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PostPosted: Fri Apr 09, 2010 9:16 pm 
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Great NIH article on treating acute pain in suboxone and methadone patients. Includes misconceptions and common practices.

http://www.ncbi.nlm.nih.gov/pmc/article ... s17732.pdf

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Last edited by hatmaker510 on Sat Nov 13, 2010 9:11 am, edited 1 time in total.

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PostPosted: Sat Apr 10, 2010 12:31 am 
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Thanks, Hatmaker, for the link. I find it interesting, and a bit gratifying, that the recommendations are exactly the same as the ones that I wrote about in the e-book advertised on this site-- right down to the same 4 suggestions about managing pain and the doses of agonists to be used for substitution of buprenorphine. As a solo-practice doc, I never know for sure if I have gone off the deep end or not. At least in this case I am still 'with the program'!


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PostPosted: Wed Apr 21, 2010 11:05 pm 
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In looking at some information completely unrelated to this topic, I came across something called "Fast Facts and Concepts" from the Medical College of Wisconsin. They have several hundred different topics there that deal with a large variety of items. They are intended for use by healthcare providers. In any event, Fast Fact and Concept #221 actually deals with the “Treatment of Pain in Patients Taking Buprenorphine for Opioid Addiction.” It looks like it was released in November 2009. It seems to have some additional suggestions for treating patients like us, who find themselves in need of pain relief in spite of the fact that we are also taking Bup on a daily basis. Although they start out by saying "While there are no clinical studies addressing how to treat pain in patients taking buprenorphine,..." they do have some good suggestions and also list nine sources for references. Although I have not looked up any of the references, they too may have some additional information.

I did find one portion very interesting: "Opioids that have a higher intrinsic activity at the mu-opioid receptor, including morphine, fentanyl, or hydromorphone, are all options, while opioids with less efficacy such as hydrocodone or codeine should be avoided." In other words, Vicodin is not suggested as a good pain medication for Bup patients, while morphine, fentanyl and Dilaudid is. My Bup doc has said to me in the past they he believes that fentanyl does the best job of competing with Bup. Unfortunately, none of this has been clinically studied so we really don't know for sure. It really would be nice if someone conducted a clinical trial so we could get some science to help determine what works the best.

I don't know if anyone has posted this web page here in the past or not, but here is it in the event that it might help others. I am also pretty certain that Dr. J. is a faculty member at the Medical College of Wisconsin. It's a huge place. Here is the paper:


http://www.mcw.edu/fastFact/ff_221.htm


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PostPosted: Wed Apr 28, 2010 5:44 pm 
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I found some more interesting articles on treating pain in bupe/methadone patients:

http://www.todayshospitalist.com/index. ... ad&cnt=776
http://www.naabt.org/education/documents/challenges.pdf
http://www.australianprescriber.com/upl ... es/980.pdf
http://www.pcssmentor.org/pcss/document ... 052307.pdf
http://escholarship.org/uc/item/0373q6pn (This one is a "Primer for Emergency Physicians).

Good stuff!

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PostPosted: Wed Mar 23, 2011 3:43 am 
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Dr. J just wrote a blog post about treating postoperative pain in bupe patients, suggesting that they be discussed with one's doctor(s).

The blog post is here: http://suboxonetalkzone.com/2011/03/22/ ... lk+Zone%29

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PostPosted: Fri Aug 05, 2011 4:00 pm 
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Hey guys,

I just joined this forum recently and just wanted to say thanks for this thread, it pretty much hits it on the head in regards to what i have been dealing with pain wise. Consider it bookmarked, I appreciate your time you have put in to the research, etc.


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PostPosted: Sat Aug 24, 2013 12:42 am 
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I am posting a reply to this thread in order to push it to the front of the section. The article linked in the original post, by hatmaker, is still an accurate consensus of the treatment of surgical pain in buprenorphine patients. The one thing I would change is the idea that people should just 'stop Suboxone for a few weeks before surgery.' Patients on buprenorphine know that such a suggestion is better in theory than in reality.

Treating pain in people on buprenorphine is all about relative doses and activities at the mu receptor. High doses of potent agonists will eventually outcompete buprenorphine. Codeine is not good agent, not so much because of potency-- but because codeine is a 'prodrug' that is converted to morphine, and some people have enzyme systems that do a poor job with that conversion.

The article in the first post of the thread should be part of every buprenorphine patient's medical library, to use in educating doctors and nurses if the patient ever needs pain relief after surgery or injury.


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PostPosted: Sat Aug 24, 2013 1:19 am 
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Yes, this article is very valuable to all of us who are on suboxone.

I want to mention my experience with treating a recent lung infection and migraine pain. This really only applies to people who are on a low dose of sub, but if you are anticipating tapering to a low dose before surgery, this may be useful information.

My suboxone doctor has prescribed me Nucynta ER to take if I have any breakthrough pain from migraines or other problems. For example, I took Nucynta during a lung infection for cough suppression and pain relief for pulled rib muscles. The combination of my normal 2mg of sub with the extended release Nucynta worked VERY well for me. I believe Nucynta is fairly potent as opiate medications go, but the very helpful part for addicts is that it has little to no euphoric effect! Nucynta itself is not new, but the ER formulas are, so it can be a little pricey. But if you only have to take it sporadically or for surgery post-op, it may be worth checking into. The other thing that is helpful to us addicts is that it is tamper-resistant like the new oxycontin pills. They can't be crushed.

I'd be interested to hear whether anyone else has experience with this med. I do think that if I had only ever had Nucynta for pain instead of percocet I may not have gotten addicted in the first place, but who knows?

Amy

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