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PostPosted: Sun Mar 19, 2017 7:24 pm 
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I find nothing more personally confusing than the issue of buprenorphine and chronic pain relief,
especially for highly tolerant opiate addicts. Which as it happens likely describes the great majority
of forum people, including me

So I'm hoping once and for all to clear some things up.

1: For a long while I was under the impression that high doses of bupe along the lines we
normally talk about here for maintenance, would usually not be effective for chronic pain relief because:

A: Such daily doses are generally well into the ceiling effect.
B: Addicts on MAT generally have a high tolerance. Therefore
C: No matter how much we take, it's not going to help.

2: It's clear I'm wrong. However I still don't understand the reasons why. I think Dr. J. has talked
about different receptors perhaps being involved. In addition there might be certain mind/body effects
at work. I don't want to use the term placebo effect, because it's my understanding that's usually
temporary.

3: I personally get no pain relief at any level that I can consciously discern. As others have recommended I've split up my daily dose. I'm currently taking 2 mg/s 4 times a day. I've also tried 4 mg'/s twice a day. But still no luck. But here again, given bupe's long half life, I'm not seeing how splitting one's dose is going to be effective. Are there small blood level spikes anyway with a multi-dose approach?

4: Since other people are getting pain relief, why aren't I? (an unanswerable, basically rhetorical question. But if feels good somehow to ask it :D

So that's a lot of questions. Of course any and all are encouraged to chime in.
Particularly interested in hearing from people are are getting pain relief. Also any docs.

Many thanks,
Godfrey


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PostPosted: Mon Mar 20, 2017 6:43 am 
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Hi Godfrey, I am so sorry to hear that tou are in pain! I do believe that I get some pain relief from suboxone. I also think it helps with the depression that I was experiencing as a result of menopause. I do not get total pain relief from all pain. For instance, I am dealing with tooth pain now. The Dentist called in an antibiotic and I have become een taking ibuprofen 800mgs three times a day. That is working. I do feel that if I was not on suboxone, I would also be taking vicodin as that is what I would do in the past. I can not tolerate tooth pain! So, I feel that the suboxone is working in place of the vicodin. Now, of course, there are many variables so I don't know whats really doing the trick. And we all experience pain differently. Hope that you are having a good start to your day! I am sure someone with much more knowledge on this topic will respond soon!


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PostPosted: Mon Mar 20, 2017 7:01 am 
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Hi Michelle,

Its always very nice to hear from you. You've a very pleasant, caring manner. I'm very
glad you get pain relief, though I'm also envious. I wonder how much of this
has to do with expectations. Maybe numbers would help. You know
how they like to ask how much pain you're in on a scale from 1-10.

The question I have is how intense do you suppose, would your every day pain be
if you weren't taking suboxone? And are you completely covered for the every day stuff, pain-wise?

I thought it interesting that you said you believed you were getting pain relief.
That's kind of an equivocal word if you know what I mean. Do you think
expectations have anything to do with it. My expectations in that department
were nil, so maybe my lack of relief has something to do with that.

I'm sorry to ask so many annoying questions :D

Best,
G.


Last edited by godfrey on Tue Mar 21, 2017 7:27 am, edited 1 time in total.

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PostPosted: Mon Mar 20, 2017 9:57 am 
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Just my opinion but when I need pain relief I take either Aleve, Tylenol, or Aspirin, depending on the type of pain. Most of the time it's Aleve. Tylenol or Aspirin for a fever.

Unlike others, I do not suffer from chronic pain. Yes, a messed up neck and sciatica along with the usual Arthritis thrown in. There have been days when I took more Suboxone to ease the pain and did seem to help some. Maybe a placebo effect? Can't say.

Good question Godfrey!

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PostPosted: Mon Mar 20, 2017 3:05 pm 
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Hey Godfrey!

I don't have chronic pain either, so I can't say how it feels to be in pain every day. I'm sure it's awful and I feel for u and anyone else who goes through it, it'd be tough!

