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I have used Stadol (buprenprphine) as a nasal spray, prescribed for migraine headache. Its nasal-spray formulation is helpful when all you can do is throw up anything oral, and you don't want to pay $$$ for an ER visit. Since I have been on long-term pain management, this med is not appropriate (for me) because it will bind on the same receptors and send me into withdrawal. In fact, my pain-med contract states that Stadol will send you into withdrawal.

I also have recieved an injection of Stadol and Phenergan at an urgent-care center for a migraine. This med does work for most of the nasty migraine pain, but it only lasted 4 hours or so- you'd better hope that the phenergan keeps you asleep for at least 12 hours! And each successive use of the spray (as directed) was less effective than the previous, so it seemed that the tolerance built up REALLY fast.

I have not heard much about the use of this med as a chronic pain management tool, but it seems that it would be a major problem that another, stronger, opioid could never be used for break-through pain, and also buprenorphine seems to have a ceiling dose.

 Speaking of Subutex vs. Suboxone thing ..... and pain management in general.... does anyone know of anything out there that maybe helpful in killing the pain, or chronic pain, once narcotic pain killers are doing damage to other organs ie stomach & digestion???? Ive been thru the whole, PT, trigger point injections ,epidural injections, steroid injections, surgeries.....  just wondering if there is anything out there other than the vicodins,percocets Ect......  cannot take Ultrams...  they are bad bad bad bad bad....... Right before i recently just lost my insurance the Dr. was in middle of doing allot of testing, blood, urine, endoscope....... and taking me off the vicodin es , and soma 350mg,because of sudden serious weight loss, without trying...... and put me on soma/codeine compound( endoscope showed tummy troubles related to narcotic use, and muscles in tummy not working..... soma/codeine really screwed my tummy,even more... the aspirin in it causes such pain......but did help with the rock hard muscle spasms but not much help with pain, and now with no insurance went back to vicodin es, and some 350's because they were way way cheaper for right now, until new insurance kicks in Sept.1st....

just wondering if there is some type of pain killer  , I'm very confused about the roxi's???? that Ive read about on here, and the suboxone????  Ive never heard of these drugs, wondering how they work as far as pain, and are the narcotics???? wondering if there is anything out there that I can look into, and maybe ask Doc about. I know Oxycontin's are a good pain killer, but frankly they scare me... took one once, from my sis who has MS and ohhhhh how sick i was... think it was just to high of a dose, but isn't there something between the vic's & perc's but not as strong as Oxycontin's???

sorry for the rambling.. been a long night~ went to see Eric Clapton in concert tonight at Blossom music center , here in Ohio, its an outdoor music venue, and was sitting on the cool hard ground .. so pains a bit outta control at the moment.... great show tho! 

Thank you for your time, and any advice.

Lilbit aka Linda

Cervial disk rupture at c5/c6.Rupture took bone spurs and embedded them into spinal cord. Cervical Spinal Fusion, then  Fustla repair of spinal cord to seal hole left by bone spur removal.

Fibromyalgia

"We have met the enemy and he is us"

 All I can say is buprenorphine is an agonist/antagonist....most are one or the other. Hope that helps.

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

Not to dog on this med, but to me, it was no good. I used to use this stuff not to get sick to got to work when I had none of the devil's pills,
(Oxycontin). I'd Take a half if one at 5:30a.m. and by the time i got home at 4:30, do some things, and take my O's, I'd get tore up just like any other time. Thats just my 2 cents. I guess you just gotta do the was it is supposed to be used and not mess up at all cause to me, it was totally easy for me to relapse on it. For me now, I,m on the long path of the methadone treatment but to each its own.On the mehadone, I never messed up once after iI got to 60 mgs. causethey started me on 40 mgs. and that didn't do the trick now I'm up to 7 to 8 80 mg. pillls a day. So if youre trying to break the habit, talk to a counsoler before you start the long road to recovery. I've been on the mmt for in 3 weeks it will be a year and it has been good to me. This weekk im going to start to drop. hopefully eveerything goes well. I'll keep you posted. Thanks for listening and I hope someome go some help outta it. Peace and be well!

(edited by TeamPharmer) 

"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 screw-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"

IMHO, opioid hyperalgesia (increased pain sensitivity) is a real phenomenon.  I have a few illicit and licit drug dependent patients and boy do they holler over things like flu vaccines and blood draws!

Do you have a psychological dependance on the drug? 

Almost everyone on high doses of narcotic analgesics for long periods of time will develop physical withdrawl symptoms when they abruptly stop the drug.  It is relatively easy to taper their dosage and use medications of other types to manage withdrawl symptoms.  People with a psychologic dependance on a drug are more difficult to treat, but are uncommon in normal practice.  There is also the concept of pseudo-addiction where people are psychologicly dependant on a drug because of fear of withdrawl symptoms or a return of severe pain if they are weaned off the drug or the drug is reduced in dosage, changed, or witheld.

