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PostPosted: Sat May 28, 2011 5:30 pm 
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Some of you know that I've been taking sub now for 2.5 years for both addiction and chronic pain. When I started I was taking 24 mg (8 mg, 3 x per day). I'm still scripted that, but I've been taking only two pills a day for a while now. A couple of months ago I changed that again. I've been taking one 8 mg pill in the am, but in the pm I've been taking only half a pill (4 mg). No problem with the drop in dosage, obviously, and for the most part, my pain level was all right. On bad days, once or twice a week, I'd take more. That's where I've been at.

Last week I started working for the first time in four years. It's not a physically strenuous job or anything, but with my disability, it's been quite an adjustment and a huge increase in my pain. But silly me didn't even recall that I'd dropped my dose down to a total of 12 mg! I was coming home from work with pain at an 8 on the pain scale and nearly in tears. On Friday I finally asked myself what the hell was I thinking! So after work I took my second full 8 mg tablet. About an hour and a half later....I felt SOOOO much better! Just that little extra 4 mg pushed me right over the edge and lowered my pain down to about a 3 or 4! I was thrilled and at the same time was kicking myself in the ass for not having done that earlier in the week.

Anyway, I'm writing and sharing about this because some people say suboxone simply doesn't work for chronic pain - ever. Of course I recognize that for some people, depending on their own unique pain, that sub may not help them as much as it does me - or at all. But I want to encourage people that suboxone CAN indeed help us recovering addicts who can no longer take full agonists to treat our chronic pain. Sub has made my pain tolerable and given me back a life that is livable, complete with pleasure and fun.

For those who don't know, dosing for pain is different than dosing for addiction. We usually dose two or more times daily rather than only once. Sub's pain properties only last about 4-6 hours instead of the 37 hours that normally applies when taking it for addiction purposes. And because we dose more often, we also usually take higher dosages than non-pain patients.

So for those of you with chronic pain who are considering going on suboxone and are wondering whether it will help you: I cannot guarantee that it WILL, however, I can say that it absolutely, most definitely does help me immensely! I've felt what my life would be like on a lower dose, much less without it altogether.

If anyone has any questions about suboxone and chronic pain, just ask. Or feel free to send me a PM.

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PostPosted: Sat May 28, 2011 8:26 pm 
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Hey Hat - theoretical question -

Do you think that the extra "booster" dose that you're taking in the evening to reduce pain is more a factor of dose or is it a matter of proportion, like just getting your dose up above what your baseline daily dose is as opposed to needing a particular dose of 16mgs?

Gah! I know that's not making any sense. What I'm trying to get at is this: You were able to lower your typical daily dose from 24mgs to 12mgs so now you can take an extra 4mgs for a decent amount of pain relief.

So, if you (or anyone really, this question is not particular to you) were able to lower your typical daily dose to 8mgs, then 12 should give some pain relief, right?

And theoretically, that should work all the way down to whatever the lowest daily dose a person could get down to and still basically get adequate pain relief...even on down into really small doses.

My thinking here is around the idea that a lot of people on Sub for chronic pain seem to be at really high doses, which makes sense if they were coming off of high doses of short-acting opiates or if they are also dealing with addiction and need the higher doses as an opiate blocker, etc. But as recovery progresses a lot of people, though certainly not all, want to taper their dose.

In that case, what you're reporting is good news. You did not have to jack your dose all the way back up to 24mgs to get pain relief - you just had to adjust it a little higher and it worked. This means that it might be possible for people taking Sub for chronic pain to taper if they want, while still getting pain relief.

Anyway - I'm glad to hear that you're still getting pain relief and finding a way to make things work as you adjust to being employed! Keep kicking ass!

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PostPosted: Sat May 28, 2011 10:35 pm 
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You bring up an excellent point, Diary. I hadn't thought of it that way. (:) You're so smart!) I just figured I'd bump back up to 16 mg and if that didn't do it then I'd continue to bump it up a bit more. Are you asking if I lowered by tolerance? Hard to say. But perhaps so and now I'm getting pain relief at lower doses than I previously only got at the higher doses. (Did that make sense?) Hell, I don't even know why I pushed myself into lowering from the 24 mg. Maybe I just felt like the dose was really high. (Also I'm relying more on my muscle relaxers these days.)

For me, my suboxone is just another pill I take. I rarely even think about it. I just take it and forget about it. Maybe that's why I didn't think about having to adjust dose even when I knew I'd have increased pain.