I have found that suboxone helps my mood. I'm 40 and I am convinced that I'm going through early menopause (something I'm sure u don't know about from person experience :) maybe ur wife though). I do have the occasional back pain, like today, and I don't think suboxone helps my back much. I had some pretty heavy dental work done a few years ago and suboxone did seem to help with that pain. So is it possible that certain kinds of pain is more manageable under suboxone? I don't know the answer to that question but it's something to think about.

I hope u do find help with ur pain though, I'm sure it's so frustrating!

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PostPosted: Mon Mar 20, 2017 3:23 pm 
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Hi Jenn,

We're here in Florida currently and there's a guy down the street with a boat called..."Male-Minnow-Pause"
It's a little boat, and he's a pretty old guy, and he fishes, so it kind of covers all bases :P

Your post brings up the question of expectations it seems to me. I've noticed people
often say, I believe it's helping me (bupe that is). Or, "it seems to help."

It's too bad we can't run controlled experiments on our own bodies. Like take your bupe in the a.m. then come home from the dentist and see how you feel. Then rewind the tape and start again. Only this time don't take your bupe in the morning, come home from the dentist again, and compare the two experiences.

Only it's not that simple because there's already plenty of bupe in your system from the day before.

It's all hard to pin down I guess is what I'm trying to say (and not doing very well at it)...


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PostPosted: Mon Mar 20, 2017 3:44 pm 
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Hi godfrey,

I too reach for Ibuprofen when I have pain. Or Naproxen which helps me too. I feel like it works with subs to cover my pain. I also have seen on this forum that Pain patients tend to take more suboxone than what you are taking.. Such as the 16-24 mg and throughout the day. Even though these people are at the ceiling level. I think the frequency of taking it 3-4 times a day does seem to help. i see you are also dosing 4 times a day but just with 2mg. Do you think you need more ? Have you had a conversation with your doctor about it. There may be something else they can give you that would mix well with the subs for severe pain. I have taking opiates when I had my teeth pulled and I took it along with my suboxone and it worked . I know that is not always looked upon positively but it does work for extreme pain. Not an everyday thing though.


I do hope you get your pain under control. there is nothing more helpless than to be in pain and not have anything you can do for it.

Good luck to you


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PostPosted: Wed Mar 22, 2017 10:45 am 
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After 10 to 15 years of severe neuropathy brought on by uncontrolled diabetes, I accidently found out that suboxone gives me a great deal of relief from the relentless burning in the bottom of my feet. I literally tried everything. I've been on gabapentin for over a decade. The highest daily dose available. 800mg. 4 times daily. I had tried fentanyl patches, hydrocodone 10 mg four times a day. Relief for a while, but eventually, after years and years, I became dependent on the narcotics, plus they were no longer helping with the burning. Other pains yes, the burning no. Thus I ended up on suboxone to help get off the narcotics. Pleasant surprise. I am a retired police officer. I am grateful for finding suboxone. I was at my wits end. Suicidal even, because of the relentless burning. I hope this helps someone. Thanks


Last edited by topgun204 on Wed Mar 22, 2017 3:50 pm, edited 1 time in total.

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PostPosted: Wed Mar 22, 2017 12:32 pm 
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topgun,

Welcome here! Glad you posted. It does really help to know this bc severe neuropathic pain, as you describe, is a horrid awful miserable pain w no effective pain meds for it w reports of higher rate of suicide so I do find this interesting. I am aware of neurologists that will say, one malady they would never want to have, is severe neuropathic pain bc its that tough and that bad. They see the misery their patients experience. I'm sorry its come your way and am thrilled to hear buprenorphine provides some relief. Can you explain more - what dose you started on, did it increase, what is current dose, is it 1, 2, multi times/day? some pain patients on this site will take it mutlt times/day. Anything you can shre will be most helpful! Thanks so much in advance, Peli

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PostPosted: Wed Mar 22, 2017 2:29 pm 
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Hey Topgun,

Mister Pelican beat me to the punch as usual. :D
Be great to give us more information.

It's terrific that you're getting relief. I too relied on opiates for over a decade. Worked splendidly
for a while. I remember feeling so good I actually felt like praying little prayers of thanks. But it's not
my style, and I was very aware it couldn't and wouldn't last.

