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PostPosted: Thu Sep 06, 2012 1:28 pm 
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Well, I've read one of the posts that led to the "NIH Public Access Acute Pain Management for Patients Receiving Maintance Methadone or Buprenorphine Therapy" (Can't link it kept telling me I'm spam)

And after reading that (well, mostly before too) I have little to no faith in the doctors response and his colleges he "consulted" to treat my pain post surgery.

So anyway here is the background information.

I'm having my Patella pulled out of the front of my knee to arthroscopic reconstruct my torn ACL. I am told using the Patella is more painful because obviously they need to make a large incision on your knee. This is happening tomorrow at 5:30 AM.

I called over a week ago telling them I need to get a straight answer before the surgery on how pain is going to be managed as well as what they are going to manage it with. This is for my piece of mind knowing if they need to titrate me they will - but at this stage I think they are going to say f--- you.

Anyway so finally they get back to me this morning (the Surgeon, oh joy), I told him of my concerns and he said he doesn't prescribe over 5mg percocet as well as they will use similar meds to treat my pain in the hospital. I am completely and 100% okay with this...If it actually works, but after having a 400mg/day oxy habit (habit lasted 14~ months, 400mg/day+ last 3 months).

I am currently on 8MG/Suboxone every morning, I have been able to get down to 2-4mg every other day or two without any real bad cravings.

Anyway after having that much of a habit, and being on suboxone (since 5/12/12) I'm concerned that I will have a tolerance the size - insert something large here, and they will label me as med-seeking and not give me any more meds - I just had a surgery last Saturday and was given the option or Morphine or Tylenol (hadn't had bupe in 4 days) and chose Tylenol without issue because the pain wasn't there. So I have faith in myself, but obviously they don't - this could be simply because they have never had to operate on a patient who uses his maintenance med for the pain as well...

As far as the surgeon is concerned... He's done, my pain is going to be managed... He talked to two "pain management colleges" who both stated to him that I will not have any issues (insert BS reason I knew he was giving me but couldn't say much to... Along the lines of "not an opiate"my response is .................. literally.

Any way, so my main question here is... if I am in pain, what do I do? The doc told me to go to my addiction specialist to get prescribed the pain meds if I needed anything above 5mg percocet... They require me to pay $100 just to talk to this guy, there is no way he is going to prescribe me an opiate - doctor refused to contact him when I told him - they said they "faxed something over".

Also he said they would be using some sort of nerve block in the hospital... That lasts one day... So coming out of that I know I'm going to be in ALL the pain I couldn't be in earlier

It would be absolutely lovely if they could give me 5mg of percocet out of the surgery and it takes away the pain, but mentally I don't think it will, and physically I don't think it will (doctor pretty much thinking this is hypothetical when I'm thinking it is what is going to happen)

So...

What should I do?


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PostPosted: Thu Sep 06, 2012 2:24 pm 
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Man, that sucks. Unfortunately, your story is not uncommon. I'm sorry you have to deal with this on top of having surgery.

One thing that might help is to have someone with you in the hospital who can advocate for you. They are not supposed to leave you with uncontrolled pain coming out of surgery but I know in that vulnerable position it can be hard to stand up for yourself. I'd also encourage you to talk to your anestesiologist before the surgery if you can, he or she might be able to help you out. They usually have a bit better understanding of opiates than the average doctor.

The nerve block should be some help. You can also ask for Toradol which is non-narcotic but is a pretty good pain reliever.

Another option, which I used when I passed kidney stones on Sub and which a few other members have also tried is to take a small dose of Sub along with your percoset. The idea is to take enough Sub (like 1mg) to help keep you out of withdrawals, cover some of your tolerance (those extra opiate receptors) but not cover all of them...thus giving the percoset a chance to work. As long as the Sub dose is low it won't block the percoset. This worked really well for me and I'd encourage you to give it a try.

Once your pain is more controlled you could also ask your Sub doctor to bump up your Sub dose for extra pain control. Then you'd dose your Sub every 4-6 hours until you're out of pain and then go back to your normal Sub dose. Of course, you might not even need this option - you might be ok with the small dose of Sub plus percoset and then go right back to regualr Sub dosing.