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PostPosted: Sun May 29, 2011 10:09 am 
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I'm not on suboxone for pain.. but 6 years ago i had a very bad car accident.
7 am i was driving to dunckin donuts for coffee,when a elderly woman had a seizer wile driving
down the hill from the other direction.her car ran into a bank over turned,went air born
and landed on top of mine. she died instantly. my injuries were spinal and a broken hand.
i have a e.m.p.i spine - neck machine that i use 3 times a week. suboxone seems to help
with the mild lingering pain,becouse i dont need to use the empi machine as much.
but i mainly use sub for addiction.


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PostPosted: Sun Jun 05, 2011 1:38 am 
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my dr says for people with pain taking less and lower dosages of SUB is way more effective than higher.. because the active metabolite of suboxone; norebuprenorphine is a full agonist and gives excellent pain relief....but will only bind if the dose of suboxone is not saturating all your receptors (around 1 or 2mgs)... in my opinon anyone taking more than 6-8mgs a day is a total waste... and taking more sub actually makes the antagonist properties more apparent and more bad side effects

He says giving people 1-2mg doses every couple hours is far more effective than higher doses because of norebuprenoprhine..
If you take more than 2-4mg dose.. chances are your receptors will be satured and the norebupe cannot bind to them...

I thought this was ridiculous but i tried it myself and it actually is true lol!!! Most people dont believe this because pyschologically they psyche themselves to thinking more is more.. and trust me the mind is a very powerful thing

I know it makes no sense at all but trust me less is more with this drug because of the NOREBUPE.. its one of the biggest secrets about this drug...

http://opioids.com/norbuprenorphine/index.html

http://en.wikipedia.org/wiki/Norbuprenorphine


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PostPosted: Sun Jun 05, 2011 6:40 am 
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I hear what you're saying. And I've tried time and again over the last 2.5 years to lower my dose (in different ways), but each time, my pain has come screaming back.

Also, the way I understand it, when the receptors are not saturated and KEPT saturated, it defeats the purpose of being on suboxone for addiction (which I am as well). Those low doses often simply don't keep the cravings at bay. Also at such low doses, sub acts more like a full agonist rather than the partial agonist that it is. When one keeps stimulating the receptors on and off like that (below the ceiling), one will "feel" the dose. Keeping them saturated is the idea of suboxone treatment.

Don't misunderstand me, I'm not disagreeing with you. I'm merely relaying my experience with trying to decrease my dose and my pain level's response to that and discussing maintenance dosing under the ceiling, as I understand it.

I'm glad you shared your perspective on it though. I do know someone who is able to dose in very small amounts and it does address her pain very well that way. It just doesn't seem to work with me.

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PostPosted: Thu Jun 09, 2011 1:43 pm 
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See this is my problem with Dr Saying suboxone works for chronic pain, because JUST suboxone does not work for chronic pain. As you said “you are relying on a lot more muscle relaxers” now a days, even if muscle relaxers are non narcotic they can become addictive and your body will become dependent on them if you take them long enough where you will need them to go on with your day without them there be a noticeable difference. In my eyes that defeats the whole purpose of Suboxone and Recovery all together and that is why it makes me upset when Suboxone Dr say it will work for chronic pain. The whole point of getting on Suboxone for pain is to get away from those drugs like painkillers, muscle relaxers and so on and going on muscle relaxers is basically starting a new addiction just Sub friendly I am sorry but that is the truth and I do want people thinking of using SUB for pain to know that. But at the same time it is not a problem for some people like you are doing well and are not letting the MR turn into a problem but when someone is early in recovery using SUB and MR can and will easily turn into a problem and now you are going to have to deal with another issue/addiction in your recovery.

All I am trying to say is Suboxone Dr Need to stop telling people it will work for true chronic pain because that is false hope and that is the last thing an addict needs when trying to get clean.

And don’t get me wrong you are doing very well but that is because you are strong minded and did not let the muscle relaxers turn into a problem but not everyone is well off when it comes to pain management.


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PostPosted: Thu Jun 09, 2011 10:49 pm 
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I was relying more on the muscle relaxers because I had returned to work and my pain had increased. And just as important, I also was not in a position to take the suboxone at work, as I was on the phones all day, literally. (Not working anymore.) I know from taking the two meds and my reaction to them (pain-wise) that each one is helping my pain in their own way. If I were to go off of the suboxone, I would have greatly increased pain. The majority of my pain is addressed by the suboxone. The zanaflex helps sort of push me over the edge, so to speak. But I've no doubt that the sub does more for my pain than the zanaflex. If I forget to take that, I'm generally fine - I don't even take it regularly, only as needed. But if I forget to take my suboxone, my pain goes up considerably. I also know other people who take suboxone for pain and who get good results from it - and that's the only thing they take.