The thing about pain is it really puts you right in the moment. It's always this painful minute that matters.
Those years of pain relief meant nothing when i was right back in the soup (that's got to be an old fashioned
expression that I don't hear much at all anymore). And when I was in pain, I was perfectly willing to exchange some blessed but temporary relief for the pain and trouble that would inevitably follow. The 12 Steppers
urge us to take things one day at a time, but it's the active addicts who really have that down to a fine art.

I'm sorry you've had so much pain...and for so long. It's clear bupe does help some people, even those with a hight opiate tolerance. Thanks so much for your post.


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PostPosted: Wed Mar 22, 2017 4:06 pm 
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I started on suboxone in August of 2016. Once my doctor discovered he could help me with the neuropathy burning, he put me on 4 mg. four times of day. I take it at 12 and 6 religiously. Unless it stops working I will take it until I die. I think I might be able to take less. I'm going to try at some point. I'm so glad it's working I'm afraid to fool with the dosage too much. My insurance pays for it. And by the way. I had open heart surgery (CABAGE) two days before Halloween after suffering an acute heart attack. The suboxone doc and the surgeon took me off suboxone for one day before surgery. I was in the hospital about a week. They had me on some kind of narcotic (Demerol I think) until I got out. When I got home I waited a couple of days and slowly started taking my suboxone again. I didn't have much residual pain from the surgery. I was just worried about getting the severe burning back under control. I'm sorry if I didn't put this follow up post in the right spot. I'm sixty-three and nearly blind so pardon any typos. Thanks. Detective Mike


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PostPosted: Wed Mar 22, 2017 6:16 pm 
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Hey Detective Mike, and welcome to the forum! Very good to hear you recovered okay from heart surgery. You and I are fairly close in age so that kind of hits home. I even went to a new Cardiologist today for a checkup so I'll know in a few weeks if all is well with my ticker.

Did you get pain relief in the hospital? That is one of the hardest things about being on Suboxone. Pain control. We have found it better to stay on a low dose and combo it up with full agonists as long as your doctor understands the tolerance factor. Many do not, as in mine. But now I can print out medical opinions here and present them to my doctor the next time I need surgery. (hopefully never)

Just wanted to give you a hearty welcome!

rule

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PostPosted: Wed Mar 22, 2017 11:19 pm 
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We're very glad to have you here, Detective Mike, and we're also glad that you made it through some scary health situations.

I lost my best friend last October from a sudden heart attack. He was 45 like me. He has left a gaping hole in my life and the lives of many others.

So you are on 4mg every 6 hours? I know it doesn't work for everyone, but thank goodness it works for you! If you were in so much pain that you thought of suicide, I'm grateful that suboxone took the pain away.

I'm also very grateful for your service and efforts to keep us safe. Welcome to the forum!

Amy

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PostPosted: Thu Mar 23, 2017 11:15 am 
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Pain is so complicated. There is a sensation component, and a suffering component (and probably many other components!). The sensation component can have many causes, and just one injury will have pain from multiple sources. A broken ankle, for example, will cause pain from the extreme activation of stretch receptors in muscles and ligaments, and from receptors in the capsule that surrounds bones, Some of the signals will travel in large-diameter nerve fibers-- the signals that come from sensory organs that measure joint position, touch, and vibration. Other signals will travel in small-diameter nerves. some myelinated (insulated) and some not. Some of those fibers come from sense organs that are activated by inflammation, by prostaglandins or fatty acids or free radicals, or by chemicals released by platelets during blood clotting or from white blood cells. All of these nerves carry pain sensation. The signals from smaller nerves will hit the brain (and consciousness) more slowly than the immediate, white-hot pain from pressure sensors. The aching that arrives late largely comes from the chemicals that build up with inflammation. Those chemicals are necessary because they attract whilte blood cells that fight infection, and trigger other cells to start dividing to heal the damage. Many of the chemicals that are released have multiple roles, favoring healing but also serving to prevent the organism from trying to bear weight on a wounded limb.

