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PostPosted: Sat Dec 06, 2014 8:24 pm 
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Two and half years ago, April 24, 2012 I had an Anterior Cervical Disectomy to get a disc removed that compressed my spine at C6. Sadly I had suffered with it for 4 years thinking it was carpal tunnel, something I had been treated for back in 95. My hands, fore arms and shoulders were involved, but mostly my hands. The surgery was a great success with C4, C5 and C6 being fused and I got prescribed Hydroco / APAP 10/325 (yes I fixed this, it was 10 not 15 - quite an astute group here), two pills every four hours as needed for pain. I was unable to sleep and got a script for ambien. At my follow up a week later I got the dosage lowered on the Hydrocodone to 7.5 because 15 was too much for my head and the pain was back before my head was. Got off the Hydrocodone starting in August of 2012 and suffered the very unpleasant withdrawl effects that lasted for more then three weeks. The radial neuropathy pain started to get worse, gabapentin, amitriptyline, and lyrica were ineffective. Tramadol helped but like the Hydrocodone messed with my head and I was gun shy after the Hydrocodone withdrawl.

I have always had a very high pain threshold and in the past when prescribed a narcotic for dental or other sundry issues that have come up, I might try one or two and set them aside. They made and still make me feel weird. Most of those scripts ended up in the trash but I still have a bottle with 13 of 20 Codeine 32mg issued in August of 75 because the bottle was cool which saved it and it has since become a keepsake. Its true I am not an addict.

Tried all the drugs and nothing really worked well and the pain kept increasing. Two years after the surgery I was taking a couple hydrocodone every other couple of days, a tramadol on other days and ibuprofen on other days.

Chronic pain is insidious and takes a huge amount of energy to combat. While explaining this to a close friend in the presence of my son, my close friend suggested cocaine and my son suggested I get some Adderall which he pointed out was legal. Thanks to my Neurologist I got some 5 mg and while I still hurt, my focus was on other things and I was doing stuff again. Of course when the Adderall wears off the pain is insufferable. Drinking helped because I can't sleep very well on Adderall and likewise with the tramadol and the hydrocodone. I had a two year follow up with my surgeon told him my tale and he got me on the butrans 7 day patch 10 mcg. The first six months of that combo was good, I would lose the first day on the new patch feeling weird and the last two days the patch was ineffective.

Thanks to the new laws I got directed to a pain management doctor and he got me on 2mg/day of Buprenorphine which packed way too much of a wallop for my head and the pain was back by mid-afternoon if I took it in the morning but my head was still out there. Currently I am taking .5mg four times a day for a couple of weeks now with a 500 mg acetomycin and I am still waiting to quit feeling odd and for the insomnia to go away. If I don't have to interact with people I do OK and the pain while still there is kept somewhat at bay. I will try to get a time released Adderall next month, I am currently taking 5 mg 2 or 3 times a day. Would like to set an alarm at 6am and take one and be sitting in front of my TV or my computer or at a movie by 7 pm.

I realize I am coming to this forum from an odd angle but perhaps some one might have some ideas. Anyway amphetamines plus opioids for pain relief is documented but not currently in vogue at the moment. Perhaps buprenorphine is not the opioid for me. Maybe there is something else out there.
Here is a reference for amphetamines plus opioids for pain relief :
http://www.practicalpainmanagement.com/ ... ts-opioids

Any thoughts or words of wisdom are appreciated, if I can make it another five years there might be a stem cell solution, I wonder sometimes if I can make it that long.


Last edited by ZeyederZ on Sat Dec 06, 2014 10:11 pm, edited 1 time in total.

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PostPosted: Sat Dec 06, 2014 9:14 pm 
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Hi ZZ and welcome to our forum.

Your situation is quite different from ours when it comes to the mental part of dependence. We addicts, overuse, overdose, and continue to chase that first high we got when we started taking opiates.

One thing did strike me as odd was your statement about Hydrocodone 15/325. I've never heard of any higher dose than 10/325 (Norco, Lortab). Unless you were taking some new version I've never heard of. There is a new one on the market w/o the Tylenol in it and it's also extended release. Not a big deal and it really has no bearing on your story.

Pain relief from Buprenorphine has been used in small doses for many years. Your method sounds good but you may find it works better for pain in even lower doses. That Butrans patch you had comes in micrograms, not milligrams, so that reinforces the use of low dose is better.

How you may benefit from this forum I don't know yet. Feel free to do a lot of research of our archives to find threads relevant to your case. Ask any questions you can think of and we'll do our best to answer them.

Hopefully, our staff Dr. will chime in with professional advice. We have other Suboxone doctors who are members and they might post also.