Bboy, it almost seems like you're saying you don't believe sub works to treat ANY chronic pain. Maybe I'm misunderstanding you. I know that suboxone didn't work out for you and that you were very unhappy on it. But that's behind you and you're happy now, right? Why not focus on that and leave the rest behind? If people are getting chronic pain relief from suboxone, good for them....good for me.

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PostPosted: Fri Jun 10, 2011 10:55 am 
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Dr. J posted something a while back on Sub and pain. I guess the trick is to get above your baseline, hence the more frequent dosing for pain patients causing spikes in one's blood level. I think Mel is correct in saying that Sub does work for pain for many people. I think it's not great for severe, acute pain, but lower level chronic pain. Also, I believe the only muscle relaxer that is truly addictive is Soma, which isn't really a true muscle relaxer but was originally a sleep aid (?).
I guess everyone needs to do what works best for them. Most addicts, I think, would prefer to at least TRY Sub because it can be dispensed by prescription instead of requiring clinic visits.


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PostPosted: Fri Jun 10, 2011 2:40 pm 
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I am sorry Hat but that is my true believe that suboxone does not work for true chronic pain on its own but must be used in combination with other drugs. Keep in mind when I say chronic pain I am talking pain levels that are exceeding an 8 maybe 7 at the lowest on a daily basis. Yes Suboxone will work great for mild pain but Drs Give you this believes that it will work for severe pain. Which is not true and that is what upsets me and why I am speaking out to the public about it because I don’t want anyone else to ever have to go through what I did? I was in a very vulnerable state of mind and was told by my suboxone Dr it would work GREAT for my pain which gave me 5 years of false hope which could of easily lead to many relapses if I didn’t have a strong support system and serious consequences if I failed a UA. And every vistit it was the same thing give it time things will get better but things never got better but thinking they would hence false hope which is why I say suboxone Dr need to stop lying about this.

Don’t get me wrong I am very happy for you that you are doing so well I truly mean that with all my heart but I fell that somebody needs to speak up on this topic before its to late for another person. If my parents didn’t pay for my treatment I would be in pain on top of a very large debt!

But I will stop posting in this thread I started my own.


And yes Lilly you are right technically speaking muscle relaxers are not considered addictive but that is not true in all cases.


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PostPosted: Mon Jun 13, 2011 7:59 pm 
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^^^ this is all subjective man... If you aren't getting pain relief from Sub i doubt any other Opiate will give you that much better relief....

Based on scientific data the fact that Buprenorphine is a thebainene derivitatve and it does bind to opiate receptors... it will help reduce pain greatly in most people... Bupe is 20-40x more potent that morphine...

the problem is alot of people confuse analgesia with euphoria with sub versus other opiates...


But again its all subjective....

I guarantee you if you have pain and you take nothing compared to taking Sub there will be a huge difference ....


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PostPosted: Tue Jun 14, 2011 5:14 pm 
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cire113 wrote:
^^^ this is all subjective man... If you aren't getting pain relief from Sub i doubt any other Opiate will give you that much better relief....

Based on scientific data the fact that Buprenorphine is a thebainene derivitatve and it does bind to opiate receptors... it will help reduce pain greatly in most people... Bupe is 20-40x more potent that morphine...

the problem is alot of people confuse analgesia with euphoria with sub versus other opiates...


But again its all subjective....

I guarantee you if you have pain and you take nothing compared to taking Sub there will be a huge difference ....


I am sorry man but I have to disagree I am living proof that you can get better pain management from other meds. First and for most I am a little confused are you saying people that don’t get any pain relief from Sub won’t get pain relief from any opiates??? I mean I think that is what you said in your first sentence. I mean bro when I was in active addiction I was never in pain like I was when on suboxone. Fentora did wonders for my pain levels, as of not taking anything than taking sub yes there would be a difference but that is just common sense, I would be a 10 with nothing vs. a 9 with Sub. But I can say I am clean still in a healthy recovery getting true pain relief since I switched to methadone a couple weeks ago. I have been able to do things this last week that I havent done in the whole 5 years I was on suboxone. As of suboxone being 20 to 40 times stronger than Morphine that is not true I was on Morphine for a little bit b4 I switched to fentora and got much better pain relief than I got from Sub.


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PostPosted: Tue Jun 14, 2011 11:58 pm 
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Here's another wrinkle to throw into this mix about pain relief, while I was on full agonist opiates, I had constant chronic pain in my ankles. While I was on Suboxone I had constant chronic pain in my ankles. A month or two after I quit Suboxone, the pain went away. Today is a good example of how I'm able to deal with whatever ankle pain I do get from time to time. I was on my feet ALL day today, walking all over the dang place and by 3pm I could feel my ankles starting to act up, it's like they start to lock up. Anyway, I took two Advil, half an hour later the pain was gone.

