Suboxone- Pain management

real quick, suboxone, subutex  does NOTHING, NADA, FOR PAIN!!!   stops withdrawls from abusing painkillers!! i know for a fact, trust me.

I was prescribed 'valaron' I have never heard of Suboxone.

<> Valaron is a high dose opiod analgesic. When I decided to ween off the medication, and use alternative therapies to treat the majority of my pain, I had absolutely NO withdrawl symptoms. Unlike the Oxy's and Roxi's (and other codiene derivitives) and even the Fentenyl patch, which when I was 1st DXed in the late 80s in the USA - heavy withdrawls. Was in Europe for over 15yrs and do believe their treatments are superior to the USA.

Europe does not allow meds like Benzos and Stadol to be prescribed - these are as illegal as herion.

<> Moved back stateside last year, and having a hard time getting pain management w/o the high addictive & breakthru pain problems. Back on the Vico apap/IBU rollercoaster (sadly).......

SpiritEyes

iv been taking suboxone for 3 months now for cronic pain and i think its all in your head im not really sure it works for pain like they say it does i take 8mg 3 times a day im not really sur it helps as much as the oxy's i was taking but i know it helps with not wanting and they also told me if i took both i would get really sick then i went for my injections i get in my back and they gave me morphine with i didnt get sick so the not being able to take both is bull too and i dont think its that good for pain eather it helps but not like real painkillers but i guess its not that bad but for really bad pain stick to painkillers for small and long pain suboxone isnt that bad

certainly not a professional, only personal experience

suboxone was never meant to be a pain suppressant. it woks wonders when one becomes addicted to opiates. its turly a wonder drug. i allows one to feel the same way before they started using opiates to maslk other things. its intention is to allow one to forego the depths of withdrawal and continue to acting like a normal part of society. i know from personal experience. i've currently been on it for 6 months now. it does not allow one to get high from it, rather it allows them to lead a normal life without going threw withfrawal. it is not intended for pain relief of anykind, just prblems related to withdrawal.

I've been wondering about this more and more since I started on Suboxone about 3 weeks ago as the result of an opioid addiction (specifically to OxyContin, which was legally prescribed to me for ongoing back pain/disc degeneration/sciatica, for which I finally had a micro/lumbardiscectomy procedure last year, which did wonders as far as getting rid of the legitimate pain I was experiencing on a daily basis).

Anyway, at that point I had gotten quite fond of many members of the opioid family and had already stopped taking the OxyContin as directed (i.e., I was not swallowing 1 pill every 8-12 hours per my MD's directions -- without getting into detail since that's not permitted on this board, I learned other ways in which they could be ingested -- but as a result of this education, I could now easily finish off a month's worth supply, which at the time was #60 OxyContin 20mg BID, in about a week...sometimes even a little less). My tolerance grew to levels I never thought possible. I also knew that the #50 Percocet 5/325 my orthopedic surgeon prescribed for the post-surgery pain wouldn't last long. In any event, I keep hearing two seemingly completely separate schools of thought on the following:

Taking a pure opiate agonist while on Suboxone for opioid dependence/addiction: Most of the research I've done makes it sound like as long as you've got enough Suboxone remaining in your opiate receptors at the time a pure opiate agonist is administered (and if you're following your Suboxone regimen, which I am to the letter, you should know that it has a long half-life, so it could conceivably still be in your system even if you haven't taken one for 2 or 3 days?) For example, as the result of a hospital/emergency type of situation (a serious car accident, broken bones, etc.), you're normally immediately administered IV morphine or Dilaudid, or whatever IV narcotic pain medication most hospitals use to help ease that kind of severe pain - will have little to no effect because some residual Suboxone is still in "control" of your own opiate receptors? The Suboxone is still blocking any or all of the pure opiate agonist you've just been dosed with from doing its thing?

