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PostPosted: Wed Mar 17, 2010 5:27 pm 
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Hi all,

Some of you may recall that in addition to my taking bupe for addiction, I also take it for pain control. Because I take it for pain, my doctor has me dosing 3 times a day, 8 mg each. I know for straight addiction recovery, this is a high dose. I've had two subox docs treating me since my induction over 15 months ago (I changed docs when we moved last year). Both doctors had me dose the same, three times a day.

What I'm wondering is if anyone else is taking it for pain, too, and if you also dose more than once a day or at a higher dose. I'm curious if this is the norm for pain control or if I'm in the minority.

Thanks,
Melissa

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PostPosted: Wed Mar 17, 2010 8:04 pm 
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Hey Mel,

As you and others know I too take the suboxone for pain along with opiate addiction. My current doctor prefers his patients to take once per day in morning but said that I can take it three times a day if it helps with my pain. I take 12mg per 24 hours. When my pain is the worst I will take it 3 - 4mg doses. If my pain is 'moderate' then I will dose 8mg in morning and 4mg in evening/night. If my pain is at it's least I will just dose in the morning. I don't bounce around all the time, and I am not practicing addictive behavior, just trying to get the most out of bupe's analgesic's properties!

I still take the suboxone for assistance with my recovery, so I will say that I use it for pain control AND addiction control. Of course I have support system that aids with the recovery along with suboxone.

Take care!

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PostPosted: Wed Mar 17, 2010 9:14 pm 
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So I have a couple questions on this topic also, not to hi-jack your post :-)

As you know I just got back on sub. Was on 12mg when I got off of it and at 12 I couldn't feel the peripheral neuropathy in my feet. I still felt the other pain condition I have but that condition isn't 24/7. I started taking it 2 days ago and was given permission to take up to 16mg if needed but the script is really for 8mg per day and she would increase it if needed. I haven't been able to take more than 6mg per day so far and I am not "trying" to increase except I don't want to feel my feet.

Q: I got up to 6mg because I could still feel my feet at 4mg. I have taken 4mg total today and I can feel my feet now so I am taking another 2mg as we speak. That ought to get rid of the foot pain I think. But for those who have pain conditions where there is intense pain but not 24/7, do you have permission to take a little extra those days and if so, what would you recommend taking if you were me?

It seems I might be best off for my feet at 4mg in the morning and then 2mg at night. It would be nice to be able to take another 4mg as needed for pain which wouldn't be regular. How would a doc prescribe for that? I don't want to take it for pain and then have a hard time going back down again.

Do you think it is best to take 2x per day or should I take 3x per day? Does it matter? Is there a level that is most effective for intense pain that isn't 24/7?

I am just trying to figure out how I should make sure I am taken care of without taking too much and my condition may not flare for a few weeks and the doc will be in Haiti then. So what should I suggest when I go back in?

Cherie


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PostPosted: Wed Mar 17, 2010 9:27 pm 
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I can't site a source for this, but I seem to recall having read that the pain relieving properties of bupe last about 6 hours.
For me, I don't always just take my 3 per day like clockwork. Some days I only need two, but on other bad days I definitely take the third one. Sometimes I have break-through pain that isn't helped by the suboxone at all. :-(

You might have to build it back up in your system before you see some relief from your neuropathy. But I don't know that for sure, I may just be talking out of my ass. If you were on 12 mg before you stopped, maybe try 4 mg 3 times a day for a few days and see how that goes. Again, you might want to work up to that slowly, since your 're-induction' wasn't quite traditional. Just try to give it more than a day or two before trying another method. It might be more trial and error than anything.

Good luck!

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PostPosted: Wed Mar 17, 2010 9:37 pm 
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Thanks! I am totally open to anyone who knows anything about this. Definitely would have to break in slow to 4mg three times per day. FYI...for anyone who hasn't been off it and gone back on...you don't know it but this stuff is strong. It no longer surprises me that crumbs can be useful.


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PostPosted: Wed Mar 17, 2010 11:20 pm 
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Yeah, in the past, I was prescribed Subutex for treating migraines, a low dose of 4mgs, twice a day. It did help alot, but was made up in a compounding pharmacy with Piroxicam (a long-acting, non-narcotic, sublingual, anti-inflammatory) mixed in. It worked very well, I never craved it, and I didn't feel whacked-out all day.

When you're having break-through pain and need to take a rescue dose, two things are important:
1. Try to take the least amount possible. The power of 1mg may surprise you.
2. Give that extra amount time to work. Sometimes, this can mean up to 2hrs for Sub.

Be miserly and be patient. You are trying to quell the pain, NOT build a tolerance. Less is more.

Be glad you have an alternative to take for pain. Sub is still (in my opinion) better than methadone or other opiates. Do not beat yourself up. Doctors used to give Heroin for coughs. Can you imagine?


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 Post subject: Hi Hat
PostPosted: Sun Nov 21, 2010 12:58 pm 
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I saw a post from you back in March. I replied here because of the topic. I hope you will see it. I had my visit with my Sub Dr. Last thursday. He spoke with my primary doctor and felt that using Suboxone for chronic pain was the way to go for me. I agreed because I have a lot of different things. I have Rheumatoid Arthritis as well as Osteoarthritis. I have chronic pain from multiple leg surgeries and the amputation offers me nerve damage pain.