Welcome here, and I hope you get something out of it.

rule

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PostPosted: Sat Dec 06, 2014 9:49 pm 
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ZeyederZ wrote:
Two and half years ago, April 24, 2012 I had an Anterior Cervical Disectomy to get a disc removed that compressed my spine at C6. Sadly I had suffered with it for 4 years thinking it was carpal tunnel, something I had been treated for back in 95. My hands, fore arms and shoulders were involved, but mostly my hands. The surgery was a great success with C4, C5 and C6 being fused and I got prescribed Hydroco / APAP 15/325, two pills every four hours as needed for pain. I was unable to sleep and got a script for ambien. At my follow up a week later I got the dosage lowered on the Hydrocodone to 7.5 because 15 was too much for my head and the pain was back before my head was. Got off the Hydrocodone starting in August of 2012 and suffered the very unpleasant withdrawl effects that lasted for more then three weeks. The radial neuropathy pain started to get worse, gabapentin, amitriptyline, and lyrica were ineffective. Tramadol helped but like the Hydrocodone messed with my head and I was gun shy after the Hydrocodone withdrawl.

I have always had a very high pain threshold and in the past when prescribed a narcotic for dental or other sundry issues that have come up, I might try one or two and set them aside. They made and still make me feel weird. Most of those scripts ended up in the trash but I still have a bottle with 13 of 20 Codeine 32mg issued in August of 75 because the bottle was cool which saved it and it has since become a keepsake. Its true I am not an addict.

Tried all the drugs and nothing really worked well and the pain kept increasing. Two years after the surgery I was taking a couple hydrocodone every other couple of days, a tramadol on other days and ibuprofen on other days.

Chronic pain is insidious and takes a huge amount of energy to combat. While explaining this to a close friend in the presence of my son, my close friend suggested cocaine and my son suggested I get some Adderall which he pointed out was legal. Thanks to my Neurologist I got some 5 mg and while I still hurt, my focus was on other things and I was doing stuff again. Of course when the Adderall wears off the pain is insufferable. Drinking helped because I can't sleep very well on Adderall and likewise with the tramadol and the hydrocodone. I had a two year follow up with my surgeon told him my tale and he got me on the butrans 7 day patch 10 mcg. The first six months of that combo was good, I would lose the first day on the new patch feeling weird and the last two days the patch was ineffective.

Thanks to the new laws I got directed to a pain management doctor and he got me on 2mg/day of Buprenorphine which packed way too much of a wallop for my head and the pain was back by mid-afternoon if I took it in the morning but my head was still out there. Currently I am taking .5mg four times a day for a couple of weeks now with a 500 mg acetomycin and I am still waiting to quit feeling odd and for the insomnia to go away. If I don't have to interact with people I do OK and the pain while still there is kept somewhat at bay. I will try to get a time released Adderall next month, I am currently taking 5 mg 2 or 3 times a day. Would like to set an alarm at 6am and take one and be sitting in front of my TV or my computer or at a movie by 7 pm.

I realize I am coming to this forum from an odd angle but perhaps some one might have some ideas. Anyway amphetamines plus opioids for pain relief is documented but not currently in vogue at the moment. Perhaps buprenorphine is not the opioid for me. Maybe there is something else out there.
Here is a reference for amphetamines plus opioids for pain relief :
http://www.practicalpainmanagement.com/ ... ts-opioids

Any thoughts or words of wisdom are appreciated, if I can make it another five years there might be a stem cell solution, I wonder sometimes if I can make it that long.


Im rather new to this particular forum but i am NOT new to pain management as my use of Buprenorphine stemmed from 10 years of chronic pain and mismanagement of being able to treat it. So I feel for you so much more then you could possibly understand. From what I can gather you have a very low tolerance to opiate/opioid medications. I applaud you for your pain thresh hold as many people in that situation are taking massive amounts of narcotics and it really hurts you more then it helps you in the long run! Take it from some who knows. I was on death bed style pain meds (stupidly for too long trying to rely ONLY on pain meds to fix the problem.

They too made me go to a pain clinic due to new laws which wasn't something I wanted to do because I loved my PC Dr. So basically lets break this down. The Norco 10/325's (they don't make 15/325's like you stated before unless a compound pharmacy makes them specifically for a patient) were causing you to have a "buzz" or "head high" long past the analgesia pain killing effects wore off? So then they cut it back to Vicodin ES or Lortab which come in 7.5's with APAP as well. (The 15,10,7.5,etc are the opiate) & those too had the same effect on you?

I'm surprised they would even recommend Buprenorphine if your tolerance was too low for even Hydrocodone. I currently take a mixture of Amitriptyline, Gabapentin, & Buprenorphine in the form of Subutex (generic just buprenorphine which I assume is what your pain Dr gave you) and it took awhile for me to adjust to it all and work out the dosages that helped.

What I'm curious about is what dosages and how long were you on the Amitriptyline & Gabapentin? Because usually for pain its 10-25mg once a day at night because it can make you sleepy. Sometimes 2x a day. I didn't start getting any help with pain until my new anesthesiologist bumped me to 50 and then to 100. I know that is more the Anti-depressant range but it made the pain killing effects much more noticeable without that head high your trying to avoid.

