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PostPosted: Wed Mar 08, 2017 12:21 am 
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Hi guys this is my first post on the forum. I want to say this is such a fantastic site because the amount of information dedicated to Suboxone and our addiction disease here is great! What I want to know is if any of you guys have noticed more pain while being on Suboxone for maintenance therapy? I have been on Suboxone 8-12mg a day for about 6 months and have noticed I feel like I have the body of a 40 year old and I am only 26. Everyday I have to take 3 or 4 ibuprofen pills due to aches and muscle pains I have through out the day. Just wondering if anyone else has felt this and what you had to do to make yourself feel better. Thank you!!


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PostPosted: Wed Mar 08, 2017 1:49 pm 
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Hi Iceman and welcome to the forum. First, let me say that there is nothing about buprenorphine that would cause extra pain. What it does chemically in the body would not cause pain.

However, when I was on 16mg of suboxone films every day, I had joint pain in my knees and hips. I would notice it when I got up out of the car especially. I was 40! But it still felt unusual and there was nothing I was doing differently besides taking the strips.

I decided to taper my dose for other reasons and when I got down as far as 6mg the joint pain stopped. And it stopped suddenly.

Here's what I think. First of all, if I had to deal with joint pain while taking the dose of suboxone that was keeping my addiction in check, I would have just dealt with the joint pain. My recovery is so much more important than an annoying side effect. In your case, I would probably cautiously drop down to 6mg a day and #1 make sure that your cravings are still gone. Give it a couple of weeks to make sure.

If that doesn't work for you, ask your doctor to try a different formulation for you. I have since switched to Zubsolv because my insurance company stopped covering suboxone.

This is my reasoning. There are inactive ingredients that make up the suboxone films. In the first couple of weeks of taking suboxone the area under my tongue became raw. Then it healed and it never happened again. My guess is that some of us are sensitive to an inactive ingredient in the strips, especially when taking a certain amount, and our bodies react to the ingredient with an inflammatory response.

I am not a doctor, or even close to a doctor. I have done research about inflammatory responses in the body, and from what I can tell, it is difficult to tell what substances cause individuals to have a inflammatory response and why. But since there is nothing about buprenorphine that would cause such a response, I think that the substance causing some folks inflammation is one that makes up the film itself.

I hope that helps. Switching to a different product would probably work. I have only heard of this happening from the films. Dropping your dose could work too. But above all, safeguard your recovery.

Amy

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PostPosted: Wed Mar 08, 2017 2:03 pm 
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Amy thank you for the reply great information! I am so happy you said that Suboxone under the tongue made it feel raw almost like a light burn. I have the same thing and yes I definitely think maybe the inactive ingredients could be the culprit. In fact beyond Buprenorphine and Naloxone I have no idea what are in these strips.

I will talk to my Suboxone doctor and see what he can do to help me stop this annoying side affect. One last thing, isn't one of the side affects of Suboxone is hyperalgesia?


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PostPosted: Wed Mar 08, 2017 3:56 pm 
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For a nice discussion of OIH go here:

http://suboxonetalkzone.com/opioid-indu ... enorphine/


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PostPosted: Wed Mar 08, 2017 11:21 pm 
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Thanks for the plug, doc. Just to clarify, I wouldn't consider muscle aches and pains to be a 'side effect' of Suboxone. Not sure why you are having them, but I assume you are taking Suboxone for a reason? Either because you were addicted to opioids, or because of something else? People actively addicted to opioid agonists often focus on one thing-- getting the next dose of agonist to avoid withdrawal. Then they go on buprenorphine medications and that goes away, and suddenly they notice how a body really feels in the absense of regular exercise and normal aging.

I've had hundreds of patients on buprenorphine products over the past 12 years- mostly Suboxone. I've never noticed complaints of aches and pains-- but I definitely notice the absence of those symptoms, to the point where I've wondered why that would be. I've had so many patients who were prescribed opioid agonists for back pain, knee pain, shoulder pain, hip pain... who transferred to buprenorphine (again, mostly Suboxone), to find that after a year or so they had no pain at all. Many of them believe the Suboxone relieves their pain, but I say the same to them that docm2 said to you-- that it is hard to find a mechanism for that effect.

The link from docm2 includes an article about opioid induced hyperalgesia, and it suggests why the specific receptor actions of buprenorphine (and methadone) might prevent opioid-induced hyperalgesia, with those two medications. In short, no-- there is not evidence that buprenorphine or Suboxone increases pain-- and some reason to suggest that it relieves chronic pain more effectively than other opioids.


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 Post subject: also interesting...
PostPosted: Wed Mar 08, 2017 11:39 pm 
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I wasn't sure if I wanted to take the time to write about this or instead save it for a blog post, but here goes...

A couple weeks ago I was reading recent studies of new analgesic compounds that act at the nociceptin receptor (NOP). Many traditional opioid agonists act at NOP, and so do some non-opioid molecules. NOP mediates opioid-like analgesia, WITHOUT tolerance and addiction.

