It is currently Wed May 23, 2018 6:49 pm



All times are UTC - 5 hours [ DST ]


Our Sponsors





Post new topic Reply to topic  [ 17 posts ] 
Author Message
PostPosted: Wed Mar 08, 2017 12:21 am 
Offline
New Poster
New Poster

Joined: Wed Mar 08, 2017 12:14 am
Posts: 2
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!!


Top
 Profile  
 
PostPosted: Wed Mar 08, 2017 1:49 pm 
Offline
Moderator
Moderator
User avatar

Joined: Thu Feb 23, 2012 4:42 am
Posts: 4501
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

_________________
Done is better than perfect!


Top
 Profile  
 
PostPosted: Wed Mar 08, 2017 2:03 pm 
Offline
New Poster
New Poster

Joined: Wed Mar 08, 2017 12:14 am
Posts: 2
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?


Top
 Profile  
 
PostPosted: Wed Mar 08, 2017 3:56 pm 
Offline
Long Time Member
Long Time Member

Joined: Thu Aug 08, 2013 5:40 pm
Posts: 533
For a nice discussion of OIH go here:

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


Top
 Profile  
 
PostPosted: Wed Mar 08, 2017 11:21 pm 
Offline
Site Admin
Site Admin
User avatar

Joined: Sun Feb 24, 2008 11:03 pm
Posts: 1563
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.


Top
 Profile  
 
 Post subject: also interesting...
PostPosted: Wed Mar 08, 2017 11:39 pm 
Offline
Site Admin
Site Admin
User avatar

Joined: Sun Feb 24, 2008 11:03 pm
Posts: 1563
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.


Top
 Profile  
 
PostPosted: Wed Mar 08, 2017 11:46 pm 
Offline
Moderator
Moderator

Joined: Fri May 01, 2015 9:58 am
Posts: 884
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!


Top
 Profile  
 
PostPosted: Thu Mar 09, 2017 12:56 am 
Offline
Moderator
Moderator
User avatar

Joined: Thu Feb 23, 2012 4:42 am
Posts: 4501
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.

_________________
Done is better than perfect!


Top
 Profile  
 
PostPosted: Thu Mar 09, 2017 8:12 am 
Offline
Site Admin
Site Admin
User avatar

Joined: Sun Feb 24, 2008 11:03 pm
Posts: 1563
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!


Top
 Profile  
 
   
PostPosted: Thu Mar 09, 2017 1:16 pm 
Offline
Super Poster
Super Poster

Joined: Fri Jul 24, 2009 10:45 pm
Posts: 144
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.


Top
 Profile  
 
PostPosted: Sat Feb 03, 2018 9:52 am 
Offline
Average Poster
Average Poster

Joined: Wed Jan 31, 2018 2:05 pm
Posts: 19
My experience on less then 2 mg of suboxone then subutex:

Nausea at first with .05 suboxone. I cut down then tapered up to 1 mg. Started to develop sick headaches within a few months. As I am a headachy person and entering menopause, I chalked it up to that. These headaches were violent causing me to throw up and kept me debilitated for the day. They were inconsistent and I'm not sure what day triggered the worst ones. Hormones? Higher dose? Less food? Again, I get a headache for everything so didn't make the connection, at first, to Sub.

I decided to research "suboxone and headache" and quickly found that naloxone could be the cause of this. I asked my doctor to switch to Subutex and took that for one month. I still get my "other" headaches, but those horrible sick ones disappeared immediately. Naloxone was definitely the cause 100%.

While on 1-2 mg Subutex for only a month, and with my sick headaches gone, I then started to notice waking in the morning with increasing joint pain and muscle aches. I felt like an elderly person. I thought I was possibly developing arthritis - after all, bupe is a pain killer and should relieve pain. Right?

Given my lesson about suboxone headache side effects, I took to google again to search joint pain and bupe. I stopped the Subutex and within 48 hours, the acute pain was gone. I still feel a "hangover" in those joints, but it's improving each day. I now wake and hop right out of bed. With Subutex, I had to lift my legs off the bed. No joke.

I know this doesn't make sense. I can only tell you how my body reacted. It is what it is, and it wasn't pain from withdrawal either. Admittedly, I am very sensitive to all medication and obviously a unique subset of people. I found that Hydrocodone works for me. I've tried a few Percocet and would take Hydrocodone any day over that. For 15 years, I never needed more than 1-2 a day. I've tried to learn the differences chemically and why different opiates would matter. I wish a scientist would conduct a study as they are not all created equal.

