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 Post subject: Back pain
PostPosted: Fri Jun 30, 2017 1:22 pm 
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I suffer from chronic intractable skeletal muscular spacsitcity in my lower back as well as tennis elbow in both arms. I hear it's better to dose multiple times a day for chronic pain. What is a good dosing schedule to keep back pain at bay? I also was thinking of starting Tylenol ER


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 Post subject: Re: Back pain
PostPosted: Fri Jun 30, 2017 5:15 pm 
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I've read on the suboxone side effect pamphlets that back pain is a side effect of taking suboxone. I've noticed that my lower back pain has worsened tremendously since starting the medication. Why does suboxone cause back pain and what can I do to reverse this? What drugs should i take to counteract the side effect of this one


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 Post subject: Re: Back pain
PostPosted: Fri Jun 30, 2017 5:35 pm 
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Hello Frank - The first question I would like to ask is if you're using Suboxone for the treatment of pain or for opioid dependence? If you need pain relief I would suggest dosing up to 3-4 times a day. But if you're primarily treating your addiction then once a day is usually best, although I prefer twice a day myself.

Also with your specific condition, I would avoid Tylenol or acetaminophen in favor of a different NSAID pain reliever. My personal experience is that Tylenol isn't a very good medicine for inflammation. I would use Ibuprofen. Keep in mind that NSAIDs can be hard on the stomach lining so be sure to check with your doctor about the benefits as opposed to the risks before starting a regimen.

I suffered from back spasms and found Baclofen to be effective at treating the symptoms. Unfortunately, it also gave me headaches. My doctor switched me to Zanaflex and that ended up being the ideal medication for me. It wasn't overly sedating so I could take it during the day and not feel like taking a nap. My mind also seemed to be more clear than with Baclofen, and that was important because I need to be able to focus.

I would like to caution you on the use of muscle relaxers though. They are great for a short-term fix when other treatments have failed. But people have been known to abuse them like anything else, and when not used properly, misuse can lead to dependence and addiction. So know what you're getting yourself into before you try one of these meds. Good luck Frank!!

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 Post subject: Re: Back pain
PostPosted: Fri Jun 30, 2017 7:42 pm 
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I suffer from chronic back pain, and used opiates for fun and because it helped with the pain. So I suppose both. I am addicted to manu other drugs and by no means am I not an opioid addict.

As for muscle relaxers, I've tried flexeril/cyclobenzoprine and Robaxin. Both make me tired as ever, especially the flexsril (best sleeping medication ever lol that will have me sleeping all day). The only pain reliever/muscle relaxers that work witbout making me a sleeping zombie besides opioids are cannabis and gabapentin (wouldn't recommend gabapentin long term though...)


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 Post subject: Re: Back pain
PostPosted: Sat Jul 01, 2017 12:01 am 
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Hi Frank and welcome here. From what I understand, Suboxone is not indicated as a pain reliever. It was developed for opiate addiction and works quite well at stopping the cravings. So it's not a matter of Suboxone causing back pain, it is just not helping it any in your case. A combination of both Buprenorphine and full agonist pain meds like Oxycodone or Fentanyl may work. You won't feel the pain meds as the Buprenorphine will block the effects. But it will or may help with your pain. That way the addict part stays quiet and you get some relief. It may not work in all cases.

Some people swear it helps with pain and there are pain patches that have Buprenorphine as the main ingredient for pain management. My guess is that it's not helping you with your bad back. But it does not cause back pain. It is still an opiate and no opiate would cause pain.

I'm hoping one of our doctors will chime in and explain it better than me.

Sorry you're still suffering. That is the worst position to be in. Needing pain relief and being an addict. We all understand that problem here.

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 Post subject: Re: Back pain
PostPosted: Sat Jul 01, 2017 1:41 am 
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So I found out some interesting information. If you read about the stated side effects on Suboxone's own website you'll notice back pain as a possible symptom - https://www.suboxone.com/medical-treatm ... rse-events

"Selected Safety Information
Common side effects of SUBOXONE Film include nausea, vomiting, drug withdrawal syndrome, headache, sweating, numb mouth, constipation, painful tongue, redness of the mouth, intoxication (feeling lightheaded or drunk), disturbance in attention, irregular heartbeat, decrease in sleep, blurred vision, back pain, fainting, dizziness, and sleepiness."

So you're not crazy Frank, it says it right there. I was surprised and hadn't read that before... or noticed it anyway. I've had back pain for many years now and if anything, I actually feel like I'm getting a certain amount of pain relief from the subs. Just another positive effect for me personally. I wish it was the same for you. The thing is though, I don't know if it's just in my head. I've been feeling all kinds of things since coming off opiates. Some good and some not so good, like really intense emotions for example.

I was initially put on Cyclobenzaprine also and I remember the drowsiness it caused. But you mentioned another effective treatment for spasms, medical marijuana. I don't know very much about it or why it works, other than it's effective at causing relaxation, but I know it works. I tried it for a short while but it just didn't work out for me. As I said before, I need to be clear headed and the marijuana that's available now is really quite potent. I experienced quite a bit of anxiety... followed by relaxation and serious "couch lock".