He upped my dosage to 12mg a.m. and 12mg p.m.

2 questions. Do you think that is a very high dosage? Also, I have regular doppler tests and ultrasounds on my right leg(left one is amputated). The last test showed some sign of poor circulation. That is a probable amputation. (terrifies me just to type it but it's the reality of the disease) On that dosage, how in the world would I prepare for that kind of surgery painwise. I would need a truckload of narcotics.

Luckily all my doctors are affiliated throught the same hospital where all my surgeries are done. It scares me to thin k of that situation. I pray my circulation holds up and I live out the rest of my years with my leg.

Thanks for all your help. You are a Godsend to this forum.

Love & Hope, Queenie


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PostPosted: Sun Nov 21, 2010 1:16 pm 
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Remember, queenie, I'm not a doctor...But I will tell you what I think of the dosing schedule your doctor gave you. Personally I think you would be better off with 8 mg, two to three times daily. Since I made this post I've learned and read up a lot on using suboxone for treating chronic pain. The suboxone lasts between only 4-6 hours. If you take 12 mg twice a day, that's 12 hours between doses. I don't think you'll get maximum pain relief that way. Some people even dose up to 4 times a day on suboxone. I'm sometimes good with two, other times I need that third one. If you take 12 mg twice, then what? If you need more you'll end up taking more than prescribed. If it were me I would stick to 8 mg, then you could dose up to three times daily. I honestly don't think you'll get more pain relief from 12 mg than you would from 8. In fact, a great many people who use sub for pain take only 2-4 mg, up to 3 times a day and that's plenty to help them. I've tried to only take 4 mg at a time, but it just doesn't touch my pain.

I'm rambling now, I know. (Too much caffeine this morning, that's my excuse and I'm sticking too it. :? ) I hope this makes some sense to you and helps. Let me know if you have more questions.

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-I'm only responsible for what I say, not for what you understand.


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PostPosted: Sun Nov 21, 2010 2:18 pm 
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Like Hat some of you may know I’m on suboxone for pain management as well along with my recovery for opiates. And Suboxone works great for my pain most days.

My dose is for 16 mgs a day but my Dr.Z gives me 10 extra pills each month in case I have a really bad pain that day. So on those days I will take 24 mgs. But 16 seems to be more than enough most days of the week. As of my dose it all depends on how I’m felling in the morning. If my pain level is high then I’ll take a full 16 in the am and then around 4 mgs in the pm after dinner time. And then ill also take 2mgs b4 I go to bed. So I dose 3 times a day but some days only 2 times a day.


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 Post subject: 8, 16,24,32 ?????
PostPosted: Sun Nov 21, 2010 2:25 pm 
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hat & BBoy, you both make perfect sense to me. My pain is fine so the subs are working. But it was also fine at a lower dosage, so I think I am taking your advice.

It leaves me, however, wondering why doctors prescribe such a high dosage?

Anyway, Thanks for being there and think positive thoughts that this leg will keep working. Surgery right now would be devestating and difficult on subs.


Love, Queenie


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 Post subject: Re: 8, 16,24,32 ?????
PostPosted: Sun Nov 21, 2010 4:06 pm 
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queenie1959 wrote:
hat & BBoy, you both make perfect sense to me. My pain is fine so the subs are working. But it was also fine at a lower dosage, so I think I am taking your advice.

It leaves me, however, wondering why doctors prescribe such a high dosage?

Anyway, Thanks for being there and think positive thoughts that this leg will keep working. Surgery right now would be devestating and difficult on subs.


Love, Queenie


Well queenie ill say a prayer for you tonight that everything works out and you don’t have to go through another surgery!

And it’s good to know that all your doctors are in some way connected cause thats always really good to have on your side in case of any serious issues. And I understand why your dr has you on such a high dose from the sound of your post you def are in some type of pain most days and they want you to be comfortable so you can go on with your everyday life. But at the same time you just got to find what works best for you with suboxone and pain management it’s almost like trial and error in a sense cause when all is said and done we all have different chemical makeup’s and what might work for me could not work for you and I know you already know that. But my point is just find what works best for you and your pain and go from there and know on bad days if you have to take more than take more just either try to remember or write down on what dose and time you took it at if it worked and stick to that.

I found taking a little journal of my dosing/pain levels really helped me find what works best for myself and I still keep a little journal on bad days.


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 Post subject: LESS IS MORE
PostPosted: Wed Dec 15, 2010 11:05 pm 
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OMG! 24MG? Get down to 2mg 3times a day. It will work so much better!
The only thing is you have to titrate down first. You have a TON of
Sub in your system and it has been compounding again and again.
Don't believe me? Okay continue at 24. :cry:


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PostPosted: Wed Dec 15, 2010 11:17 pm 
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Hatmaker i take 6 mg split into two doses for the question you asked so at about ten am i take a half then about four pm i take two mgs more for pain and maitenance.