Edit by Amy: Char, you are welcome to include any anecdotal evidence in your experience. And you are welcome to share studies from scientific sources. On this forum, however, we don't allow blanket statements that look like fact without solid scientific evidence to back it up. Therefore I erased your last sentence.


Top
 Profile  
 
PostPosted: Sat Feb 03, 2018 2:29 pm 
Offline
Moderator
Moderator
User avatar

Joined: Thu Feb 23, 2012 4:42 am
Posts: 4501
Char, I understand that you've had a bevy of complaints about suboxone and subutex as medications. That has been your experience and I respect that. The thing is that buprenorphine has been studied exhaustively since the mid 80s and scientific study has not found the same thing.

Is it possible that inactive ingredients in suboxone and subutex cause some strange side effects in some people. I think that's possible, although I imagine that at least the pill form is made up of ingredients that have been used many times over in different medications.

I wonder if something in the formulation caused my immune system to overreact? Have you heard why normally healthy people are dying from influenza this year? Apparently it's because their immune system overreacts to the virus and creates a "cytokine storm", which causes inflammation in the lungs to the extent that breathing becomes impossible.

Well, what if something in the formulation triggers an inflammatory response to our joints if there is enough of it in our system? There is a lot that is unknown about why our immune systems attack our own bodies, but there are enough autoimmune diseases like multiple sclerosis to know that our bodies can overrespond to our own bodies, treating a normal part of the body like a foreign invader.

Is it so much of a stretch to imagine that our immune system might overreact to a component of a medication, which could cause inflammation at the joints? I admit. I don't know enough about anatomy and physiology to understand if that is a possibility.

What I'm getting at, however, is that there may not be a straight line from A to B in this situation. So to say that subutex definitely causes pain is just not supportable. We rely on science in our forum. Anecdotal evidence is fine to a point, but when it comes to declarations about a medication that is saving so many lives, we don't accept anecdotes as proof.

Amy

_________________
Done is better than perfect!


Top
 Profile  
 
   
PostPosted: Sat Feb 03, 2018 9:08 pm 
Offline
Average Poster
Average Poster

Joined: Wed Jan 31, 2018 2:05 pm
Posts: 19
I came here because I felt it important to report an obviously rare side effect of taking Subutex.

Now maybe it's not a direct line but nevertheless, I put A in my mouth and I experienced a physiological result B - pain in joints. I confirmed this because I stopped taking A and the B stopped.

It would be horrible for someone to have the same experience and not have a doctor believe them. That is why I posted my story so they can see others have it too. Before posting here, I read some posts disputing the claim saying that withdrawal is what causes joint pain. Whilst that may be true for others and the norm, this was not the case for me, and clearly a very few others. Again, my point for posting was to share. Without feedback, how are people and the drug manufacturers supposed to be informed.

I read another post mentioning it being psychosomatic. How offensive to those of us who have real pain from taking the pill Subutex - whether it be an inflammatory response as Amy suggested, or something else.

"Our experiences with buprenorphine" so says the title of this site.


Top
 Profile  
 
PostPosted: Sat Feb 03, 2018 10:22 pm 
Offline
Moderator
Moderator
User avatar

Joined: Thu Feb 23, 2012 4:42 am
Posts: 4501
Hi Char. I do understand where you're coming from. And it must have been frustrating to deal with certain physical problems and not have a super clear idea of where they come from.

I have seen this suggestion several times. If you want your experience heard, my suggestion is to contact the FDA. Here is a link that should get you to a page where you can share your story.

https://www.accessdata.fda.gov/scripts/ ... rting.home

I hope that it helps you to report your findings.

Amy

_________________
Done is better than perfect!


Top
 Profile  
 
PostPosted: Sat Feb 03, 2018 11:50 pm 
Offline
Site Admin
Site Admin
User avatar

Joined: Sun Feb 24, 2008 11:03 pm
Posts: 1563
As someone who assesses personality all day, every day, I know first hand that psychosomatic symptoms are EXTREMELY common-- and in every case, the person doesn't realize the pain is coming from central pain circuits, triggered by emotions or memories. Those who have insight and an open mind do well; those who refuse to take outside opinions into account don't do so well.

