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PostPosted: Thu Jun 23, 2011 11:26 pm 
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Skip to para. 5 if you just want surgery details. Bkgd:

I'd been on subox for almost 2 yrs from chronic sciatic pain from a past l4/l5 herniation. It was working fine but I had concerns about having w/drawal symptoms which I never experienced on Norco. I'd let my doc talk me into subox b/c he was convinced that I was hooked on the Norco even tho I'd been on 3/day for years, but since I couldn't function w/out those due to pain, he said I was addicted. They said "stop the norco and start taking subox when you go into w/drawal." A week later I called and said I wasn't in w/drawal but certainly in a lot of pain, and they said start subox. The first time I tried to taper, I experienced real opiate w/drawal for the first time and went back to him very angry.

On take 2, I was down .5mg / day when I herniated my L3/4 disc. My doc refused to change my med regimen to treat the acute pain. He said take more suboxone and then go off it 24 hrs before surgery, that they'd done it many times for their patients and everything was just fine. I had to wait a month for surgery and I got up to 5-6 mg/day w/little relief. Finally, about 5 days before, I went through illegal channels for Norco, stopped Subox and experienced mild w/drawal and total pain relief.

My surgeon hadn't heard much about Subox but what he'd heard wasn't good. I sent him that article I found in here about the research paper on subox and acute pain and asked him to talk to his staff about potential issues. He was very concerned and nice but there was only so much he could recommend, but he did get the pain doc to agree to let him handle my pain meds until I was fully recovered.

I went into surgery determined to never take subox again. I hoped I could somehow taper off the pain meds Rx'd by the surgeon, ending up free of everything. I was guilty about "cheating" but hopeful that it would make things easier during my hospital stay. As it turned out, I can't imagine how much worse it would have been if I hadn't.

I woke up from surgery screaming, to the shock of the surgical team. I was given Dilaudid and intravenous acetaminophen and it got me to just strong wincing. From that point, the doc had ordered 10 mg percocet every 4 hrs, which handled the pain fine, but I was constantly in w/drawal. The nurses would not give me any more percs due to APAP toxicity risks, and they wouldn't give me any alternative. The reality is that once a doc writes orders nurses are legally and ethically bound to them, and many hesitate or are forbidden to call docs to modify meds for non-life-threatening situations. They probably won't have been briefed on the conversations you had w/the docs, it may be really busy during their shift, they may have biases about pain meds or difficult patients. I was lucky to have sweet nurses who listened to my situation and did everything they could w/in their limits.

I talked to the surgeon before I left, and his team's consensus was that I should not torture myself by trying to get off Subox and heal at the same time. They seemed shocked at my pain doc's approach and advice.

WARNING: IF YOU HAVE OPIATE ADDICTION ISSUES, SOME OF THE FOLLOWING MAY BE TRIGGERING

Once I was home I managed my own dosing with the goal of managing both pain and w/drawal w/the fastest possible taper. I only needed a perc Rx for a week and one for norco a couple of days after that, and continued to avoid Subox. Two weeks later, it's clear that my surgery has been successful - even the old chronic pain is gone - so there's no reason to take ANY pain meds. However, even with NO PAIN I've had to go back on the Subox to avoid w/drawal. I'm on 1mg/day and planning to get off as quickly as possible. It's so clear to me that this doc is in it for the $$ and has no interest in real pain mgmt, or in me.

I have a friend in the public health sector who has given me a promising taper plan, including supplemental meds (not controlled substances) which lessen w/drawal symptoms during the first 2-3 weeks I get to zero. I'll post those results in a couple of months and I hope it's a better story than this one.

If I had it to do over again, I would:
1. Demand treatment for acute pain sooner, with medical articles and references to back me up, and stop Subox as far in advance as possible. Possibly raise pain mgmt w/the surgeon earlier too.
2. Work w/the surgeon to come up with a plan in writing for the hospital stay, including contingencies for bad results, so that nurses or others "out of the loop" during planning have easy info.
3. Probably break the law if I had to. It's sad how all the DEA, regulations, etc. have made good people have to do bad things to manage their own health.

I hope this helps you more than scares you. Speak up for yourself.


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PostPosted: Fri Jun 24, 2011 7:38 pm 
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Sorry tx, I had C6-C7 fusion and never had a bit of pain, I was on tramadol for 3 yrs prior to surgery, sounds like your Dr. is a pain pill nazi..... they wanted to give me meds stronger than tramadol, but by that time I was in love with tramadol.. I NEVER tried or used anything but Tramadol... I'm finding out now that tramadol is really addicting for people with bipolar II issues.. There are people who use it for that and not pain... I miss the feeling to this day.. Mike


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PostPosted: Sun Jun 26, 2011 12:17 pm 
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It was unconscionable for your doc to put you on Sub when you were on 3 Norcos a day and had NO withdrawals from stopping! By putting you on Sub he created a physical addiction that wasn't there! I would be pissed off if I were you. If he really wanted you to switch to Bupe he should have put you on the patch, which is a really low dose.
If were you I would get off of Sub ASAP and find a new doc.
I'm truly sorry for what you have been through. I wish you a speedy recovery from your surgery.
Lilly


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 Post subject: One-month update
PostPosted: Tue Jul 12, 2011 2:38 pm 
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I had a frank conversation w/the doc's PA, with whom I've had a pretty good relationship. She took complete accountability for their mis-management of the acute pain before the surgery. However, she said that after the surgery, it was the hospital staff's responsibility to page the surgeon when I was having trouble, who would have in turn paged the pain doc based on the prior discussions. They apparently dropped the ball - no calls were made despite my repeated discussions w/the nurses, nice though they were. So I'm mad, but it's probably best to move forward.

This so reminds me of when I had my son. If his father had not been there to enforce the birth plan we'd made w/the OB/GYN, the nurses would have done whatever they usually did. I was certainly in no condition to say otherwise. So god forbid there's a next time, but I'll be sure my husband is my advocate in case the communication between nurses & docs breaks down, as seems common.

So what now? Funny you mention the patch, @Lillyval, because that's exactly what we decided to do. I've just gone from .5 mg/day tablet to the equiv. 200 mcg (that's microgram, folks) Butrans patch in hopes of continuing the taper, assuming that all my chronic pain stays gone. It's only been 24 hrs so I have no strong opinion yet.

My surgery results in general are still amazing! I'm back at work part-time and only feel bad if I sit too much.


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

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