There are some folks around here who've had surgery on Sub, you could reach out to them or look through the forum for their stories. Laddertipper is one, Rule62 is another and I know there are more.

I hope things work out well for you, please update us when you can.

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PostPosted: Thu Sep 06, 2012 2:46 pm 
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Thanks for the quick response.

I forgot to say the surgeon who is doing the knee surgery told me to get pain meds from my addiction specialist... saying he had consulted two of his pain management colleges on the matter (I know I mentioned the consulting but not who he said to get it from)... I'm under the impression they can't even prescribe opiates, let alone would they.

I've sat there and called multiple times, I plan to bring a print out of that article with me - but the doctor outright told me he won't prescribe over 5mg of percocet - as I reiterate GREAT if it works, but my intuition is it won't. Other than that... What can I really do? He obviously thinks nothing of my pain - and when I respond to people who have an attitude is such I normally just get angry :/

I would try what you suggested, but I plan to taper to 0 pretty much coming out of this surgery (at this point for me it's mind over matter, the W/D's from subs are mild just like a bad cold, no motiviation, but nowhere near the pain of oxy W/D's) and I'm cooped up in bed anyway


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PostPosted: Thu Sep 06, 2012 4:31 pm 
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I recently had surgery, they had to cut behind my ear about 3 inches. They did it with no opiates in the anesthesia (nerve block and propothol) and just gave me 5mg Vicodin for recovery. I took 1.5mg sub along with the Vics and was fine. Some days I just took Tylenol with my sub. The sub will help you, going to zero sub while recovering from surgery seems like a pretty bad idea no offense.

Good luck,

-Glen b


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PostPosted: Thu Sep 06, 2012 4:51 pm 
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Even if you're not worried about withdrawal from Sub, taking that small dose with your pain meds will make the percoset more effective because of your higher tolerance.

Good luck!

PS - any MD can prescribe opiates.

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PostPosted: Thu Sep 06, 2012 6:51 pm 
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Diary of a Quitter wrote:
Even if you're not worried about withdrawal from Sub, taking that small dose with your pain meds will make the percoset more effective because of your higher tolerance.

Good luck!

PS - any MD can prescribe opiates.


I understand it might be a good idea to extend the sub treatment a bit longer.


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PostPosted: Fri Sep 07, 2012 1:02 am 
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First of all just try to relax. I know what you are going through and I can tell you that as long as you have done everything you can the rest of it is out of your control and worrying about will only increase your anxiety, which I have found increases the pain you feel.
just like you I had 500mg+ oxy habit for about 5 years, but have been clean for 18mo on 16mg of subs.
I just had elbow surgery last week Wednesday to fix a fractured elbow where they had to remove a large bone fragment, reattach part of my triceps tendon, and move my ulnar nerve, and like you I was worried about pain management. I had a plan to not use any narcotics if possible, but I was fully aware that unmanaged pain can be more of a trigger than if I used in a controlled manner, so I had someone close to me willing to manage the meds if needed, someone who both knew my history and could keep the meds out of my house yet be able to get them to me if needed. Like you I tried to have everything planned out but lets face it doctors suck when it comes to talking to one another, so things weren’t completely set by the time I went in for surgery; however I knew that worrying about it was only going to make things worse and did my best to trust that god would bring me through it. I’m 8 days post-op and my pain level never was worse than before my surgery.