Increasing the dosage without your doctor's instruction, craving the medication, anticipation of your next dosage, and using the drug in ways that can be socially or physically dangerous can all be signs of psychologic dependence.  You say that you still are in pain.  Is the pain tolerable?  Did your doctor discuss using Suboxone as a chronic pain medication now that you are off traditional narcotics?

My sister also had problems with meds after gastric bypass.  She had excellent relief of her chronic back pain with Motrin, but after bypass was told not to use any NSAID's including injectable Toradol (ketorolac) even occasionally.  She hated the sedation and nausea of narcotics.  She has been successfully managed with interventional pain management techniques, primarily epidural and facet joint injections.

whatever, but the point was i was addicted to opiates, got on suboxone, about 2 months into it i got my tonsils out, they gave me codeine syrup it didnt do anything so i relapsed for 2 days, then when i realized what i was doing i got back on suboxone the 3rd day and i was in horrible pain. so the day after that i tried taking about 4 or 5 times what i usually take and it did absolutely nothing to relieve my pain. So i duno where you're hearing this, but in my experience, no, suboxone has less affect on pain than tylenol

brupenorphine (the drug in suboxone) has been used to treat pain,  but only intravenously; which the naloxone in suboxone would prevent you from injecting it.

Dr Lois.

My gastric bypass was nearly 3 years ago. More Recently I had a Ventral Hernia Repair and a Granuloma removal ( about the size of a medium sized Kiwi fruit). then that was complicated by an abcess the size of the upper knuckle of my thumb, and a Saroma. I had 2 invasive surgeries on Jan 17th and Feb 1st. I was packing (wet to dry) with 13 feet of Kerlix gauze 3 times a day. I was sent home from the hospital with the instructions that i had to wait for my 7 inch inscision to heal from the inside out, insted of having a nice steri striped wound. It BLEW. And yes I still hurt. I feel like I have a hot hatchet in my gut. I have a 17 mo old that I still have to carry around. I have re ripped my gut twice ( 1 time because I was wearing a seat belt and we stopped fast).

The withdrawls scare the Diaharea out of me! I was not a Ocontin canidate because of the gastric bypass, my peristalsis moves far to fast. and stuff is out of my belly in 15 mor less. On top of that some of my absorbtive tract is gone. There by rendering any "extended or Continuious Release" medication a waste of most of the pill.

I went into medical detox while still in pain and was treated with Bupe/Suboxone for a total of 5 days ( 1st day was alllllll lorazapam, I don't remember much).

I would have rather o'd'd and not woken up than go thru cold turkey with drawls again. I have reactions to Clonidine. 80/44 is not normal, I was hospitalized after trying to CT with Clonidine, passed out cause of the blood pressure, woke up feeling normal. Only to find out that the doc put morphine in my IV, and said get your self into medical detox.

I know that MMT can be a lifesaver for people. I commend them for seeing that in themselves and getting their butts to the clinic everymorning, but for me... I didn't want an 8 month detox. I wanted OFF. But comparitively I was not using very long/not self medicating ( you could consider the fact that I went thru a script real fast, not abiding by terms on bottle, but I wasnt' scoring OC, morphine, or other stuff) I just wanted off. I didn';t want to put my fam thru this anymore. It was ridiculus (the thoughts I was having about od'ing) and I wanted off the rollercoaster FAST.

I still hurt. and I could care less if Dr Lois thinks I'm and addict or not. I know I have at the veryleast a problem. When I have to go in ofr a nother surgery, I will have a step down program before I go into the OR. My fiancee will control my med acsess much like a MMT.