My understanding is that another reason why Suboxone works so well in getting one's opiate addiction under control is because of this exact reason: even if one slipped/relapsed and took an OxyContin or a Percocet tablet while concurrently undergoing Suboxone treatment, the patient on a Suboxone regimen wouldn't feel the resultant euphoria/"high"/pain relief that they'd come to expect to feel in the past and was what made that particular drug so appealing that one became addicted to it in the first place ? So what are the hospital's options in relieving or at least attempting to lessen your pain? Just put you under a general anesthesia and do what they need to do, or give you a high dosage of IV Buprenex (which is just another brand name for buprenorphine), the same medicine that's in Suboxone/Subutex tabs, just in injectable form and with no naloxone added [except in Suboxone's case.]

However, I believe in one of the really long Suboxone threads from last summer/fall, several people who were going through addiction programs with Suboxone as the primary ingredient (in addition to psychotherapy, counseling, etc.) claimed that "Suboxone sucks," particularly since they were able to still use one or more OxyContin tabs, and it got them to the same "place" as it did before they started on Suboxone? Are there highly individual reasons for this - i.e. why someone can be on Suboxone, yet continue to take the very drugs they're supposedly trying to get off of? (all of the -codones, OC's, etc.) Personally knowing that that couldn't (or shouldn't) happen was one of the biggest selling points for me - that even I happened to come across a Percocet, taking it just to get that "buzz" would be for naught since the Suboxone basically won't let a pure opioid agonist's receptors enter the opiate receptors of the individual trying to get off of them? So far every time I've gone to my addiction doctor one of the first things that happens is a urine test - I'm not sure if it's just to make sure patients are taking their Suboxone as prescribed (I can't see why someone wouldn't, considering they're about $6/pill) or are they still taking the pure agonist narcs that they've paid (and are still paying to get off of?

I realize I've asked about 30 questions in this one post, and I certainly don't expect them all to be answered, but if someone could shed some light on some of the concerns I brought up I'd be most grateful, as there's still very little real research that's I, at least, have been unable to locate on the Web. There are a number of sites that laud Suboxone's benefits (and rightly so in my opinion) but apparently it's not as cut and dry as I'd been led to believe.

Thanks for reading. If anyone has some comments, feedback, or whatever, please feel free to contribute/correct/clarify.

~qh

bubjr

naloxone is only there to prevent iv use and my theory anyway is that it isn't needed its a way to patent it(have you noticed how much suboxone costs) and it might be a way to legitamize it.  Put two generic drugs together and you have a whole new drug, at least as far as drug companies are concerned

Kirby is correct...Suboxone is a medication used to help Opiod addicts "Kick the Habit"....very similar to Heroine Addicts using Methodone to get off Heroine.

Well lets start with a quick history. I have had 3 lwr. laminectomies(starting at L5/S1 and up) and now even a cervical fusion from C3 to C7. This all began over 10 years ago. My left leg has been asleep and very painful for that time+. The fusion was done 1.5 yrs ago and my left arm is also a problem now. Over the years I have been on it all. Well here comes the meds. I have been prescribed at one point 6 80mg. Oxycontins every 12hrs. You get immune and need more and more. I even went cold turkey of 6/80's(YES 6-80MG. TABS).  So I how bad it can get. This was because that was not even working anymore. Did it to lower my immunity.  My doctor at that time was not scared of the DEA but that has changed. Just about 8 months ago he cut the dose back to where there was no help. Would not raise it again and we had a falling out. Today finally at a new pain clinic they are actually starting me on suboxone. So give me a week and I have some answers for you. And oh yea as far as getting high on pain pills. I got news for you if your getting any buzz from them you are not having that much pain! One more for the original ? Yes I have a history. Been there done that. Well I am back and after 5 days on the suboxone. I can tell you this. It don't work worth a dam so far. We will see after titration and time, but I will probaly have to play the game for a while till they get me back on some proper medication. Still gobbling tylenol and asprin by the bottles. Yes I know its killing my liver. Would rather not live than live with this much pain. Well ladies and gentleman. Three weeks and after some titration I have to say I am actually getting some relief. I admit I was sceptical to begin with but it is helping quite well. The biggest plus I would say to this medication is no one wants to swipe them all the time. In my mind this was one of the best pain meds out there. If not just for the reason they are useless to the junkies.