One molecule in development was discussed in a review in Smithsonian Magazine-- a molecule called bu08028. Of course, I noticed the 'bu', and as I read further the article said that bu08028 has a structure similar to buprenorphine. That led to the obvious question-- does buprenorphine have actions at NOP? If so, that could explain some of the analgesia that people report from the drug.

I sent a message to the person who developed bu08028 through LinkedIN. He is a professor and Head of Medicinal Chemistry at the University of Bath, in the UK. He wrote back yesterday. Interestingly, he works with the person who was a primary developer of buprenorphine.

Part of his response: There is lots of literature suggesting buprenorphine has some NOP activity, but some controversy as to whether the low affinity/low efficacy has clinical relevance. There are various unique attributes to buprenorphine that makes teasing out cause and effect somewhat difficult. It's one of the things that prompted us to look for buprenorphine-like compounds with higher NOP activity.

I also mentioned my interest in combining buprenorphine with opioid agonists, and he described his own interests in that same direction. I'm hoping to continue to 'pick his brain' on a couple topics, and I'll share them here as we go.

On a side note, it is so cool that it is possible to read about a new development, find the person involved, and communicate with that person. I used LinkedIN often for these types of 'missions', and I often hear back from people who are at the forefront of the science on an issue. it doesn't work at all with politicians or celebrities-- but scientists are often willing to share their ideas about the areas where they have expertise.


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PostPosted: Wed Mar 08, 2017 11:46 pm 
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Hi Iceman, Welcome! I can only share my experience with you and that is that suboxone has helped with the pain that I have in my knees from osteoarthritis. I did notice that, for the pain, less was more. I started at 24mgs and am now at 4mgs, taking 2mgs in the am and 2mgs in the pm. This is what works best for me! Good luck! I hope that you are able to find a dosage of suboxone that works best for you! It has made a tremendous and positive impact on my life!


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PostPosted: Thu Mar 09, 2017 12:56 am 
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I'm so glad that docm2 jumped in with Dr. Junig's blog post about hyperalgesia. So many topics have been covered by the Talk Zone over the years, there is just a wealth of information there!

http://suboxonetalkzone.com/

Given the information provided by Dr. Junig, it seems less likely that the pain you're feeling is caused by hyperalgesia. My hypothesis is nowhere near proven, at all, but it's the best I've been able to come up with.

So far, and this is not definitive, the only people I've seen complain about the joint pain and the sore, raw feeling under the tongue are people on the suboxone strips. There are a few foods that bother my mouth in the same way, although not at the same intensity. Some spicy chips, and some fruits, pomegranates especially. Suboxone strips are usually going under the tongue once every day. I, personally, used to sit there with the strips under my tongue for an hour or more. Usually I was on my computer, not talking or eating, so I just let the strips sit there for however long.

There are also items we ingest that can cause joint inflammation. The main one I can think of without looking it up are foods with high amounts of purine that cause uric acid build up, resulting in gout. Refined sugar promotes excessive amounts of pro-inflammatory cytokines. I don't know much about that, but my point is that there are substances we ingest that cause inflammatory responses, and those responses do not affect all people in the same way.

Therefore it stands to reason that there could be a substance in the make up of the strips that directly or indirectly causes an inflammatory response in the joints of some people, particularly at higher levels.

That's my story and I'm sticking to it! :)

Amy

P.S. I didn't read the additional posts written by Dr. Junig before I posted. I would just like to say, with no offense to Dr. Junig, that I have heard of people describing this joint response several times on the forum and there are always people (including me) who have replied that they, too, have experienced the joint pain being mentioned. I have not been diligent about double checking this, but I have only noticed this response from people on the strips. Like I said, when I was tapering, the joint pain totally stopped when I tapered from 8mg to 6mg of the strips. I noticed it right then and there and totally attributed it to the lower amount of the strip I was taking.

However, and this may explain why Dr. J hasn't heard of this side effect from his patients, the joint pain I experienced was more of an annoyance than a life changer. It was noticeable, but I never brought it up to my suboxone doctor. To me, the miracle of my addiction being put into remission was so much more important and obvious than me groaning a bit getting out of my car. It was noticeable, but it didn't affect my life enough that I complained about it.

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PostPosted: Thu Mar 09, 2017 8:12 am 
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Likewise, Amy, I didn't mean to deny your experience. I have had patients who simply do not want the film, don't tolerate the film, or feel lousy on the film. I don't agree with many doctors out there-- who think that every patient trying to avoid the film must be trying to inject buprenorphine!

I've even had patients willing to pay for any other product, instead of taking the film (covered by insurance) at a much lower cost. So I know that there are issues with the film-- I just hesitate to call it a side effect until we know what is going on!


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PostPosted: Thu Mar 09, 2017 1:16 pm 
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iceman, You do not mention what type of job or activities that you do which might explain your aches and pains. Taking ibuprofen for decades might have side effects that you don't want. I am much older than you are and find that buprenorphine, I take 2 mg a day, helps with the normal aches and pains of aging. If you don't have a reason for your pain, maybe you should go to your primary care doctor to get things checked out. There are many auto immune muscle and bone issues that cause pain. Good luck.


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

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

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