Then there are longer-term changes that make pain last. The local pain receptors may keep firing if there is still inflammation or damage, but even if everything is healed the pain may persist. The thought is that pain becomes 'remembered' by the brain in a process similar to how other things are remembered, where pathways that are used repeatedly tend to build stronger connections, favoring them to keep firing even when the initial trigger is gone. That is called 'central pain', and there are few good treatments for that problem. Neuropathic pain is thought to be from nerves that are damaged or inflamed, that keep firing even when the damage has been largely fixed. Viruses like herpes live in neurons and hide there, causing the body to attack the neurons. Or the neurons are damaged by the virus even after the virus is gone, so that the nerve keeps firing. In diabetes, high blood sugar causes damage to nerves (I do not know the exact mechanism but I believe it is through leading to the prodution of oxidized free radicals and other compounds). Those nerves fire and send a pain signal. Antiseizure meds reduce the abnormal activity, and are helpful for neuropathic pain.

The point with all of this is that one person's pain may have entirely different sense receptors, nerves, or processing that another person's pain.

Godfrey, about the ceiling effect and pain.... let's assign a number that represents the 'opioid effect' of a certain drug. Let's say that you give a patient oxycodone 60 mg every day, and that provides an opioid effect of '10'. Whether an opioid effect of '10' provides pain relief or not depends on tolerance-- so if the patient just started pain meds, '10' treats his pain. But in 6 months his tolerance is now equal to his daily dose of oxycodone, so '10' does not treat his pain.

He can increase his oxycodone dose to 200 mg, and now his opioid effect is '20' and he gets pain relief, at least until tolerance goes up again.

Let's say instead of increasing oxycodone to 20, he goes on buprenorphine. If he takes a 1/2 mg of buprenorphine per day he has an opioid effect of 5--- so he is in withdrawal, and the pain is accentuated. So he increases his buprenorphine to 8 mg per day, and now his opioid effect is '10'. He no longer has withdrawal, because that effect equals his tolerance. but he has no effective pain relief. So he increases his buprenorpine dose to 24 mg per day... but the opioid effect of that dose is still just '10', so he feels exactly the same as when he took 8 mg.

Let's say our patient is then locked in a prison in Mexico, and he gets no narcotic. He leaves prison a year later, and let's say he still has the same pain as when he went in. He finds an old 8 mg tab of buprenorphine and takes it, and gets an opioid effect of 10 again. THIS time it gives great pain relief, because the 10 is higher than his opioid tolerance. if he takes 24 mg of buprenorphine, he still gets '10' of opioid effect, and the relief is the same as 8 mg of buprenorphine.

I don't know if that answers the question about buprenorphine and pain... the pain relief from opioids relies on getting opioid stimulation higher than your tolerance. The relief from buprenorphine is limited because there is only so much opioid effect that the med will provide.

Make sense?


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PostPosted: Thu Mar 23, 2017 11:48 am 
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It does, doc. And I so greatly appreciate the time you take to try and help me. It certainly explains why the poor guy who's been locked in a Mexican jail gets pain relief with his tolerance now reduced to essentially that of an opiate naive person, I would suppose.

And I'm going to hang onto the following statement of yours, and trot it out for myself whenever i start feeling somehow rooked that I'm getting no pain relief:

"The point with all of this is that one person's pain may have entirely different sense receptors, nerves, or processing that another person's pain."

I also keep coming back to the issue of expectations. I wonder if I'd started bupe with the belief
that it would help my pain, things might be different. I've been on the forum awhile and notice, as
in this thread, that people often use slightly ambiguous words when describing their pain relief
with bupe. It "seems to help" "I believe it helps." Statements like that..

When people are taking opiates for pain relief at least to start out, nobody ever uses such words. It helps, they know it helps, and there's no need for words that offer a little wiggle room.

Maybe I'm reading too much into that. In any case, I greatly appreciate every post on this thread.