The other problem is stigma. There was a man in my outpatient group that was being treated for heroin addiction. He was probably in his early 30's but looked like he was 60. The man had been through the ringer. He became addicted to opiates after doctors had put him on high doses of pain meds while treating his epilepsy. He used marijuana to stop the seizures and they kicked him out of pain management because of it. Facing daily pain and withdrawal symptoms, he turned to heroin.

It's sad because the only medicine that really worked was the medical CBD oil and yet they wouldn't let him have that and opiates for pain at the same time even though the weed was legal. He had to decide to treat the pain or the seizures on a daily basis. Broke my heart to see a good man like that get beat down by the system. But it happens all the time. Even with subs, stigma is a huge problem, especially for people with chronic pain issues like yourself.

I hope you find something that works for you Frank. Keep searching man, the answer is out there!!

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 Post subject: Re: Back pain
PostPosted: Sat Jul 01, 2017 1:51 am 
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rule62 wrote:
So it's not a matter of Suboxone causing back pain, it is just not helping it any in your case.


Hey Rule - I'm like you... I didn't even know that was a possible side effect, and I've been reading just about everything I can about subs since I started taking them in April. I've heard much more about headaches and sweating as fairly common side effects. I don't know why they would cause back pain. I hope one of the good docs will show up and fill us in.

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 Post subject: Re: Back pain
PostPosted: Sat Jul 01, 2017 8:41 am 
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I'm sorry but regardless, I don't believe suboxone causes back pain. They have to list every little side effect that's probably ever been reported to them. That doesn't mean it's a common side effect. The only side effect I got from that list was sweating (in the beginning of treatment) and tiredness.

If u already have a back problem, which u do because u gave the name of what was wrong (I can't remember exactly what u said). So u already have a back problem, suboxone isn't causing this problem, it's just not helping the pain with this existing problem. And I'm with Rule, I don't think suboxone is very good at helping pain which is ok because it's not for pain, it's for addiction treatment.

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 Post subject: Re: Back pain
PostPosted: Sat Jul 01, 2017 9:21 am 
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There are plenty of people who use buprenorphine for pain, including me. It is useful for certain people as pain relief. But the dosing would have to occur every 6 hours because the analgesic effect does wear off. I don't know if we are ever all going to agree on this subject.

Amy

P.S. Buprenorphine was developed specifically for pain and used extensively in Europe. Vets prescribe it now for our animal friends' pain.

https://en.wikipedia.org/wiki/Buprenorphine

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 Post subject: Re: Back pain
PostPosted: Sat Jul 01, 2017 11:20 am 
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I was referring to suboxone specifically not being developed for pain.

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 Post subject: Re: Back pain
PostPosted: Sat Jul 01, 2017 1:41 pm 
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I stand corrected. Frank, I had to re-read your original post to see that you mentioned reading the information on the pamphlet. Several times I've read that insert and didn't see that side effect. Now I'll have to save it the next time I get a new box and try to find what you're talking about.

The only other thing I wanted to mention was the difference between Suboxone and plain Buprenorphine. Suboxone is meant specifically for opiate abuse. The manufacturer added Naloxone with the Buprenorphine to try to prevent addicts from shooting it up. (that doesn't work from what I've seen here)

Buprenorphine is the main ingredient for pain relief. So my answer was not very clear. Yes, it is indicated for use to ease pain. Generic Buprenorphine used to be called Subutex but they don't make the name brand anymore. There is a generic pill out there from what I've heard.

Amy has it correct about Europe using it way before the U.S. for pain relief. They dose it in micrograms vs milligrams. We have a few here too like the Butran's Patch.

Sorry for the confusion and I hope your back pain can get under control.

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 Post subject: Re: Back pain
PostPosted: Sat Jul 01, 2017 3:51 pm 
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I've done some researching and found that in this thread a spine specialist told their patient they needed to get off Suboxone because it might be causing their back issue and another person said they had gotten back pain from Subs.

https://www.drugs.com/answers/can-subox ... 89708.html

Here's another thread i found where someone reported back and another nerve pain from Subs, though unlike me their issues were non existent prior to starting the medication. My issue has just somewhat drastically exacerbated since starting treatment, though right now the benefits outweigh the pain it's causing me.

http://www.healthboards.com/boards/addi ... oxone.html

Im sure most of you have read in detail the enormous fold out panphlet they give you in every suboxone box that lists all side effects, studies, the moledcular structure of bupe, etc. And having read that because I'm sorry JennJenn but I'm going to have to disagree with you on you stating they have to list every little side effect that's ever been given to them because pain and back pain specifically are reported side effects in multiple controlled studies including hundreds of patients, both placebo and with dosages ranging from Very Low to High, with the tablets vs the film, and in studies ranging from 4 weeks to 16 weeks. In the 16 week study the back pain reported seemed to increase as the dose increased, possibly indicating the medication was causing it but I don't want to draw any conclusions. In total, %38 experienced either pain or back pain in that study. 24% generalized pain and 14% specifically back pain. Which is strange because it was invented IM or IV for pain in the ug range. It would seem very unprofessional for them to have to list a symptom someone reports without looking into it scientifically and concluding that the medication had something to do with the side effect.

