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 Post subject: Knee surgery pain HELP
PostPosted: Mon May 09, 2011 4:27 pm 
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Ok so my boyfriend just had knee surgery. He takes sub and still messes around with opanas. He works for his insurance company so did not tell the doctor about his suboxone or opiate use. They told him he has a high tolerance (obviously). Problem is the pain meds did not do a thing for him and now the nerve blocker is wearing off. SO. They wont give him anything stronger. I want to know if he can go to a pain clinic and not use his insurance to get opana or something stronger. We live in east bay northern california. Any advice would be greatly appreciated.


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PostPosted: Mon May 09, 2011 6:11 pm 
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Unfortunately, if he has taken Suboxone within the last 24-48 hours (at minimum) it won't matter where he goes or what he gets for pain. If it is a narcotic, it will be nearly 100% blocked by the Suboxone he has taken. Many people report it taking three or four days without ANY Suboxone to get any pain relief from an opiate. Many say that it takes as much as two weeks to get a decent amount of pain relief. That is just the sad truth of it all. So going to a pain clinic or whatever won't make any difference. He either needs to try a non-narcotic pain medication (and those typically don't work as well - especially after surgery) or needs to wait it out by not taking any Suboxone at all and then higher than normal amounts of opiate pain medication. There are papers and other information on this board that will provide additional info but at this point it will just tell him what it is he should have done a week ago. It won't help all too much with the present situation.

I wish I had better news for you. Hopefully he will be able to tough through it.


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PostPosted: Tue May 10, 2011 7:46 pm 
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I agree. I would add, though, that the blockade is 'competitive' and ANY dose of buprenorphine can be overcome if the dose of agonist is high enough. But for 16 mg of Suboxone, that may require 500 mg of oxycodone--- a dose that is far from practical. High doses of opioids can be used by anesthesiologists in the OR-- a high dose of fentanyl or sufenta will do the trick-- but it would be very dangerous to try to overcome the block in an unmonitored setting, without access to resuscitation equipment.

I usually have people go to 4-8 mg of Suboxone a week before the surgery, and to 4 mg per day starting the day of surgery. I then prescribe 15 mg of oxycodone, 1-2 tabs every 4 hours. People generally do well with that approach.

Feel free to take the article from my web site that describes treating pain in people on buprenorphine; the article can be found here: www.suboxonetalkzone.com/bupe.pain.pdf


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