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PostPosted: Fri May 13, 2011 11:56 pm 
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I halve been taking subs 8 mg 3x a day for about four years. Ten of those years with lupus which did number on all of my joints especially my knees. I came toma point where I decided to accept the physical pain of the lupus and end the pain of addiction. It has been very painful but am much happier. I just had an MRI of my left knee and need a fulll knee replacement. Suboxone takes about six days to clear my system and am able to take a narcotic. A couple of months ago I switched to the film strips and found I only need two a day. My question is should taper down over a couple of months until I'm off of them completely and take the pain meds I know I'll need for a while or go cold turkey a week before the surgery. Either way I'm going back on to the subs but find the least amount to feel normal. Thanks for the chance to ask.


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PostPosted: Sat May 14, 2011 12:25 am 
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Hi topher69 - Welcome to the forum.

Sorry to hear about your pain and your need for knee surgery. That doesn't sound like fun.

From what you wrote it seems like what you're saying is that after 6 days off of Sub you are able to get pain relief from opiate pain medication? If so, do you have to take a higher dose than normal to get relief?

I wish I knew what to advise you to do. We had another member who got a knee replacement. I believe she stayed on Suboxone until 3 days before her surgery and despite massive amounts of post-operative pain meds, she was unable to get any pain control at all. She was just miserable with pain - and she was a nurse who went into the situation armed with tons of information and what seemed like a solid plan.

I'm not trying to scare you or anything - this is just the only other similar experience that I know of.

I would say that if you've found that pain meds are effective for you after 6 days off Sub, than at the very least do that. Tapering down over a couple of months might be even better, as it will probably bring your opiate tolerance down and make any pain meds you need to take more effective. So if you're able to do that, then go for it. You may find that you need far less Suboxone to maintain than you think. And if you are able to taper down and off Suboxone before your surgery, you won't be dealing with withdrawals from going cold-turkey six days before your operation.

Please talk with your Sub doctor and your surgeon about your situation so they can have a good plan in place for you. You will likely need more pain meds than a non-addicted patient would need; higher doses and given more frequently. And you'll want to have a plan in place for switching back to Suboxone once the acute pain has resolved.

Hopefully some of our other members will chime in. We have a great group here, some with medical experience and others who have been through surgery while on Suboxone. There is also an article posted in the "Links" section of the forum about treating acute post-surgical pain in Suboxone patients. I'd recommend printing it out and showing it to your doctors.

Keep us posted and good luck!

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PostPosted: Sat May 14, 2011 7:55 am 
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Here's the thread with the paper about treating acute pain in sub/methadone patients: http://suboxforum.com/viewtopic.php?p=27727#27727

And here's the direct link to the article (http://www.ncbi.nlm.nih.gov/pmc/article ... s17732.pdf)

It's a pretty easy read and it has 7 pages of references. Many of us have used it when we had medical procedures/surgeries done while on sub. Some of us have even given this paper (from the NIH, a very reputable organization) to our doctors.

I hope it helps.

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PostPosted: Tue May 17, 2011 11:21 am 
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Hi there. I'm new to this forum, but thought I'd jump right in and tell you my experience recently having hip surgery. My sub doc first told me that I'd need to stop subs and go on pain pills about 4 days prior to surgery. Surgery was scheduled for a Tuesday, went to see her (sub doc) on the Fri before. Then she tells me to continue the subs until the morning of the surgery, then take whatever pain pills the ortho prescribed. Totally conflicting info she gave me! I was terrified the pain meds wouldn't work. But what could I do at that point? Oh and also ~ side note here ~ she FAXED a letter to my ortho on that Monday before surgery telling him I was a sub patient (which he knew) and telling him to only rx me pain meds for 7 days, tops. FAXED! How confidential is that? The entire office could read it, whether it was marked confidential or not. Anyway, back to the surgery .... I was in horrible pain coming out of anesthesia even though I had a nerve block done right before the surgery that was supposed to help and last 24 hours. Given dilaudid in recovery, a lot of it, and finally got some relief. Sent home with perc 5's for 10 days. I had to take 3 or 4 at a time to get any pain relief. But once the major pain subsided which was maybe 4-5 days after, I was okay.
Expect pain. There seems to be conflicting info on the subject of suboxone and surgical pain management. I don't know, maybe what works for someone might not work for someone else. I'm also on 8mg three times a day, and just recently switched to the strips which do seem to work better. Your surgeon and sub doc and anesthesiologist should all work together on your case. I think the lack of communciation on my docs part, and the info she gave me as far as stopping sub and starting narcotics prior to surgery, then apparently changing her mind about that, didn't work in my favor. I wish now that I had been able to stop the subs and take narcotics prior to the surgery, maybe the pain wouldn't have been so bad? I don't know. Just relating my experience with it. Goodluck!


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PostPosted: Tue May 17, 2011 3:59 pm 
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Hi RockerMom and welcome. I just wanted to say thanks for sharing your experience. Your doc's first idea, from all the papers I've read on the subject was a pretty good one. Too bad about the 180. If you ever have to have surgery again, check out that paper I posted above. Again, welcome.

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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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