From my own anecdotal experience my back pain is severely worsened the hours leading up to my first dose of the day, and after 4-5 hours of dosing. I get a good warm suboxone buzz that uplifts my mood and energy for the first few hours and it does seem to help with pain, but after those hours I get sleepy and the analgesia goes away. I will try multiple times a day dosing. Im on 16 so 4x4. If I get to sleepy I'll take some modafinil to counteract that side effect.

Cheers!
Frank Matthews


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 Post subject: Re: Back pain
PostPosted: Sat Jul 01, 2017 8:30 pm 
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jennjenn wrote:
I was referring to suboxone specifically not being developed for pain.


Oh! Of course! You're absolutely right! I was skimming when I should have read harder! :)

Amy

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 Post subject: Re: Back pain
PostPosted: Sun Jul 02, 2017 12:43 am 
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"in this thread a spine specialist told their patient they needed to get off Suboxone because it might be causing their back issue"

Just to clarify, this was not a spine specialist stating this, this is poster saying her spine specialist said this.

"In total, %38 experienced either pain or back pain in that study. 24% generalized pain and 14% specifically back pain."

No no no. on the 38%. This is a comingled symptom list. Its any and all possible symptoms anyone might have that might or might not have existed before. So say 2 tennis elbows and back pain and whatever other symptoms folks might have, would all be recorded - but not reported - unless they add into what other participants record that adds to a greater than 5% incidence, then are reported. For ex, tennis elbow, pimples and morning wood could have been recorded but did not make the 5% report cutoff.

The table is not meant to add patients and % symptoms. If so, then there would be 2050 patients out of only 731 actual ones in the studies and 260% out of only a 100 % possible total.

Also, the 4 wk showed placebo at 11% w more back pain than bup patients. the 16 wk showed no placebo group, it was plain bup compared to bup/nx.

Oh yah. yep. makes sense the table reported pain. Anecdotally, tons and tons of pain complaints here after starting and stabilising on bup, Why? bc no longer on full opiates with the better pain control they provided.

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 Post subject: Re: Back pain
PostPosted: Sun Jul 02, 2017 6:54 pm 
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Pelican wrote:
Anecdotally, tons and tons of pain complaints here after starting and stabilising on bup, Why? bc no longer on full opiates with the better pain control they provided.


Hey Peli - You make a very good point here and one that a lot of people in pain don't think of right away. it appears his pain increased quite a bit after starting the subs. Logic says that it could be from stopping the full opiates and their more effective control over pain. Definitely report it to your doctor Frank. Hope you find some relief, back pain can be really hard to live with day after day.

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 Post subject: Re: Back pain
PostPosted: Wed Jul 05, 2017 11:04 am 
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Ii have chronic hip pain, and started dosing 3 x a day with suboxone, now im down to 2x.
After years on oxy, I had a hyperanalgesic effect-my pain was worse on them bc your brain tricks you and makes you think your pain is worse bc your brain wants meds. my pain was 10x worse on pain pills then without them. You can google "hyperanalgesia"

But from a pain standpoint, once a day dosing of subs, I'd never sleep.
6a, 12p, 3p seemed to work. I'd divide the doses.


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 Post subject: Re: Back pain
PostPosted: Mon Jul 10, 2017 1:50 pm 
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@pelican in the 16 week study 24% experienced pain and %14 experienced back pain


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 Post subject: Re: Back pain
PostPosted: Mon Jul 10, 2017 4:40 pm 
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FrankMatthews wrote:
@pelican in the 16 week study 24% experienced pain and %14 experienced back pain


I don't want us to get too carried away discussing the details of just one study, unless that's what you're interested in. Back pain is listed on Suboxone's website under "common side effects" regardless if we have all experienced it or not it is happening. I've taken a look at some other forums out there just out of curiosity and I was able to find quite a few instances of people reporting new or worsening back problems while on subs.

I still think Peli makes a great point but I also believe Frank when he says his pain is worse. I just don't know what mechanism of bupe would cause this. So I'll try to look at more research findings, if I can find them. I have been dealing with chronic back pain for years now and used to get muscle spasms almost daily. I feel like I'm actually getting some marked relief from the buprenorphine and I'm very grateful for it. I wasn't expecting to get that benefit out of this medicine.

How are you doing Frank? Have you tried to adjust your dosage a little bit? Please report back if you're still having problems.

- OM

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 Post subject: Re: Back pain
PostPosted: Mon Jul 10, 2017 5:03 pm 
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I think it's also important to remember, as Dr. Junig has pointed out, that pain is very subjective and that the mind has a great deal of power in pain's effects on our bodies.

Amy

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 Post subject: Re: Back pain
PostPosted: Tue Jul 11, 2017 11:16 pm 
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The pain definitely is not psychosomatic. I have found that when I dose every 4-6 hours it relieves me of the back pain. When I get outside that range of dosing the back pain becomes terrible!

Ps the only reason I cited that study is because it is one of two listed on the pamphlet when I get my sub films


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