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PostPosted: Fri Dec 02, 2016 6:15 pm 
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I hinted in my introduction post, that I am a chronic pain patient.

I thought I was "over" being in chronic pain, with the successful back surgeries I had in September and October of this year. (first was to remove some bones and disk material that were impinging on some nerves, and the second was to repair damage done by the previous surgery).

Most of my severe pre-operative and post-operative pain was over, so I didn't think I still needed pain support. I can usually tolerate pain levels up to a solid three without it interfering with my day-to-day so long as I know whatever is causing the pain isn't an emergency or going to get worse.

I was told when I started this, that Suboxone would also help with my pain, and it does, for about three hours. During those three hours, it's almost as though I never had any pain to begin with, and no cravings, and just Me, going about my day as a Domestic Engineer.

Then Hour Four comes along, and all of the aches and pains and limitations caused by those pains sets in, until my evening dose. I feel tired, draggy, irritable, and generally disgusted with life in the whole middle of my day.

I don't like it, not one bit. I have tried OTC pain remedies such as aspirin and Aleve, but they only take a small portion of the pain away, and none of the irritability and feeling of general malaise.

My current dosing schedule is 4mg at 8AM and 4mg at 8PM.

I want to talk to my doctor about adding 4mg at the halfway point between the morning and night doses, as 4mg really knocks the pain out for me and returns me to my previous energy levels, physically and mentally.

Sorting out my motivation is kind of hard for me right now. I don't like being in pain, but I don't want to be chasing a high, or have to deal with the issues of not being able to get the drug should my insurance company decide that I should be off it because initially, it was approved for detox and not pain management in my case.

I will be bringing these concerns up with my doctor at my next appointment, and hopefully, since pain management is the main thrust of this clinic, might have answers to questions that I don't know how to ask yet, or solutions for my chronic pain that don't involve the drugs I found easy to abuse before I started using Suboxone.


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PostPosted: Fri Dec 02, 2016 8:04 pm 
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I'm assuming you were physically addicted to opiates? I ask because I wasn't aware that buprenorphine
would have an analgesic effect in one so addicted. I'll get out of the way so that someone with more knowledge can shed some light.


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PostPosted: Fri Dec 02, 2016 9:55 pm 
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godfrey wrote:
I'm assuming you were physically addicted to opiates? I ask because I wasn't aware that buprenorphine
would have an analgesic effect in one so addicted. I'll get out of the way so that someone with more knowledge can shed some light.


I was physically dependent on opiates, and was ramping up to becoming outright addicted like I was to the Tramadol I abused. Old patterns and behaviors were appearing as I approached the end of the pain management therapy. My fear of the withdrawals, and of letting go of the feeling of invincibility the pills gave me, made me realize I was headed down a road to ruin if I didn't find the exit, and quickly.

When I first sought medical pain relief and treatment for my back, the pain doctor and I talked at length and in detail about the very real possibility of my experiencing a complete relapse if I sought opiate relief. We weighed the pros and cons, and made a plan for when I no longer needed the opiates.

While my lower back itself is healed and pain free post-op, I have other issues like arthritic knees, and osteoarthritis in every one of my joints that has chosen NOW to act up. My average untreated overall pain level is in the neighborhood of a five. Suboxone takes it down to just shy of a zero while it is working. Even if the nausea never really goes all the way away, I'll take feeling queasy from time to time over being in pain and unable to keep up with the things I want to do.


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PostPosted: Fri Dec 02, 2016 10:49 pm 
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I see, thanks for that clarification. So that makes sense that you're getting pain relief. Not physically addicted, plus I think tramadol's a partial agonist.

Have you considered using less, instead of more? I think bupe is paradoxically (at least to me) more powerful in smaller doses. I'm clearly out of my depth. I hope someone comes in with better information soon as I'm very interested in this as well.


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PostPosted: Fri Dec 02, 2016 11:21 pm 
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Hi Dayglowsunshine, what I can tell you is that suboxone really helps me with the pain I have from osteoarthritis in my knees. I currently take 2mgs am and 2mgs pm. I sometimes take an extra 2mgs in the middle of the day especially if it is rainy and cold and my knees are really feeling it. 6mgs per day is what I am prescribed. I have also found that it helps with the depression that I was experiencing as a result of menopause. So it really has helped me in several different ways!


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PostPosted: Sat Dec 03, 2016 11:04 am 
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I understand you are taking 4 mg twice a day. Rather than increase your dose you could try taking it more frequently. For example, continue the 4 mg in the morning, take 2 mg midday (when the pain is flaring) and 2 mg in the evening. Same total dosage but spread out more. The analgesic effect of Suboxone is 8 hours or less.
I met a person two years ago that was taking 16 mg twice a day. We have ever so slowly worked our way down so she is now taking 2 mg three times a day, and is back to work, loving on the kids again. She has three different specific pain generators and is doing well.
In spite of high tolerance pre treatment I have several patients getting good enough pain control to allow for them to be high functioning again. Same level of pain control but not all the problems of high dose full agonists.
Last paragraph was for Godfrey, you can get pain control with Suboxone in spite of very high tolerances with DOC.


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PostPosted: Sat Dec 03, 2016 11:32 am 
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docm2 wrote:
I understand you are taking 4 mg twice a day. Rather than increase your dose you could try taking it more frequently. For example, continue the 4 mg in the morning, take 2 mg midday (when the pain is flaring) and 2 mg in the evening. Same total dosage but spread out more. The analgesic effect of Suboxone is 8 hours or less.
I met a person two years ago that was taking 16 mg twice a day. We have ever so slowly worked our way down so she is now taking 2 mg three times a day, and is back to work, loving on the kids again. She has three different specific pain generators and is doing well.
In spite of high tolerance pre treatment I have several patients getting good enough pain control to allow for them to be high functioning again. Same level of pain control but not all the problems of high dose full agonists.
Last paragraph was for Godfrey, you can get pain control with Suboxone in spite of very high tolerances with DOC.


Splitting the evening dose will help with the elephant in the room I didn't mention, and that is the cost. Right now, it is zero out-of-pocket, but Jan 1, I have to pay full retail until I've met my deductible of $3500. I already have very expensive drugs for diabetes that aren't available in generic form, and after some of the posts I've read on this forum, I don't know that I trust the generic equivalent of Suboxone just yet.

Thanks for the heads-up, as full functionality was the goal of seeking treatment for my back problems to begin with. I am only 47 years old, and I feel I am WAY too young to be sat down just because my skeleton has decided I've worked hard enough already. There are few feelings I enjoy more than that tired feeling at the end of the day from hard work, and the sense of accomplishment from seeing the results of my labor (like a clean, comfortable home and an attractive, visually appealing yard, or maybe one day, a fat paycheck).


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PostPosted: Sat Dec 03, 2016 1:57 pm 
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Less is more with Buprenorphine. Docm2 is spot on. Once you get down to very low doses you'll realize the analgesic effect is so much more. Ergo; the Butrans Patch in micrograms.

Good luck receiving adequate pain relief and welcome to the forum,

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