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PostPosted: Sat Dec 18, 2010 12:09 am 
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Hi Everyone,

I am due to go through my withdrawal Sunday night with induction Monday morning. After reading many of the posts here, I am getting even more frightened than I was already. I have been on opiates for 10 years for severe chronic pain - a degenerative bone disease in all my joints that causes them to collapse. I have had many surgeries, including joint replacement. I also have benefited significantly from pain relief for fibromyalgia-like pain and severe GI pain (autoimmune disease), and I am in the midst of a bowel flare-up.

My question has to do with withdrawal. By 6 hours after my last dose of oxycodone, I will begin being in the worst kind of hell imaginable. By 7 hours I will be rolling around on the bed, having severe joint pain, yawning frequently, getting a rising fever, increased heart rate, completely unable to sit still. I am not in good health. I am 5'7" and weigh 98 pounds. My doctor wants my last dosage to be 18 hours before induction. This means 12 hours of absolute agony. I don't know why I enter such severe withdrawal so fast, but I do not want to land myself in the hospital. Is there anyone out there who has been the same? Is it unheard of to have such severe withdrawal so quickly?

I think this is going to be the worst experience since I spent 18 hours with a perforated colon almost 20 years ago and I am terrified. I looked up the COWS scale and am convinced I will already be in moderate withdrawal within 8 hours of last dose. Do I really need to put myself through extra hell because my doctor is basing his advice on his average patient? Wouldn't it be better to have to wait for induction in the doctors office than to put myself through such profound pain and withdrawal and dose later than he says? After all, I have put myself through the beginning stages of withdrawal hundreds of times over the past 10 years because I often forget to dose on time, and I know my body. I know what I'm in for: it gets very ugly, very fast.

I just discovered this forum and haven't yet found many posts for chronic pain. I worry that I won't be able to deal with breakthrough pain anymore, and also am concerned that I may not get as good relief from Suboxone as I did from fentanyl and morphine. (I'm just on the oxycodone now because I had to get the fentanyl out of my system).

I would sure appreciate hearing from you more experienced folks on what you think. I sure hope I'm doing the right thing.

Thank you!


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PostPosted: Sat Dec 18, 2010 12:49 am 
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Hi Shonya and welcome! I hope you find the info and support here that you're looking for (I know I have). When it comes to being in withdrawal before induction, it's not a matter of how long, but rather how bad the w/d are. (But it sounds like you already know that.) I'm not entirely clear, is your doctor doing your induction in his/her office? If that's the case then the doctor will use the COWS worksheet and his/her experience to determine if you're far enough into withdrawals. It's really hard to tell you what to do. Obviously, you're in control of when you take that last dose. If you're correct about the timing of when you start withdrawing badly, couldn't you try to time it right? Just keep in mind that however bad you fear the pre-induction withdrawals will be, believe me, precipitated withdrawals are so much worse!

I also take suboxone for pain control, as do some others on this forum. You'll find the majority of sub patients are on it for addiction though; using it for pain relief is still off-label. It sounds like you have some pretty severe pain and unfortunately I can't tell you that sub will address all of it for you. Even for just my fibro and bladder pain, the sub only reduces the pain enough to make most days tolerable. It doesn't completely erase the pain the way full agonists can. I know you probably didn't want to hear that, but I just want to be honest with you.

Those of us on suboxone for both pain and addiction found ourselves in a position of having to live with a certain amount of pain. The upshot of being on sub though is that the craziness of active addiction is gone. It's a balancing act, in a way, between our addiction and our chronic pain.

I don't know if I'm helping here or making you more terrified. If you have some specific questions, please don't hesitate to ask them. Just focus on the fact that your discomfort on Sunday is temporary and before you know it you will be amazed at how "normal" you feel. Post as often as you need to before then and let us know how you're doing. Again, welcome!

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PostPosted: Sat Dec 18, 2010 1:48 am 
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Thank you Hatmaker. I very much appreciate your response, and I know you are well respected in this forum.