I had a 7 cm tumor removed from my left ovary where they also had to remove my uterus, left ovary, left fallopian tube due to severe endometriosis and the condition where cysts are growing to the inner lining of the uterus.  During this surgery it was discovered that my bladder had adhered to my uterus which is evidently common is a patient that has had several c-sections close together.  I had one in 2000, due to 100% placenta previa, and two thirteen months apart in 2005 and 2006. 

During the process of scraping my bladder away from my uterus, the surgeon severed a vessel in my bladder, I bled all night, ultimately losing about 2500cc's of blood.  The next morning, my OB called in a urologist and I had emergency surgery to repair the vessel and had to have two units of whole blood before the anaesthesiologist felt I could survive the anesthesia.

Anyway, I had been taking Lortab 7.5 for the abdominal pain and a bulging disc with a disc tear and spinal stenosis for about 6 months before the surgery.  I woke up from the surgery feeling like I had been sawed in half and felt EVERYTHING.  Since then, I have been given the Lortab over and over, with 2 pain management doctors telling me it is the only thing that will take away the burning in my back and legs.  I had 2 of the steroid injections in my back and was told a laminectomy would only reverse itself within a year and I would have to have another one.

My point, and it's relation to this thread, is that my doctor now wants to put me on Suboxone, he has the license and says he treats many "miracle" patients with it.  I wanted to get off the pain killers, but because of the placement and direction of the disc bulge, my susceptibility for tumors and noted "shadows" on my MRI that could or could not be small tumors on my spine, my doctor suggests I have to have some form of pain management.

I am very active in my community, I volunteer on the board of directors for a large, nationwide known marathon in my city, I have a full-time job and three small children.  I was naturally skeptical of a little known drug, indicated for addiction treatment and not approved by the FDA for pain relief.  I do not want to end up dependant on this like some do on Methadone. I was curious as to how your patient is doing on it, does it control their pain at all?

Please let me know as soon as you can, I have an appt Monday afternoon to begin the Suboxone.  I am supposed to stay at the office 2 hrs. and have the drug slowly administered by the doctor to determine my dosage.  This sounds like out-patient rehab to me.  I would rather quit the meds altogether and get on an exercise or palates regimen to help loosen up the disc spaces.  I have heard this works wonders, but I have now had 3 doctors that are well respected and known all over the country as orthopedic specialists that my injury is permanent and will get worse before it gets better.

Please, anyone, let me know what you think.

Some answers.

This is from NIH (From an article on a study done in Europe on Buprenorphine in pain management 

"Buprenorphine has been widely used and studied for over 20 years and shown to be an effective opioid analgesic. The μ-agonistic profile of buprenorphine, combined with high analgesic potency and efficacy, good safety profile, ease of opioid switch, and reversibility by μ-antagonists makes this drug a valuable option for long-term treatment in a wide range of chronic pain indications."

This is from Clinical Pharmacology & Therapeutics (2008), a domestic US study 

demonstrated that the combination of an opioid agonist and ultra-low doses (0.001–0.1 g/kg)7 of an opioid antagonist can enhance antinociception/analgesia" 

From this my take is that is is widely use in Europe, Australia and New Zealand and has been for decades but that we are finally looking at it for pain management. I looked myself 3-4 years ago but no doctors were using it to treat cronic pain. I ended up on methodone but recently stopped. I still had debilitating pain so I found a doctor who treats pain with suboxone. My guess is the patient limit was stopping doctors from considering pain patents but now that's it's been relaxed we will see it used more.   

Most likely it was the acetaminophen (Tylenol) in the Vicodin causing your Stomach and GI issues.

It might be a good idea to talk to your physician about switching you to a full agonist opioid without the added Acetaminophen.

IE; Oxycodone which is what Oxycontin is but without the time release

Then there's Morphine, Fentanyl,etc.