I know I read somewhere about long term opiate use actually causing an increased sensitivity to pain, if I can find the article, I'll post a link.

Like the title of this thread says, the right dose of Suboxone does make all the difference, for me, the correct dose was zero.

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PostPosted: Wed Jun 15, 2011 1:49 pm 
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Romeo wrote:
Here's another wrinkle to throw into this mix about pain relief, while I was on full agonist opiates, I had constant chronic pain in my ankles. While I was on Suboxone I had constant chronic pain in my ankles. A month or two after I quit Suboxone, the pain went away. Today is a good example of how I'm able to deal with whatever ankle pain I do get from time to time. I was on my feet ALL day today, walking all over the dang place and by 3pm I could feel my ankles starting to act up, it's like they start to lock up. Anyway, I took two Advil, half an hour later the pain was gone.

I know I read somewhere about long term opiate use actually causing an increased sensitivity to pain, if I can find the article, I'll post a link.

Like the title of this thread says, the right dose of Suboxone does make all the difference, for me, the correct dose was zero.


That is cool you mention that Rom because I have actually heard that before, def try to find that article please I would like to read it.


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PostPosted: Sun Jul 17, 2011 10:53 am 
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Hatmaker, I just read this post about your chronic pain and although I started the subox for tapering to find a non opiate for pain relief, I can tell you that the suboxone has my pain under excellent control. It is a neuropathic condition that I am being treated for. My doctor had mentioned that if at the end of all this other meds did not work out.. he was suggesting bupenorphine in the patch form. Do you know much about that? Has that been discussed here much ? I'm encouraged to hear how well it works for your pain
Anita

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PostPosted: Sun Jul 17, 2011 11:12 am 
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The patch version is called Butrans and it releases a very small dose of buprenorphine around the clock. It's meant specifically for people who suffer from chronic pain, but it's been discussed as a possible use in tapering. My husband has peripheral neuropathy (non-diabetes related) and they suggested Butrans for him, but never followed through with it. You are about the third person who has said suboxone is very good in treating neuropathy. I really wish they'd try the Butrans on him.

If you can't find a non-opiate treatment, Butrans might be the perfect solution for you. Sub/bupe the only option for my pain, which is why I'll probably be on it for life. I can never go back to using regular opiates for my chronic pain and I don't see it being alleviated anytime in this lifetime. So sub/bupe is the only solution for me.

And if you do find a non-opiate solution, please let me know so my husband can try it! His neuropathy is so bad that's it's already caused muscle damage. His pain is severe and constant. He's in the process of weaning himself off the opiates he's been on over the last few months. Lucky him - he doesn't like how they make him feel.

Sorry for the tangent....

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PostPosted: Sun Jul 17, 2011 12:02 pm 
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Hatmaker, so sorry to hear of your long term pain challenges as well as your husbands. Mine too is non-diabetic and I will most certainly keep you posted. They are first wanting to try the "usual" an nortryptiline mix with Gabapentin or Lyrica. So, I don't know if there will be a magic bullet but I fall into the same place as your husband, I don't like the way opiates make me feel and I also cannot tolerate them. Is it really true that the bupe does not pose the same tolerance "increasing dose" dilemma that other opiates present? Is your pain still covered by the same long standing dose ?
Anita

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PostPosted: Sun Jul 17, 2011 12:37 pm 
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Yes, that's true about bupe, there's no tolerance building and no need to raise one's dose to get the same effect. That's what the ceiling effect is about. Anything above it and additional dosages don't do anything....even no additional respiratory depression. That's why you won't hear about anyone dying from an overdose from suboxone alone, unless you're talking about an opiate naive person and even then it usually will only make them sick. Usually it's from a mixture of sub and something like a benzo.

The thing is, when it comes to pain, everyone is different and sub works a little differently. For example, multiple day dosing is needed as it's pain properties only last about 4-6 hours. I usually take on average 12-16 mg per day. Now on a REALLY bad day or flare up, I'll take 24, but I've never gone above that. Cravings are really individualized, too. That's why some people take 4 mg and are fine at that dose (which is about the ceiling) and others need 16 mg - it's whatever they need to prevent cravings. And that amount depends on their tolerance.

It can be very confusing. It took me a while to understand all of suboxone's mechanisms, so to speak. And I learned most of it right here on the forum and from Dr. J (and my own research). So don't feel bad if you don't understand it all yet. Maybe someone else will come along and explain it differently. Donh is always really good at it. (Where have you been, Don?)

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PostPosted: Sat Jul 23, 2011 10:06 pm 
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this thread is really helpful- I wish more doctors who treat pain would read this!

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