Did I take Oxy 15's to get loaded?!?!? No. I took them to releive pain. help me sleep. be a mom ( housework, laundry still needed to get done, wether or not I hurt. There are expectations placed apon me and I can't explain to my kids, sorry, there are no forks or clean plates, underwear or jeans cause mommy hurts to bad). I basicly had to pop a pill and cowboy up. Honestly the only time my pain was FULLY controleed is when I overtook at night so I could sleep. I muddled thru it during the day. I took less in the day, so I could sleep at night, In hind sight, I forgot I had the halcion, so I could have used that, but frankly I'm not a "taker" of benzo's. The week I ran out early, I had asked to be tapered off.... (cut my script by 30 pills) and I had asked for something non habbitforming or addictive SHORT TERM ( like rozerem, like u see on tv) to help me sleep. I hadn't slept more than 3 hours at night since my initial surgery in Jan. I felt like a zombie cause of lack of sleep, and it scared me to overtake at night, even though, blessedly, my pain was gone. 3 hours later It started back with a vengence. But I knew how much I had taken 3 hours earlier, and made the concoius choice not to pop another pill until it was at least 8 hours later. ( i failed at that twice) but for the most part I just stared at the ceiling, praying for sleep (again, a narcoleptic with sleep issues, who would have ever thought). But my pain clinic Doc wouldnt "muddy the waters" with a sleep med becuase I also had a history of Sleep Apnea, so he refered me back to my Sleep disorders med specialist. He is mostly retired, and bec caus of cost issues surounding Modofinil (Provigil) and a cardiac intolerance to Dexidrine, I haven't seen him in a long time, they archived my file, and I have to restart his clinic with a new referal... that takes a butt load of time, when you volunteered to loose 30 pills in a script. ITs now been a month 3.3 weeks, and I still haven't even gotten the referal to process, let alone an appointment. I no longer have Sleep Apnea, because I lost half my body weight ( was 270, now 135) actually after the surgeries, and the sedentary activity (because of the hernia pain pre-surg) ( I also had a thingfor popsicles ( they seemed to num some of the tearing pain, plus becuase of the nasuea related to how painful I was, Half the time Popscicles was the only way I was maintiaining my blood sugar or what I could keep down) I had went up to 155. SInce my first surg, my pain and gut have been so affected by nasuea, I'm back to 135).

Point is. As a "Doc". unless you have my full history infront of you, you aren't capable of making an informed diagnosis. I don't have idopathic pain. I don't have phantom pain. I currently am probably destroying my liver with APAP. but thats MY ONLY option.

I CANNOT TAKE IBUPROFIN. IT IS CONTRA INDICATED FOR GASTRIC BYPASS PATIENTS, ON TOP OF THAT I HAVE AN ACTUAL ALLERGY (DOCUMENTED 2 YEARS BEFORE MY GB) TO IBU. ITS MILD (NOT ANAPHALAXIS) BUT STILL CAUSES MODERATE SYMPTOMS FOR ME THAT LASTS FOR ABOUT A MONTH, JUST WITH ONE DOSE!!!! BLLISTERS AND SUCH. I ALSO RECENTLY (X-MAS NIGHT) WAS DIAGNOSED WITH AN ALLERGY TO ULTRAM (TRAMADOL) THAT CAUSED SEVERE SWELLING OF THE FACE, LEGS, ARMS, WELL, I LOOKED LIKE A MACYS FLOOT WITH LIPS LIKE I JUST HAD A COLOGEN PROCEDURE GONE TEREBLY WRONG. AND IT WASN'T TREATABLE WITH BENYDRYL. I WAS PUT ON CIMETIDINE TO COMBAT IT. SO WHAT ARE MY OPTIONS? OPIOD THERAPY FOR PAIN, BUT I'M A WUSS WHEN IT COMES TO PAIN, AND WITHDRAWL. I KNOW THAT NOW. BETTER NOW AT 28 (HAD TO REMIND MYSELF) THAN AT 40, TRYING TO  DULL THE PAIN) --- NOT PUTTING ANY OF YOU DOWN WHO HAVE GONE THAT ROAD) WE ALL HAVE OUR OWN DEMONS AND ISSUES. I APPLAUDE YOU FOR SEEKING MMT, N/A, WHAT EVER YOU DO TO KEEP IT IN CHECK.

BETTER THAN LOSING MY KIDS.

SORRY I WAS SO UPSET IN THIS POST, I JUST REALLY FELT PUT DOWN BECUASE FOR ME? WITHDRAWLS FROM OPIATES IS NOT SOMETHING I WILL TOLLERATE, I DID IT COLD TURKEY ONCE, AND I KNOW MY LIMITS.

THIS WILL PROBABLY GET DELETED, BUT I FELT I HAD TO RESPOND.

BUPE/ SUBOXONE, WAS MY LIFESAVER, IT KEPT ME FROM OD'ING WITH THE PROMISE OF NO SEVER COLD TURKEY WITHDRAWLS.

quahog:

Even good research has trouble overcoming personal observation, in doctors and patients!  I am aware that the phenomena is speculative.  Thank you for the info.

I think a lot of people are reluctant to presecribe adequate analgesia for chronic pain because of fear of getting in trouble with state medical boards or the DEA, and because chronic pain patients are difficult to manage and take a lot of time to evaluate. 

"We have met the enemy and he is us"

 Gutpdx:

 Thanks for sharing your story.  Wow.  I may tell my tale, but I'm new here (first day) so I thinkl I'll wait.