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PostPosted: Thu Mar 23, 2017 3:50 pm 
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Thanks for the comments. I posted what I did in hopes that somebody suffering from diabetic neuropathy (severe burning on the bottom of their feet) and have tried everything under the sun including narcotics, anti-depressants, etc. understand that I am getting great pain relief from the burning by using suboxone and Neurontin. Both. Neither work alone. I don't think I'm getting relief, I'm actually getting relief. I love my life now. I feel great and want to help others. Thanks. God bless those among us who are suffering and are desperately looking for relief. Detective Mike


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PostPosted: Thu Mar 23, 2017 4:02 pm 
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Wow! Awesome post by Suboxdoc! I learned so much about pain here. I have always been curious about the pain relief one gets from Suboxone. I can tell ya I got a lot more at 8 mg than I do at 1 mg. I think all I am getting from 1 mg is a safety measure from hitting Suboxone withdrawals. I'm living on the edge I feel like. Great post Godfrey. Sincerely, Angie


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PostPosted: Fri Mar 24, 2017 12:31 am 
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topgun204 wrote:
Thanks for the comments. I posted what I did in hopes that somebody suffering from diabetic neuropathy (severe burning on the bottom of their feet) and have tried everything under the sun including narcotics, anti-depressants, etc. understand that I am getting great pain relief from the burning by using suboxone and Neurontin. Both. Neither work alone. I don't think I'm getting relief, I'm actually getting relief. I love my life now. I feel great and want to help others. Thanks. God bless those among us who are suffering and are desperately looking for relief. Detective Mike


Indeed, Detective Mike.

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PostPosted: Fri Mar 24, 2017 12:35 am 
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I can only use the example of my dental work while on Suboxone...
I can say that Suboxone DEFINITELY helped...because I remember the pain before I was on Suboxone with abscesses and having extractions performed...it was awful.
I would take a few norcos or tabs before going into the dentist (during active addiction and with a pretty high tolerance)...and damn the pain!
It was agony. Probably because I was so tolerant of opiates..they really just made me feel normal, so I was not getting any pain relief...
After years of abusing opiates, the damage to my teeth was obvious. By the time I found suboxone and cleaned my life up, it was too late...
One of my last dental visits while in agony was not very promising. I was told that I only had 3 teeth left, out of 27, that didn't have some sort of decay...
One by one, I got them yanked out...until I got down to only ten.
Once I hit ten, I had enough. I scheduled the extractions of the remaining ten..
But I had been on Suboxone for roughly 5 years at that time.
I was very scared, and even requested to be gassed...
This was when I found that nitrous doesn't work on me. The dentist pumped me up with nitrous for nearly 30 minutes before stopping it to say "we've had it at over 100% way too long, you're in the 5% of people who don't get anything from it"...
That was ...encouraging..
At any rate, he numbed me up..and started pulling. Prior to walking into his office I took (2) 8mg-2mg Suboxone films...one behind the other. If I remember, I waited about ten minutes between them...but it was literally 20 minutes before I walked in his door.

Having them pulled -- felt it a couple times, had to be numbed 3 more times on top of the initial 5 shots he gave me. 2 of the 10 extractions were eye teeth, and 2 of the 10 were front bottom ...which have the longest root of any teeth...

I wasn't pain free (but I never was pain free, even with the help of opiates).
The pain was very tolerable when I got home.
And after I got home, while reading the papers about avoiding dry sockets (and smoking a cig while doing so)...I took another suboxone, and went to bed ..
My best option to deal with that situation was to take a nap on the first day...
Later that evening I took a couple ibuprofen, and went to bed again.

Sure, I had some pain associated with that...but it was, I repeat, very tolerable. I wasn't miserable...and I could easily handle it. It was actually much easier than I had anticipated.
So, that's my two cents on pain relief. Does Suboxone help? yep..no doubt.
Does anything make pain go away? no. Opiates just make you not give a damn that the pain is there to begin with. You still have pain...you just don't care about it. It's not a factor while opiates are working..
Suboxone has that tendency...but it's not nearly as strong, especially in a opiate-tolerant person.

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PostPosted: Thu Mar 30, 2017 5:58 am 
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if i'm having a lot of pain i take 4 advil (i used to be prescribed ibuprofen 800s which i took along with fioricet for migraines)
so, the 4 advil doesn't seen excessive to me. i was told 3200mg was ok to take in a day, but only for short periods of time.

also wouldn't neurontin help with pain? especially to the poster with diabetic foot pain/burning?

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