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PostPosted: Sun Mar 05, 2017 11:53 pm 
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A friend has asked that I ask all of you for advice.
He has been on painkillers for over a decade. The painkillers are for his knees. He has had surgery, but there is no cartiledge(sp?) left. There is extensive damage to the bones from them rubbing. He needs new knees but won't go on disability in order to get them done. if he doesn't go on disability he has to wait til he's 50! which is quite a long way off. He is the main financial support of his family and loves his job though its very physical and painful.

He is prescribed 4 Roxy 15s a day, but has been taking 20 a day.
He recently took suboxone for a week. He is now down to 6 roxys a day, with the goal to get down to his prescribed 4. His medical dr. is certified to prescribe suboxone. He's worried if he asks to try it he won't be allowed to go back on the roxys. He said the suboxone did not help with the pain. He is also bi-polar and some of the use is likely to self-medicate bi-polar depression.

What do you think? Open to any/all suggestions.
Thank you!
You are all awesome people. I've never had anyone to talk to about stuff like this and I am so glad this forum exists!

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PostPosted: Mon Mar 06, 2017 9:58 pm 
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No great answer, sister! I used to write a blog for psychcentral called 'an epidemic of addiction'-- feel free to check it out anyone, as it is still there-- and at one point I wrote a series about chronic pain. I realized as I wrote it that people with severe chronic pain are simply 'out of luck', given the current state of knowledge. I believe that there are some things that would help now, such as combining opioid agonists with buprenorphine to anchor tolerance and block addiction... but that approach never gained the traction that I hoped it would when I first started talking about it (if you Google 'analgesia without addiction' and suboxonetalkzone you will find it). Likewise there are some things in the future, such as nociceptin receptor agonists, that will help with chronic pain. But for now, there is just no solution for people with severe, chronic pain.

A couple thoughts... I hear the history you described very often, and usually the person with the pain has neglected a few options. It is very rare, and unusual, for ALL of the cartilage to wear out in a young person. Sometimes the person hears that an orthopedist exaggerate things, and then the patient exaggerates a bit more. In a young person, many times the cartilage is there, but it has folds or other irregularities that cause pain, just as a pebble in your shoe causes pain. He should have an arthroscopy to clean things out and trim off any jagged edges, and remove loose pieces. There are also arthroscopic procedures that might increase the formation of new cartilage. Some orthopedists even to cartilage grafts. There is also a product that mimics synovial fluid that can be injected in the office, to lubricate and cushion the knee joint.

The situation with pain pills is very simple. At this point, anything that provides narcotic-level analgesia is subject to tolerance. That analgesia will fade over time. There is no way around it.

No good doctor is going to do a total knee in a young person because they only last about 10-15 years, and then they need to be replaced again-- and it is hard to get a good result in a second knee replacement. The fear is that a total knee at 40 will mean that he will be wheelchair-bound by the time he is 60-- when he still may have 40 years of life ahead.

It sounds as if buprenorphine is not an answer. He MIGHT do better on buprenorphine after a period of time... but he might not.

I don't have a solution. I think his best option is to make sure that any arthroscopic repairs are done, and then to consider cartilage grafting or Synvisc injections... and then to avoid any recurrent injury to his knees while awaiting eventual knee replacement. Tell him good luck!


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PostPosted: Thu Mar 09, 2017 4:57 pm 
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suboxdoc wrote:
No great answer, sister! I used to write a blog for psychcentral called 'an epidemic of addiction'-- feel free to check it out anyone, as it is still there-- and at one point I wrote a series about chronic pain. I realized as I wrote it that people with severe chronic pain are simply 'out of luck', given the current state of knowledge. I believe that there are some things that would help now, such as combining opioid agonists with buprenorphine to anchor tolerance and block addiction... but that approach never gained the traction that I hoped it would when I first started talking about it (if you Google 'analgesia without addiction' and suboxonetalkzone you will find it). Likewise there are some things in the future, such as nociceptin receptor agonists, that will help with chronic pain. But for now, there is just no solution for people with severe, chronic pain.

A couple thoughts... I hear the history you described very often, and usually the person with the pain has neglected a few options. It is very rare, and unusual, for ALL of the cartilage to wear out in a young person. Sometimes the person hears that an orthopedist exaggerate things, and then the patient exaggerates a bit more. In a young person, many times the cartilage is there, but it has folds or other irregularities that cause pain, just as a pebble in your shoe causes pain. He should have an arthroscopy to clean things out and trim off any jagged edges, and remove loose pieces. There are also arthroscopic procedures that might increase the formation of new cartilage. Some orthopedists even to cartilage grafts. There is also a product that mimics synovial fluid that can be injected in the office, to lubricate and cushion the knee joint.

The situation with pain pills is very simple. At this point, anything that provides narcotic-level analgesia is subject to tolerance. That analgesia will fade over time. There is no way around it.

No good doctor is going to do a total knee in a young person because they only last about 10-15 years, and then they need to be replaced again-- and it is hard to get a good result in a second knee replacement. The fear is that a total knee at 40 will mean that he will be wheelchair-bound by the time he is 60-- when he still may have 40 years of life ahead.

It sounds as if buprenorphine is not an answer. He MIGHT do better on buprenorphine after a period of time... but he might not.

I don't have a solution. I think his best option is to make sure that any arthroscopic repairs are done, and then to consider cartilage grafting or Synvisc injections... and then to avoid any recurrent injury to his knees while awaiting eventual knee replacement. Tell him good luck!


Thanks for the response, Doc!
He has talked to his Dr. about hyaluronic acid injections. (the chicken dimple serum :) )
yes, i guess that was a little dramatic. he has had surgeries to repair ligaments and clean things up, but the bones are rubbing, causing actual bone damage that can be seen in x-rays.
they are starting to do knee replacements earlier because they want people back to work. he was even told he'd be able to run marathons, but he wouldn't be able to pick up heavy objects.

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PostPosted: Thu Mar 09, 2017 6:51 pm 
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Hi Sister, so very sorry that your friend is in pain. I did have a client, a 55 yr old woman with a hx of addiction and bipolar disorder who had the injections done. They gave her such relief in her right knee and very little relief in the left. I don't know exactly what was wrong with her knees other than what she told us....both knees shot to shit with bone rubbing on bone! Good luck! I just feel so bad for people who have to live with chronic pain!


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PostPosted: Sat Mar 11, 2017 6:12 am 
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Michelle F. wrote:
Hi Sister, so very sorry that your friend is in pain. I did have a client, a 55 yr old woman with a hx of addiction and bipolar disorder who had the injections done. They gave her such relief in her right knee and very little relief in the left. I don't know exactly what was wrong with her knees other than what she told us....both knees shot to shit with bone rubbing on bone! Good luck! I just feel so bad for people who have to live with chronic pain!


thank you!
the hyalauric acid injections?

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