I am getting it prescribed on a nonopioid replacement therapy basis by a leading doctor who teaches physicians how to use it. He prescribes it "off label" for me. I came upon it after coming off normal pain killers and then my pain returned. I tried everything to cure the pain but it wasn't happening. I recognized that with the other, standard pain killers, tolerance develops quickly and the pain starts to break through quickly requiring ever increasing doses. I knew about suboxone because I work in the field of drug and alcohol treatment. The pain doctors I went to at the time prescribed it as a way to help people dependent on pain meds to detox. I tracked down the doctor I have been seeing and he did not balk at all in taking me on. I did have a history of opioid addiction many years prior. While he treats such patients on an outpatient basis, like I said, I am a pain client. I was clean and sober with no desire to be on any opioids for nearly 10 years before this stupid pain entered my life. I'd much rather take nothing, especially since I've had to shell out lots of money to fill it when glitches occurred with my insurance. Because I am offlabel, insurances can decline to cover it. My doctor did tell me the patch was going to be approved soon in the U.S. I hope so, so I don't have to deal with arbitrary bureaucrats who deny me my pain meds and make me pay a small fortune. I love it as a pain drug. It really blocks the pain thoroughly and there is no risk or craving or any such thing to increase your dose. Its like takinig an antidepressant, if you've had that experience. It works "behind the scenes". I stayed on a very low dose and its been fine. I advocate it as an alternative to the standard, very risky and IMO inadequate medications out there.

Hi Libit,

I am not sure which opiates you have tried, but there are many different ones, each of which are slightly different chemically.  Because of this, each opiate can have slightly different side effects for each individual; there may be opiates that won't give you such negative side effects.

You can get hydrocodone (Vicodin) without Tylenol in it.  That may help with your digestive track issues.  I take morphine 3-4 times a day, and that works well for me.  I also use oxycodone (not the same as oxycontin).  You can get oxycodone with or without tylenol added to it.  It sounds like you can't tolerate tylenol and aspirin at all.

Other options that can help with pain and muscle spasms would be barbiturates and/or tranquilizers.  I have found that I need a mix of meds to control my pain and muscle spasms.  So, I use morphine regularly. oxycodone for breakthrough pain, baclofen for muscle spasms, and clonazepam (Klonopin) for severe muscle spasms.

Are you seeing a chronic pain specialist? They have more education about the specific differences between each opiate and understand the subtle art of prescribing opiates.

Funnyhaha

Fibromyalgia

Good luck!

That is correct. Suboxone has naloxone while Subutex does not, making Subutex a drug that can be taken along with other opiates. This is a problem when it comes to treating opiate addiction as it is more effective to treat a patient with an opiate blocker to lower the chances of relapse. Simply knowing you are on an opiate blocker has a powerful psychological impact on ones thinking when it comes to considering whether or not to pop a pill or do heroin during treatment. I have heard, although do not know the legitimacy of these sources, that Subutex has an inflated price and is more difficult to get a hold of these days in comparison to Suboxone.  

Suboxone, Methadone, etc. Are in a group called Opiate blockers and are given to patients that are in one of three categories: 1.) Heroin addicts, 2.) Opioid medication/narcotic abusers and/or users of narcotics with extremely hig tolerance and 3.) people who are allergic to opioid medications that can't stomach demerol and morphine and/or derivatives of opium. I, myself, have taken opiate medications for many years due to ruptured discs in my lower back. The only problem is I have grown tolerant to these medications and topped out on all the meds I was taking...The next step was to either go to hydromorphone and/or straight morphine, which left me with no room for error or any other steps to take to manage my pain. After talking with SEVERAL well-knowledged and long-Practicing Pain Managment doctors, they agreed to stop using Acute medications to treat a chronic problem. Therefore, I was put on methadone and was taken off of oxycontin 80mg 3x daily, lorcet 650/10 1-2 6x daily( as many as was allowed by law and the company that made the drug) Soma 350 mg 6 x daily, and xanax 2mg bars 3x daily. Yeah, I was on lot of stuff and I also realize that what helps me may not be such a good idea for others. Methadone does come with its demons...i.e. the withdrawals from methadone was one of the most freaky, knocking you down to the absolute bottom and make you crawl thru the floor to get lower so you can feel worse pain I have ever gone thru in my entire life but, in the same instance, has been one of the best medications I have taken for pain managment. Withdrawals caused my testosterone levels to shoot sky high.