My advice is you call your sub dr and leave a message about your concerns that you may not be able to get adequate pain management from your surgeon and you fear that the pain maybe a rigger for you and you are just trying to be preemptive. It isn’t drug-seeking if you are honest about your situation and you have legitimate pain issues or concerns. After that it’s out of your hands and if 5mg percs are all you get to work with then you just go from there. Furthermore, ask your surgeon for some gabapentin, it’s for nerve pain but a friend of mine who is a nurse practitioner in the ortho field highly recommended it to me and I feel it worked. Also as someone else pointed out toradol is also very good, so ask for a shot of that before you are discharged if they aren’t already planning on giving it to you.
Other than those few things I think the biggest thing is to get the nerve block and pray it lasts as long as possible. It helps more than anything else at relieving pain in the long run, so do it and pray. And even while the block is still working you should get plenty of rest, ice, elevation, ibuprofen, Tylenol, and then repeat. For the first 4-5 keep ice on it almost all times, alternate ibuprofen and tyleonal about every 2-3 hours, and do everything you can do to avoid moving it, especially when the block is working.
Lastly, even though subs aren’t great for treating pain they do work, and I think someone already touched on the dosing for treating pain.

Most importantly…don’t let your pain get out of control; because the higher it gets the harder it is to get back down.

So try and relax because you’ve tried to prepare for the worst but now you have to hope for the best!

Sorry if some of this isn’t the most well written shit, but I only have one hand.


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PostPosted: Sat Sep 08, 2012 11:47 pm 
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how was your surgery jimmydean?


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PostPosted: Sun Sep 09, 2012 6:46 am 
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I've been following this thread to see how it all worked out for you JimmyDean....and GlenBee tricked me! LOL! I thought maybe it was you who posted an update! hahaha, so Glenbee beat me to the punch, and already asked, so please fill us in as soon as you are feeling up to it!!!!

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PostPosted: Mon Sep 10, 2012 9:01 am 
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Hi guys first update... the anesthesiologist was amazing she actually said she had already read the article i brought in but re-read it anway i believe she actually spoke with my doc who ended up prescribing 4x what he said he would (still leaves me in some pain but it is manageable with advil and i space the percs out as long as possible. I seem to wake up in far more pain than if i stay awake - i was able to go 12on hours before another perc but when i sleep i wake up after 3the hrs and in a ton of pain... dunno why but havent been able to get much sleep because of this... anyway so i am maintaining on 1 10mg oxycontin every 12time hrs and 2 5 mg percand every 6 hours been icing all day every day tryi ng to get swelling/pain down hopefully i am moving in just a couple days... i still cant get over how little help my sub do i actually is/was if i hadnt stopped the meds on my own agenda 3-4 days before the surgery and did 1not day like he said im sure id be writhing in pain all day


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PostPosted: Mon Sep 10, 2012 9:04 am 
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Btw sorry for the bad grammar typing from phone!


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PostPosted: Wed Sep 12, 2012 8:35 am 
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I know nobody has responsed yet hut wanted to provide another update. I am simply maintaining the low percocet/ oxycontin dosea. I actually plan to try and use them to finish the sub taper.... i have not had any cravings whatsoever but i am not taking any more than prescribed (because infact a bit less after the first couple of days) has amyome ever heard of someome doing that? Has anyone actually heard of tapering your subs down (because i am at about 2-4mg every 3-5 days , or is that just extending the withdrawal? I am ready to quit ... i stopped the 400+mg/day oxy habit cold turkey... first time i stopped subs the same and no wds... but i was having cravings (no relapse) and got back on subs... worst mistake of my life i absolutely hate them and how they make me feel ....


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PostPosted: Wed Sep 12, 2012 7:23 pm 
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It sounds like you have been off of Subs now for about 6-8 days. If you are ok on the Percocet and not in WD you can probably taper off of that and not go back on Sub to taper off. When the pain is improved you can probably reduce your Percs by about 5mg/day and not suffer significant WD. (this is my humble opinion after having gone off Sub a couple of times, I'm not a medical professional).
The important thing is to have a plan to stay off the opiates once you are off the Sub. You already know how those cravings kick in. I have found that there is a lot of help out there from other recovering addicts, but you have to be willing to put yourself out there and ask. I'm glad everything went well with the surgery and anesthesiologist. I wish you the best for your recovery.
Lilly


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PostPosted: Thu Sep 13, 2012 5:15 pm 
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I am already down 20mg/day on the percs, i am going into slight w/ds between doses but slowly lessening the dose i hope it works!


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