 Best to all.

well done for your truthfulness , respect where respect is due ....................... you keep that monkey off your shoulder ............ well done again.

Not what the Europeans and many pain management specialists in the US think.   Suboxone or Subutex are not rapid onset analgesics, they may be dosed once a day.  Your problem with Suboxone may have been that you were not a chronic pain patient when you had your tonsils removed.  Subutex has an elimination half life of 37 hours.   You needed acute short term pain relief.  The other factor is that  you may not have been given a high enough dosage to achieve pain relief.   Your expectations for pain control may have been too high. Tonsilectomies hurt and no one should expect to be pain free afterwards. 

Gtrplayer: 

 agree with what you are saying.  I do not know how the Europeans manage this problem in chronic pain patients.  I can find very little literature on managing chronic pain with Suboxone, which is why I ended up at this site.  I do  not know if a short acting mixed agonist-antagonist like Stadol, which is available in the US as a nasal spray and for IV injection, would do the trick.  I started one very motivated chronic pain patient on Suboxone last week.  I told the patient that because of the mixed agonist-antagonist properties, breakthrough pain management could be a problem.  He has Ultram (Tramadol) for back-up, but in the past that has not been adequate by itself.  

Tramadol can be used along with agonist only narcotics without causing withdrawl symptoms even though Tramadol is only partially antagonized by naloxone.  Withdrawal symptoms, if they occur, should be mild with both Stadol and Tramadol.     

Cost of FDA approval for a second indication is probably the only thing that is keeping it from being submitted for use in pain management in the US.  Since it is approved for one thing, but can be used for another, if it works for pain,  eventually sales for the non-approved use will increase, and the drug company makes a profit without all the expensive studies and application to the FDA. 

I believe the approval for Sildenafil for pulmonary hypertension came years after it came on the market for erectile dysfunction.  I did not know that it was originally developed as a drug for pulmonary hypertension.  I can understand why though.  Pulmonary hypertension is rare, and  the prolonged life expectancy studies took five or six years to complete.  Erectile dysfunction is common and Sildenafil's effect on erectile dysfunction is clear and immediate.  There is a huge and healthy market for Viagra, but a tiny and short lived market for Revatio!

I think they may never get around to applying for FDA approval for Suboxone or Subutex for pain, since the pain market is already crowded with drugs.  For narcotic withdrawl or maintenance, there was only methadone to compete with.  Viagra and Revatio are both first in their class.

Managing chonic pain in patients who are currently using or have been addicted to illicit drugs is a very difficult problem.  They are afraid of getting hooked, and afraid narcotics will stimulate their craving for the high of drugs like heroin.  They are at risk of using illicit drugs for pain control especially if you do not give them adequate analgesia.  They often have poor insurance or no insurance, chaotic lifestyles, and transportation issues which add to the problem.  This is the group that is most likely to benefit from suboxone. 

Severe pain, or surgical analgesia in patients maintained on suboxone can be achieved by high doses of Subutex IV, or perhaps another mixed agonist-antagonist like Stadol IV.  High doses of agonist only narcotics should only cause minimal withdrawl symptoms.  There is a paucity of actual literature on these issues however. 

I have heard that Subutex is the most common pain mangement drug in Europe.  If this is true then Subutex/Suboxone may come to be used more widely in the US.  One HMO I contacted about a prior authorization for OxyContin suggested I try switching the patient to Suboxone!      

In my experience it has been an issue.  I have had to discharge legitimate chronic pain patients with illicit drug use problems who had repeatedly dirty urines (cocaine, heroin, and benzodiazapines).  One was even traveling out of state to get additional medication so that it would not show up on my states computerized record of scheduled drugs he recieved.  My one and only suboxone chronic pain patient requested suboxone himself.  I was very reluctant to use it because I did not have any experience with suboxone, and do not have the DEA certificate that allows you to use it for people currently addicted to narcotics.  I spoke to a couple pain management specialists and two pharmacists about the issue, researched the DEA rules for perscribing suboxone for chonic pain, and read everything I could find on the subject. 

A pain management specialist I spoke to about this issue told me that Subutex was the most commonly perscribed chronic pain medication in Europe.  I cannot verify this statement.

I was surprised by the suggestion of the Medical Director for the HMO's pharmaceutical plan as well.  I am sure their recommendation is entirely cost driven.

It was probably the FDA that required the product information to state that Suboxone/Subutex should not be used for chronic pain.   Clearly it is used for chronic pain management in the UK, NZ, and Aust. (refer to the links posted earlier by others). 

Have you ever seen suboxone or subutex used for chronic pain mangement?  What do you do to monitor compliance with their narcotic contract in patients with addiction issues?

What do you percieve as being the risks of using Suboxone/Subutex for chronic pain management?