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 Post subject: Re: LESS IS MORE
PostPosted: Wed Dec 15, 2010 11:29 pm 
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LifeIzGut wrote:
OMG! 24MG? Get down to 2mg 3times a day. It will work so much better!
The only thing is you have to titrate down first. You have a TON of
Sub in your system and it has been compounding again and again.
Don't believe me? Okay continue at 24. :cry:


(FYI-This post is almost 10 months old.) For those of you who are unfamiliar with my journey, I have tried to go down in dosage, but my pain is not controlled. It's not THAT unusual to dose for pain with 8 mg 2-3 times a day.

(Also FYI -It's best to state your experience rather than tell someone what they have to/should do.)

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PostPosted: Wed Dec 15, 2010 11:59 pm 
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I'm with Hatmaker. I found that post offensive, rude, and actually a bit ignorant. I take suboxone for pain and I take 8mg per day and sometimes 16mg if I am in a lot of pain. On the worst of the worst days, even 16mg doesn't work. I only get an extra 10 pills per month. I had pain at about a 4 for three days and then had pain at a 7-8 for five days. I don't have enough sub to get me through that at 16mg. I can handle quite a bit of pain. But it WEARS on you. It becomes exhausting. By Monday morning this week I woke up IN PAIN AGAIN and thought to myself "I don't care if I die at this point. I am tired of living like this". I am not a depressed person. I have a condition where in moments I can go from a pain level of 7 down to a 2-3 in five minutes. When my condition stops flaring suddenly, I go from not caring if I die, to going about my day like a normal person and enjoying my work, husband, friends, etc. I immediately forget all about how miserable I was. Point being, unless you are someone who has pain and knows pain, and have tried using suboxone for pain, you have no idea what one "should" be taking.

According to LifeIsGut, I am on about 3x the amount I need to be on. If that were the case, I would probably be dead by now because I would have put a gun to my head long long ago. I don't need to be pain free all the time. I am ok with that. But I would highly prefer pain that doesn't exceed a 4 and even more so prefer that pain levels up to 7-8 do NOT EVER last more than a day. I am already compromising by using sub for my pain instead of a full agonist which means my pain will rarely be less than a 3. I can live with that.

Hatmaker has done more research on this topic than anyone I know. From my own personal experience she is absolutely correct. Suboxone building up in your system DOESN'T help control pain any better at these high doses. Taking an extra 8mg when I am in pain is the ONLY thing keeping me alive on those days. If I didn't have it, I don't know what I would do.

I also agree it only lasts about 4 hours when you are on these levels and you really don't need more than about 4-8mg to control pain.

Cherie

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PostPosted: Thu Dec 16, 2010 12:00 am 
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Let me clarify....4-8 mg at a time. Not ALL day.

Cherie

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PostPosted: Thu Dec 16, 2010 11:13 am 
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Lifeizgut,

Were you able to manage your severe pain by dropping down to 2mg three times a day? Man, that's incredible that such a low dose would be able to control severe chronic pain. I'm astounded. Astonished. Flabbergasted.

I would love to hear your story. What kind of pain do you suffer from, how well did the 2mg three times a day ease your pain?

You were trying to treat chronic pain with suboxone, right?


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PostPosted: Thu Dec 16, 2010 4:42 pm 
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hatmaker510 wrote:
Hi all,

Some of you may recall that in addition to my taking bupe for addiction, I also take it for pain control. Because I take it for pain, my doctor has me dosing 3 times a day, 8 mg each. I know for straight addiction recovery, this is a high dose. I've had two subox docs treating me since my induction over 15 months ago (I changed docs when we moved last year). Both doctors had me dose the same, three times a day.

What I'm wondering is if anyone else is taking it for pain, too, and if you also dose more than once a day or at a higher dose. I'm curious if this is the norm for pain control or if I'm in the minority.

Thanks,
Melissa


Well you know Mel I’m in the same boat you are. Yes I dose more than once a day and yes I am on a high dose for pain.

Basically this is how my day of suboxone works.
I take 14 mgs in the AM
Then I’ll take 8 mg after dinner
And one last dose of 4 mg b4 bed

I use to be on just 16 but as you know I reinjured my knee and the time of year does not help so my dosed was increased back to 24.


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 Post subject: please explain
PostPosted: Thu Dec 16, 2010 5:25 pm 
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LifeIzGut, I've got no problem with you making that statement. If all of us who are or have taken it for pain under a doctor's advice have been doing something seriously wrong, I do want to know. However, you need to provide support for what you just said. You made a very strong blanket statement, but you gave no supporting information. I really don't get that, because when I give specific advice like that, as in saying everyone 'should' do a certain thing, I make sure I know what I'm talking about and can back it up.

I took Suboxone for pain for a couple years and I was at 32 mg. That's how much it took to make a dent in my severe pain. I did wean down after 6 months on it, and my pain escalated, so I had to go back up and stay at 32 mg a while longer. 4-6 mg is effective for blocking your opiate receptors, but it's not always effective for managing chronic pain. It's also not always effective for managing addiction because many people still get dangerous cravings at that low a dose.

Please understand that everyone is different. Everyone's treatment will also be different and as far as I know, there are hard and fast rules for how much and how long people should take Suboxone.

laddertipper

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