you're on but it's never ok for some crack pot to give medical direction.

I am really sorry that you did not understand my post (or my grammer).  I do not give medical advice, but I do discuss the indications for drugs, common off-label uses, relative potency, and dosage recommendations.  So does the PDR. 

Doctors in the US are encouraged to use the language of their patients. This is not even a patient or the office, let alone a PhD thesis, it is a message board! To dog someone, meaning to nag or hound (another cainine verb), is a common colloquialism in my neck of the woods. 

People give advice about things they know nothing about all the time.  I try to give information that is accurate. I never give medical advice on the internet, but often give advice on how to negotiate medical encounters.  It is up to each one of us to validate the information we collect by comparing several sources.

I am sorry you had such a terrible time with suboxone.  I am currently rather discouraged by the lack clinical efficacy of buprenorphone for pain management.  It may be effective in opiate naive people, but in opioid experienced or in opioid addicted people, it is not proving very useful for pain management.  What I have heard from patients and addiction specialists regarding buprenorphone's effectiveness in preventing narcotic withdrawl and relapse, is that it is quite effective.  Quite the opposite of what you experienced.     

Regarding the maximum recommended dosage of Subutex, in the US, for quick reference go to one of the approved suboxone certification training sites like: http://www1.buprenorphinecme.com/PageReq?

"The recommended buprenorphine dose is 12 to 16 mg/day for opioid-dependent patients; patients who are not opioid dependent may require a lower dose. The minimum effective dose has been found to be 8 mg/day, and the maximum dose is 32 mg/day. Most patients can be started and maintained on the combination tablet. Of course, every patient is different, so there is no absolute standard."

Standards of medical care do vary by country.  The recommendations in England may be quite different than in the US.

Do you know what an "ad hominim" attack is?  They are generally frowned upon, and do not lend credibility to the attacker.

From what my doc told me when perscribing my suboxone is that the Nalox stuff in suboxone does get 1% absorbed and causes headaches. So my doc said for patients who have this problem and can be trusted not to abuse it, they are switched to subutex. Only downside is it's $3 more a pill.

I can relate mikeou812..never been on sub, but I have been on and off pain meds for several years due to chronic pain issues and am up against the same situation in regards to the increase in pain when the meds are stopped. I wish I didn't have to take anything, but when I discontinue pain meds the pain skyrockets and I end up either being in bed or sitting in a chair, so I opt for the medication..it gives me my mobility and makes the difference between nite and day.

Hello, I have been thinking bout this for a few days and have to chime in on it. I have been on and off pain meds for a while. I went on suboxone for a few months and my dr, doesnt do maintenace just 2 to 3 month detox, so he sent me to another dr and i just recently started suboxone again. I choose to because my cravings are just over whelming and I have no problem walking into a "walk in clinic" or "emergency clinic" and walking out with scripts for 100 percocet, 80 vicoprofin, and so on. I have done it many many times and i DONT want to any more. I sustained a injury on my hand at work about a year and a a half ago and the pain is redicioulous. I do not want to get back on the pain meds, so i am back on suboxone. I am a meatcutter, just like the one you see at your local grocery store hahahah, I use my hand for 8 hours a day cutting meat and oh boy it hurts like blazes, BUT when i dose 8mg before work per my doctor orders I can bear the pain, it doesnt take it all away but sure does help......I dont know bout anyone else but it does for me.... and thats all I take is 8mg daily..I have the option of another 4mg later in the day but I usually never do and I bring the extra pills with me to my appointment and my dr uses them towards my next script he is very very strict.

I didn't think Suboxone was an opiod i thought that it was just used for getting of of opiods and drugs i never heard of it being used for patients with chronic pain.

Actually Suboxone isn't either an agonist or an antagonist.  Buphinoripnine is a partial opiate agonist, and naloxone is an opiate antagonist.  Since Suboxone combines the two it is a combination partial opiate agonist/opiate antagonist 4:1 ratio.

Check with a licensed MD before you take any suggestions!

i tried df 118 30 mg continous on top of subutex once , and within 10 mins was in withdrawels

subutex if swallowed has absolutely no effect what so ever................ not one iota.... must be taken sublingually.

(edited by admin)

hi dont know if its too late to respond but just read your question about suboxone being used as a relief for chronic pain. ABSOLUTELY NOT!! dont mind getting personal about it but just dont have time to get into right now. but as quickly as i can put it for u, suboxone is used to get people off of opiates, ex: vicodin, oxicontin, percocet, heroin, etc. it is a opiate blocker as a matter of fact and is used to stop u from going through withdrawls after being on any kind of opiates for a long period of time. stops u from getting sick. and also has to be weened off of. works fabulous but not even close or in same catagory of a painkiller. hope that helps a little for u. if u have any other questions feel free to write back. but whoever told u that, not a clue. hope to god not a doctor!

danielle