I am sorry to babble, but we, as pain managment communities, MUST realize the responsibilities that we carry when we go and get a script filled and decide to take these meds that these doctors are prescribing to us and their good and BAD effects on our bodies and minds. If I was asked today if I would ever go back on methadone, I am here to tell you that I am already back on it but, with a greater understanding of what I have to face if I don't pass a drug screen or if my doctor calls and wants to do a pill count or if I am at the wrong place at the wrong time and am caught with these meds around illegal narcotics or as simple as having alcohol in my system along side of my meds. As far as your tummy is concerned, if you can, try prilosec OTC..omeprazole 20mg...I had GERD corrective surgery about 6 years ago and I still have to take a close second to nexium and it works with the meds you mentioned earlier. Think about opioids and then think about how they work in stopping your nerves from communicating and then look at how opiate blockers work in the same manner. Ultimately, as I am not a doctor, I cannot tell you what is best for you, I can only give you what i know from what I have experienced in hopes that you understand my results and can achieve the same goals as many of us strive for and that is a standard of living that isn't ladled with pain and bad memories because of not being able to enjoy yourself because of not getting the results you want with the meds you have.

(edited by admin) 

Yes I have used suboxone for pain management. It's fairly effective as a pain reliever, but you have to take what's considered high doses 24mg a day. That's 3 8mg. tablets per day. Suboxone is expensive also with 93 tablets costing close to $600. Plus you have to pay the expense of being a member of a clinic $300 to $500 a month and you may be required to attend weekly meetings at the clinic. You can not take pain medication while on suboxone because it blocks the receptor sites. If you were in an accident and they gave you a shot of morphine you would go into instant withdrawls Another draw back that I found is that Suboxone at higher doses kills my sex drive and any possibility of reaching a climax. Last, but certainly not least, is the fact that most pain specialists will not touch you if you've been on suboxone because they automatically assume you are a drug abuser. I would not recommend it unless you are having trouble managing your meds.

BRUCE JONES

Suboxone puts blockers or "doors" over your opiate receptacles. Very good choice if you want to get away traditional opiate based pain management. It is also used as an effective recovery tool.

That puzzles me also. I would like to know the answer to that too.

Hi everyone! Although I have never been on subs I do know a fair amount about the drug. There is a lot of concern about a person on subs needing immediate pain relief due to an injury or accident. I know someone on subutex who is a chronic pain patient. This person needed acute pain relief due to needing a surgical proceedure. She was informed by her MD that the ONLY OPIOD/NARCOTIC PAIN MED THAT WILL BREAK THRU THE BUPE/SUBS IS FENTANYL. Aparently this is the only drug strong enough to knock the subs off the receptor sites. I hope this helps anyone in need. Take care, lil red 0005

Perhaps danielle, but I'm praying (respectfully) that you're wrong.   Like so many other Nam Vets, I've been down that long, hard, rocky road of pain with injuries sustained in Nam.  Cervical, occipital and spinal pain has effectively impaired and altered life as I knew it...  from not only my view of the living, but how the living views me.  Been on a vast aray of opioids for a very long, long time.  There's no living with them, and there's no living without them.  Nothing personal, but my life (or what's left of it) depends upon your being wrong.  One morning I was feeling espeacially sick (probably) from trying to medicate my way back to the living from the nightmares that frequents my sleep when pain breaks through the opioid barrier.  And as I got to looking at a readout of all the pain meds I'd consumed over the last 6 months, I began thinking.  My God, what am I doing to myself?   It was disgusting.  Nobody should have to live like that.  I went straight to my doctor and demanded to be taken off everything except my life preserving meds.  The opioids had to go.  They were killing me.  The doctor made a call and sent me to a doctor who specializes in opioid depentent, chronic pain sufferers.  He started me out on 8 mg. suboxone twice daily.  The first day seemed to hold some promises of the suboxone working for me.  I pray with all sincerity that the suboxone can and will mediate the opioid dependence and the pain well enough to quell the ever increasing surges of pain and susequent opioids. Again, I pray you're wrong danielle.   I pray for you too.  Thanks,  rickj

December 8th, 2008

I stumbled upon this site and thought there were absolutely NO info re: Suboxone. I started the drug in October 2006 in a rehab. I am down to 1/2 of a 2mg SUBLINGUAL tablet.