Everyone who has been through successful treatment knows that we recovered because we were willing to accept information from outside ourselves-- so the saying, 'our best ideas and feelings brought us here' (or some other variation). My point is that the opinions here are motivated by the desire to be helpful, and provide accurate information. There are sites out there (I've even written for one of them in the past) that keeps readers coming back by essentially saying 'everything you say is exactly right and valid, so don't let anyone ever tell you anything different! It's THEM, not YOU!' I don't see the value of that advice.

All that said, YOUR symptoms Char, sound like histamine release. Some opioids, especially morphine (but buprenorphine and morphine molecules have a number of similarities), trigger the release of histamine as they enter the bloodstream. I don't know the exact mechanism, but I should- and I'll write again soon with that info. But the effect is fast, within the first minute or two, and causes aches in the joints. The same things happen in some people after a sneeze, where sudden histamine release causes the eyes to water, itching, or aching in arms and legs.

The histamine release is used by paramedics; they give 2 mg of IV morphine in the ambulance, and the heart patient feels calm and the pain goes away... but also the release of histamine opens the veins (preload) and arteries (afterload) to reduce the work and oxygen demand by the heart.

Char, I'd look at timing to rule out or support the histamine idea. Buprenorphine taken sublingually peaks at about 3-4 hours. In my experience during inductions, people start to feel buprenorphine effects at about 20-30 minutes, maybe longer. So if you have aches in the first few minutes, it is probably from histamine release. The pain is not 'harmful' (again, we feel it every time we sneeze), and should go away after a few days (things that trigger histamine, like allergic reactions, can be overwhelmed by chronic exposure).

If it is something that doesn't fit my timing, then report it. Those reports on other meds have led to the removal or relabeling of the medication.


Top
 Profile  
 
PostPosted: Sun Feb 04, 2018 9:39 am 
Offline
Average Poster
Average Poster

Joined: Wed Jan 31, 2018 2:05 pm
Posts: 19
It could very well be a histamine response. Unfortunately, I'm vague and the pain really seemed to run together, but noting that night and first thing in the morning it was at it's worst. I'll also add that I was basically feeling unwell all day with no energy. It was making me sick, or toxic. To me this is "harmful". It was my body telling me I was poisoning myself.

I am open to all people having psychosomatic symptoms. However, if people and especially doctors use that to discount actual symptoms reported, we aren't helping. IMHO, this should be a consideration only after ruling out all other options. Planting that seed upfront is concerning, and I would think that anyone with real pain and sickness would also find it offensive - to them. When someone is truly suffering from physiological pain, and someone suggests it's in your head? Well, I rest my case. I'm glad all the Wellbutrin XL patients were validated eventually.

Moving along, thank you for the histamine suggestion. Thank you Amy for the support.


Top
 Profile  
 
PostPosted: Sun Feb 04, 2018 11:30 am 
Offline
Average Poster
Average Poster

Joined: Wed Jan 31, 2018 2:05 pm
Posts: 19
I've started to research the histamine response and am finding it quite intriguing. Thank you again for bringing this to my attention.

While my main complaint was acute joint pain for obvious reasons, now with more information I can review my other symptoms and try to connect the dots. At over 50 I still get a few blemishes, and I noticed the surrounding skin when pinched would become more inflamed than normal. I think this might also support histamine in my system. I mentioned the unusual malaise in my previous post, and will add diminished libido, decreased vision, and short term memory issues. I was willing to accept these, but my body decided to speak louder with pain to warn me of toxicity and have me stop.

The suboxone vs. subutex has me stumped regarding pain - the naloxone headaches are a no brainer. Best I can figure is it was timing and dosage. Perhaps the histamine was slowly building and when I changed to Subutex, it being slightly stronger without naloxone antagonizing it (if I'm not mistaking the science) I went into histamine overdrive. Maybe I also took a smidge more with the pill being harder to divide. Either way, my dose is very low so my sensitivity must be extremely high. This would make sense if I'm essentially allergic to it. I have read reports of joint pain from suboxone kicking in after several months too.

This post is me trying to figure it out.


Top
 Profile  
 
Display posts from previous:  Sort by  
Post new topic Reply to topic  [ 17 posts ] 

All times are UTC - 5 hours [ DST ]


Who is online

Users browsing this forum: No registered users and 1 guest


You cannot post new topics in this forum
You cannot reply to topics in this forum
You cannot edit your posts in this forum
You cannot delete your posts in this forum
You cannot post attachments in this forum

Search for:
Jump to:  
Our Sponsors
Suboxone Forum latest topics RSS feed Subscribe to the entire forum

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

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

Powered by phpBB® Forum Software © phpBB Group