Then the Gabapentin was the same deal. A few Dr's tried it but it wasn't until my anesthesiologist showed me how safe Gabapentin was & that there were a lot of people on doses in excess of 3600 mg a day that I realized my 100mg 3x a day was a small dose. When he went to 300mg 3x a day it started to work great. Especially for nerve pain opiates won't even touch. It's what that medication was designed for. If you haven't tried those 2 meds in a decent enough dose safely don't write them off like I did because they worked magic for me.

Also buprenorphone might not be the drug for you. It is multiple times stronger then morphine by weight and way stronger then hydros so I'm shocked if you were having issues with hydros they even tried butrans. I'm assuming you are in the US?? Because in Europe they have a pain medication called "Temgesic" & it is buprenorphine for pain management but the dosing is 0.3mg a tablet. That sounds like what you need if you are splitting up a 2mg tablet into 4 0.5mg doses. In America we have "Buprenex" but it is a IV/IM medication only and it's also done in 0.3mg but most people aren't to up for poking a muscle every time they need their meds. It isn't practical.

My advice to you Is go try to have a heart to heart with your pain Dr' and lay it all out on the line and see what he thinks. From my personal experience the narcotic pain killer opiate/opioid with the least "euphoria" or "head" feeling your talking about that actually killed pain amazingly without making me feel the least bit high was the Duragesic Fentanyl Patches. With your tolerance being what it is they make very very small dosage ones at only 12.5 mcg (yes micrograms!) an hr. Even when I was up on 75-100mcg an hour I had amazing pain relief with little to no mental fogginess or high as long as you use them as directed on don't stupidly try to abuse them for a buzz they are great medication. One patch every 3 days and that is it. No pills to always remember etc.

Talk to your Dr and if you lay things out like you did here I'm sure he would understand and maybe have even a better idea but that is the one strong pain killing opiate I have a lot of experience with that never made me feel the least bit high or cloudy even on does 8x as high as their smallest 12.5 mcg doses. Plus the new technology in the matrix patches makes me far safer for patients and Dr's when it comes to a-holes who divert meds and ruin it for the patients who need them.

Wow I apologize for my long replies I feel like the mods are going to ban me one day for going way too in depth I just have avast amount of experience and knowledge nad being in your shoes I want to make sure you get your life back. I have empathy for anyone experience any chronic iretractable pain.

Stay strong, I promise you it will get better. I used to think people were so corny for saying that but it is true and we are hear to help! You can always PM me if you want to talk more personal. I'd love to help you.

-Jonathan


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PostPosted: Sat Dec 06, 2014 9:58 pm 
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rule62 wrote:
Hi ZZ and welcome to our forum.
One thing did strike me as odd was your statement about Hydrocodone 15/325. I've never heard of any higher dose than 10/325 (Norco, Lortab). Unless you were taking some new version I've never heard of. There is a new one on the market w/o the Tylenol in it and it's also extended release. Not a big deal and it really has no bearing on your story.


I was thinking the same thing but what generally happens if it isn't a misquote is that the Dr' will write the RX and you can't go to a huge chain pharmacy you have to find a local compounding pharmacy. They will generally have them by hospitals. Due to liver problems I've had them make me 30mg Hydrocodone capsules with just Hydrocodone no APAP because I preferred Hydro for pain over Oxy 30mg's for pain but couldn't tolerate the APAP especially in doses that I would need to get out of pain using Norco 10/325's... 30mg of Hydrocodone would have given me about a gram of APAP on a failing liver. They were even able to compound 16mg Dilaudid IR for me (US biggest dose being 8mg) and 60mg Morphine Sulfate IR (Not MS Contin) because the MS IR only came in 30s.

It was not only more cost effective because of it being less pills but it was better for my liver to process less pills & all the binders. Compounding pharmacies that will make meds up from scratch for you are great. I wouldn't ,be surprised if they would make something similar to "Temgesic" for this man so he could get 0.3mg Bupe pills.


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PostPosted: Wed Dec 10, 2014 6:46 pm 
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I got some good information from JonWrong and cut my Buprenorphine dosage back to .2mg in the AM and .2mg in the PM along with 500mg of acetaminophen. I also knock back a 5mg of adderall when I get up and another at noon. I might take another 5mg of adderall if I have to deal with people later in the afternoon. Skipped my Saturday night dosage of bup and started this on Sunday. I still don’t have a clear head, but I hurt about the same, maybe a bit more, but actually got some exercise yesterday – mowed the lawn, got the weed hacker out and all that then installed an HD TV antenna both projects successful. A nice 70 degree sunny day on the south Tejas Sea.

Anyway I will probably keep cutting back the bup until I get a clear head and talk to the Dr and try the Duragesic Fentanyl Patches suggested by JonWrong.

Thanks, I appreciate the help – I clearly needed it.


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