Suboxone has been my:

antidepressant

my anti anxiety

and my pain reliever.

I don't care what others say, YOU need to experience the PROGRAM before you make ANY judgement on Suboxone.

I see you ALL are confused about Suboxone, and as one said, NO--you CANNOT absolutely NOT---ake any other opiate in CONJUNCTION with Suboxone, I did and almost died.....

I would love to share my experience if it is to be helpful to anyone.

HOWEVER---this all may look good, but have you ever talked to anyone who is trying to DISCONTINUE Suboxone?

THAT, my friends, is the problem and why I am "NotKrazyBoutSub"

{Edited to remove email address mod/3}

Suboxone can be used successfully for ongoing chronic pain management.  But not with these absurd 16mg, 24mg doses and more.  Suboxone can help but it HAS to be done properly.  It's not something I normally recommend, but it does have a place and it can be used successfully.

If you want to use subs for chronic pain you don't need any more than 2mg daily.  If you wish to discuss this further you can contact me and I will share my decade of experience with you.  I've been giving advice for suboxone use for a long time with lots of success.  God bless.

The above post was in response to Dr. L's question. I'd like to add that perhaps the reason suboxone is so effective and so widely used for pain management in EVERY other civilized country is because the FDA is a bunch of crooks who stand to benefit from putting "Not to be used in patients with chronic pain" on the label. And this country is obsessed with opiates, perhaps people in other countries get pain relief from suboxone because that is what they are seeking. Suboxone is 3 parts thebaine (the same derivative as morphine) and one part opiate blocker. It is a very powerful opiate, it's sad that it is labeled as only for use in opiate addiction here in the US, when many people could no doubt benefit from it's pain relief without the tolerance issues that accompany a pure opiate. I had the tolerance of a elephant, and I suffered unimaginable pain post op due to being severely undermedicated, so much so, that I couldn't speak to tell them how much pain I was in. I had 6 surgeries after, and the pain was managed no better, due in part I'm sure, because of the fact that I'm female and weighed 90lbs at the time, but mostly due to my tolerance. I was on a dilaudid pump and could not be off of it long enough to go down to XRay, they had to rush down with a morphine shot. Even though suboxone has a opiate blocker, if I was in a accident today and needed that type of pain managed, it would be MUCH better managed than it was when I was in pain management.

More than half of the people who advise the government on the safety,etc of a drug are receiving money (directly, stocks) from the pharmauctical companies who stand to benefit from the outcome. These people are referred to as the FDA. They do NOT have your best interests at heart people!

I'm sorry that you have suffered so much and I pray the suboxone works for you as it did for me. I suffer from severe PTSD and it has helped immensely with that. I did have a period of pretty much constant nightmares, and I have trouble with sleep, but overall my mood and general state of anxiety is immproved with the use of suboxone over that of  the heavy narcotics I was taking before. There's no rollarcoaster of pain with suboxone. It has worked well as a opiate pain reliever all over the world (although not indicated in the US for chronic pain, it is widely and successfully used in every other country for the management of a wide variety of chronic pain indications). I've noticed that when someone has the preconcieved idea that suboxone is not a effective pain reliever, it usually isn't for them. If you are open to it, more often than not there are good results, as I hope there will be for you! God Bless.

a dr that i use if i have to take suboxone for w/d told me that he doses 24mg a day for use if trying to quell chronic pain. thats because i did ask him if it could be used for pain. but 4 a day is a strong dose, for my w/d he doses me 16mg a day, which i really only think i need 1. i think there is a ceiling effect with the suboxone. ive never been rxd subutex though but do wonder how that would work. as for pain i dont think very highly of suboxone. for w/d and if youre in some kind of program i think it can be a lifesaver though. i really dont like the effects of suboxone after it settles in and its doing its day to day job. but it does work though, and it is a strong med. i just cant seem to stay with it, and i know thats because everything else is thrown at me and darn if u need help i believe its harder to get than just using your regular meds. but anyways this doc says he uses 4 8/2 for people on that road.