I am concerned about the pain relief of suboxone. Even on the full agonists, I am never out of pain. I usually am at about a 3, and then there are days where it escalates from there. That said, I wonder if the suboxone is going to give me enough relief to be able to stay at a 3. If I escalate to a 5 as a baseline, I may not be able to tolerate it. I plan to try an implant device that gives low frequencies where the signals hit the brain before the pain signals do. I can't help but wonder whether I should be doing that BEFORE I do the suboxone, but it is all set for Monday morning now and I just want to get it over with.

I'm a bit confused about what constitutes addiction. I have never used the meds for any kind of emotional relief and I never think about them until my body starts to hurt. If one has a chronic pain condition, when is one an addict and when is he/she just intolerant to physical pain? I have a long history of being terribly undertreated for pain, so for me the whole thing is about the issue of control and how much pain I can tolerate. I get very suicidal when it all gets too much. Being in pain 100% of the time is so draining. Only other chronic pain sufferers like you will understand that. I have also developed a hypersensitivity syndrome on the narcotics so that now I am so much more sensitive to pain than I used to be. My doctor tells me that can take up to a year to revert. It's part of the reason I want to change.

The issue of breakthrough pain concerns me too, after understanding that more suboxone will not help. And, if the suboxone only lasts about 4 hours, how is 3X per day dosing going to be sufficient to cope with constant severe pain?

Thanks for your input.


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PostPosted: Sat Dec 18, 2010 7:16 am 
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Hi again and thank you for the kind words. If you decide to go the sub route, your doctor can always up your dose to more than 3x per day. That's just the average.

OK - addiction vs dependence. From what you are describing, it certainly sounds to me like you are dependent, but not addicted. Some things you would want to check yourself on would be the following: do you take the meds as prescribed or do you take more; do you run out of meds early each month; do you ever buy drugs on the street; are there negative consequences in your life/relationships due to your drug use; etc. I think you get my point. (If you want to understand more, just Google dependence vs addiction - you'll get a wealth of info.)

Regarding your hypersensitivity to pain....Have you heard of opioid-induced hyperalgesia? I'm pretty sure I experienced this - the more pain meds I took and the longer I took them, the MORE pain I actually had. If that's the case with you, then your pain might actually start to dissipate when you go off the full agonist opiates. Just the very fact that I went off the morphine and percs and on to sub actually lessened my pain. It's something to think about/consider.

Suboxone is capable of relieving some chronic pain for a lot of people. It's helped me tremendously - more than I thought it could. Then there are some who state that it doesn't help their pain at all. When you're in the kind of pain you are in, it sucks everything out of you and affects your entire life. I think of it this way: You already probably have a pretty high tolerance to opiates, you need to go off them anyway (right?), so suboxone might actually be a good choice for you.

What is the implant device you are talking about? Are you talking about a TENS unit? If it works, is it capable of erasing all of your pain, or maybe just some of it? Is it possible for you to do both the implant AND suboxone in an effort to achieve the very most in pain relief? That's something that I would want to know.

Sorry for rambling a bit - I hope this information helps you out. Again, if you have more questions, just ask away. I really hope this works out for you - that you can finally get some pain relief. You deserve it! Hang in there and remain hopeful.

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-As I have grown older, I've learned that pleasing everyone is impossible, but pissing everyone off is a piece of cake.

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


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PostPosted: Sun Dec 19, 2010 9:58 am 
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Withdrawal is mostly a subjective experience, which is why the COWS scale exists. I never have and I never will understand doctors who insist on some arbitrary time frame for withdrawal before induction. Clearly, you have to be in moderate withdrawal to start taking suboxone if you want to avoid precipitated withdrawal.

I don't encourage anyone to lie to their doctor, but the fact is, the onset of withdrawal is different for everyone.

If you are truly in moderate withdrawal, then when you take suboxone for the first time, you should be fine.

The pain management angle is another matter entirely and not one that I have any direct experience with.

Best of luck, Shonya, and please try to update us on how you make out.


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