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PostPosted: Sun Jun 05, 2016 3:38 pm 
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Hey all,

I currently take 8mgs of suboxone a day for 4 months and have oral surgery to remove 8 teeth. 3 molars, 2 which are impacted and need to be cut, which I understand to be very painful.

I'm not so worried about going under but I am extremely worried about post op pain.

I had a consult with the oral surgeon and was completely honest and expressed my concerns about post operative pain and my options. I had done my research and was prepared. He simply said my suboxone will be sufficient for post op pain. From what I've read and understand it is not very effective for pain relief. I asked if he would be willing to prescribe something stronger for only a few days such as hydromorphone, opana, or fentantly which were the only drugs that I read would be sufficient to overcome the suboxones effects. He looked at me like I had 3 heads. I am thinking I will talk to my GP who writes my suboxone to see if he will be willing to write a 5 day supply of something that will overcome the subs.

Forgive me if any of my information is incorrect and if so please correct me. I welcome all advice and am quite anxious about this.

My biggest fear is if nothing is done for extreme post operative pain I will go back to what I know worked, and is unfortunately easier to get than any pain killers for me which is heroin.

When I'm honest with the docs they hear heroin and I'm automatically stigmatized and all my options are taken off the table.

I'm considering to just lie to the doctors. I don't want to but they are so closed minded and unfortunately for me it's easier to get heroin than preacription for an opiod that will sufficiently relieve my pain. I'm not seeking to get high. I don't want to do heroin anymore and almost always a doctor sees my history and just say drug seeking behavior take your ibu800.

Im at my wits end.

Help.


Thanks,

Steven


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PostPosted: Sun Jun 05, 2016 7:00 pm 
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Hey StevenV,

Welcome here. While not on bup at the time, I had lots of dental surgery and implant work done w different oral surgeons. Frankly, I was already on such high levels of my DOC that the post-op opiate script did nothing to help. But, these tips really helped me post op and made all go pretty well:

I asked for additional marcain (longer acting) blocks, either at the end of the procedure or if procedure was done early in the day, I'd get a ride back late day for more blocks (injections) to keep me numb all night.

Also, consider asking about oral steroids (prednisone) post-op. I had major dental surgery done w and wo and it resulted w a huge decrease in pain. I learned to ask for a prednisone script, if its not already a part of post-op care. Makes a huge difference! Its more powerful than OTC anti-inflammatories.

After, keep your head truly elevated!! For 24-36 hrs. Cold paks as well. Swelling is the enemy. Do not let gravity pull more fluid into the mouth and make it worse! That's why anti-inflammatories (Prednisone, Aleve, Advil) are so helpful.

Have you found Dr. J's surgery guide? Look it over and take into your Bup GP. I'm going to let others comment on going into oral surgery on 8 mgs bup bc have no experience w that part. Wishing you my best, P

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Did well on Suboxone. Stopped May 2011.
Stopping went well -- its the staying stopped -- where the real work begins.
Coming here 'keeps recovery green'.


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PostPosted: Sun Jun 05, 2016 7:26 pm 
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I've searched the forum and can't find the surgery guide. Forgive me.. Would someone be so kind as to point me in that direction?

Steve


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PostPosted: Sun Jun 05, 2016 7:50 pm 
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no worries, its available thru the Talkzone link at top

Dr. J's handout
http://suboxonetalkzone.com/surgery.pdf

More links w info
http://suboxonetalkzone.com/taking-bupr ... #more-3132

http://suboxonetalkzone.com/post-op-pai ... #more-2809

http://suboxonetalkzone.com/im-on-subox ... #more-2380

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Did well on Suboxone. Stopped May 2011.
Stopping went well -- its the staying stopped -- where the real work begins.
Coming here 'keeps recovery green'.


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PostPosted: Sun Jun 05, 2016 8:11 pm 
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For dental surgery, surgeons block pain using local anesthetic that wears off after 8-12 hours. Some oral surgeons avoid opioids, and use ibuprofen when the block wears off. I can't speak to whether opioids are necessary in your specific case-- but if opioids ARE indicated, then buprenorphine is not sufficient in people chronically on the medication. Tolerance allows people to feel normal-- and 'normal' does not cut it for surgical pain!!

I provide patients with some basic information when they have surgery. Understand that it is NEVER appropriate to use heroin to treat one's own pain. It is NEVER appropriate for a person to treat himself or herself with opioids. The information is intended ONLY to spur discussion with your physician.

The first link, http://www.suboxonetalkzone.com/bupe.postop.pain.pdf , is what I give to patients to take to surgeons. The second, http://www.suboxonetalkzone.com/im-on-suboxone-can-i-have-surgery/ , is an article from NIH that discusses surgery in people on buprenorphine. I strongly disagree with the NIH conclusion that people can simply stop buprenorphine prior to surgery. Whoever suggested that idea has no idea what people go through when they simply 'stop Suboxone'.

Feel free to copy either/both of them!


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PostPosted: Sun Jun 05, 2016 8:11 pm 
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We're both typing at the same time! thanks Pelican!


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PostPosted: Mon Jun 06, 2016 12:02 am 
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Thanks very much for the plethora of information. I read all then pdfs and the more information I have the better. I just wish my docs would actually read those documents. My current plan is to talk to my GP who writes the subs and ask him to speak with the anesthesiologist. I believe I may be over reacting. I was panicking and still am slightly.

I will not resort to heroin. Worst case scenario if after the surgery and I'm in unbearable pain I will attempt to see my GP and seek his advice. If it simply become unbearable would an ER visit be silly?

I plan taking my dose down to 4 mgs pre op and after the operation to take 2mgs for pain relief if necessary. I sincerely don't want to relapse but so frustrated with the stigma and being pigeonholed by doctors because of my addiction history. Does using small amounts of suboxone as a pain reliever ever 4-6 house sound feasible? And if things get out of hand seek emergency visit to GP or worst case an ER for an opiod shot in a controlled setting?

I have several opiod options at my disposal (not legal) and DO NOT want to go that route. I know it's a slippery slope.

Another alternative after reading the above links was high doses of OxyContin (roxi 30s?) temporarily (I believe I could get my GP to write a week supply, though not sure how pharmacist will react to this) and as quickly as possible getting back on the subs.

Are those options more reasonable to you more educated and experienced fellows?

Thanks again so much for your time. You guys have been more helpful than the oral surgeon by far.


Again,

Thank you sincerely,

Steven


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PostPosted: Mon Jun 06, 2016 10:40 am 
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Hey Steven,

Yes see if GP will talk w anesthesiologist. The anesthesiologist will keep you well covered during your dental work. Ime, the anesthesiologist did not prescribe post-op meds, the oral surgeon did and yours has already implied you have 3 heads (said no)

Idk if small amts of bup post-op will help for pain relief. Yes, ER is always an option if it gets tough.

My thoughts are to see your bup GP w the surgery guide + other articles printed out, ask for exactly what Dr. J recommends - type and dosage.

I encourage a script for prednisone. Also, do not underestimate the pain relief from cold. Post-op joint replacement surgery now includes circulating ice water joint wraps. markedly reduces need for pain meds. You could wrap cold packs to face w a scarf.

I respond to dental posts bc I had many surgeries for total mouth reconstruction due to a childhood accident and malabsorption issues causing poor teeth. As a result, I ended up w a long 10 yr run on fentanyl . My message is to be very very careful w using opiates for dental pain!!

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Did well on Suboxone. Stopped May 2011.
Stopping went well -- its the staying stopped -- where the real work begins.
Coming here 'keeps recovery green'.


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PostPosted: Mon Jun 06, 2016 11:13 am 
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When my wisdom teeth were pulled all I needed was Ibuprofen. My Oral Surgeon gave me opiates and they didn't do anything for the pain. Dr. Junig had it right, anti-inflammatory drugs are the best option. But then it all depends on how severe the procedure will be.

Print out the info and bring it with you is my best suggestion.

You'll be fine. Most of it is in our minds and we make it out to be much worse than it is.

rule

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PostPosted: Mon Jun 06, 2016 12:57 pm 
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I had all 4 wisdom teeth cut out (before I was addicted) and even though the dr gave me hydrocodone 7.5, I honestly managed very well with ibuprofen 800 and cold pks on each side. It actually wasnt as painful as I expected. After I started suboxone, I've had 2 bk teeth removed (very bk nobody can tell lol) and the dr was gonna give me pain medicine but I told him I'd rather just have the ibuprofen only, and it worked fine. I was very upfront with him about being on suboxone and he was still going to write me a script but I felt it wasn't necessary. Everyone is different though on how they deal with pain. I'd definitely print out Dr J's info on surgery with suboxone and show it to ur dr like rule suggested. If u can't print it then just let him read it from ur phone or something.

I totally understand the worries u have but I think you'll be ok. Good luck!

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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

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