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 Post subject: Suboxone for pain?
PostPosted: Wed May 24, 2017 6:28 pm 
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Hello. My husband is on methadone for pain, he has been taking a high dose. After being with the same pain doctor for over 10 years his pain doctor wants him to to go on suboxone. He assures him this will help his pain. He has severe pain, both knees need replacement, his back needs a fusion but he is not a good candidate for surgery. I am trying to find out if suboxone can be used for pain. Is it used for pain? Thank you, Dee
I feel this is happening due to new govt regulations. Something changed Jan 1st. The doctor stopped accepting Medicare so we now pay.

Update 5/26/17 I just remembered something. While talking to another pain patient he said that the new govt regulations or the Surgeon General letter to doctors stated that they wanted pain doctors to limit their prescriptions to no more than 100 MG per day. I wonder if this affected my husbands doctor.
I am now searching for pain management doctors in our area.


Last edited by Dee19 on Fri May 26, 2017 10:12 am, edited 1 time in total.

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 Post subject: Re: Suboxone for pain?
PostPosted: Thu May 25, 2017 12:05 pm 
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I would get a second opinion on that diagnosis. Methadone is by far a stronger pain reliever than Buprenorphine is. (Suboxone) In the U.S.A., it is not a very popular pain management drug. There are some pain patches called Butrans but they are surely not very strong.

It is a step down the ladder for pain relief IMO. My hope is our resident doctor or one of our visiting physicians will chime in on this topic. We members are only addicts who use the medication for addiction problems, just like it's intended for. Some people swear it helps with pain and it may in fact work for your husband. But coming off such a strong pain med like Methadone won't be easy.

Yes, a 2nd opinion is in order.

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 Post subject: Re: Suboxone for pain?
PostPosted: Thu May 25, 2017 12:41 pm 
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Thank you so very much! I joined Monday, searching for information before piston my question. I hope I placed in right place. Thanks again!


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 Post subject: Re: Suboxone for pain?
PostPosted: Thu May 25, 2017 6:40 pm 
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I take this medication to treat my addiction, but I too suffer from chronic pain and was wondering if there would be any relief while taking it. I'm still fairly new to it, and just started in April but I feel like I'm getting at least a minimal amount of pain relief for my back, but not my headaches.

That being said, I can't imagine someone with the issues you mentioned taking this after being on methadone and being satisfied with the results. I honestly wish it was otherwise because my chronic pain is one of my biggest triggers to overuse pain medicine.

Has your husband been using the methadone as prescribed or has he needed to take more for the same amount of relief? Or put another way, is this strictly an insurance matter or has he had some problems maintaining his dosage? I'm curious why the doctor would suggest buprenorphine out of the different meds available.

I hope you find some helpful answers here and I encourage you to read any other posts that may discuss Suboxone and chronic pain. Good luck :D

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Last edited by OpenMind on Thu May 25, 2017 10:56 pm, edited 1 time in total.

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 Post subject: Re: Suboxone for pain?
PostPosted: Thu May 25, 2017 7:54 pm 
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Hi Dee, Welcome! I was prescribed tramadol for osteoarthritis in my knees. I became addicted to it and that is how suboxone entered my life. I was also experiencing depression as a result of menopause. Suboxone has helped me three fold. My knees do feel better, the depression is less, and addiction completely in remisson. Morphine is stronger than trams but I was taking 40 to 50, 50 mg tabs of tramadol a day. I could not afford it once they changed the class of drug in August of 2014. Been on suboxone since. Started at 24 mg and have weaned down to 4 mgs. Please keep us informed as to how your husband does.


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 Post subject: Re: Suboxone for pain?
PostPosted: Thu May 25, 2017 8:33 pm 
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Thank you for all responses. He hasn't had any problems with medication compliance with his pain contact or had any other problems. This idea started before the first of the year. The doctor said medicare was changing requirements so he was no longer accepting Medicare so now he doesn't accept any ins. Our secondary ins has no problem paying for his prescriptions. Because its expensive he told my husband he would
see him every other month but in order to legally do this he would need to reduce amount of methadone, at the time 170, now 140. As he started to reduce 10mg every other month he began to say suboxone would take care of pain. I don't believe the doctor but thought hoped I was wrong. I was hoping for advice. I asked if my husband could see another doc and were told no one would take him due to his high dose. Is there a place to look for a doctor? Thank you, Dee


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 Post subject: Re: Suboxone for pain?
PostPosted: Thu May 25, 2017 9:18 pm 
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Hi Dee,
I'm also not a doctor but I would echo what others have said- you should get a second opinion. Buprenorphine (drug in Suboxone) was initially developed to treat pain. It is still used for chronic pain-usually in very small doses. Butrans is a skin patch and Belbucca is a film that dissolves in your check. These preparations give less than 1mg per day of Buprenorphine while Suboxone maintenance doses are usually between 8-16 mg.

In other words, Suboxone has a lot more buprenorphine in it than the other products used to treat pain. The reason for this is that addiction requires these high doses, while pain has been shown to respond at very low doses and seems to plateau at lower doses. Using the higher doses found in Suboxone have not proven to be more effective than very low doses. So, if your husband does not have addiction issues there should be no reason why your doctor would be recommending Suboxone. Furthermore, Methadone is a stronger pain reliever than Buprenorphine, so it would not make sense to switch. Finally, he is on such a high dose that it makes even less sense.

Anecdotally, I have chronic pain, became addicted to painkillers, and have found Suboxone to be an excellent pain reliever, and I know some people do get pain relief from Suboxone, but it's certainly not the strongest pain medication out there. I would definitely look into the situation more and get a second opinion. Good Luck!

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 Post subject: Re: Suboxone for pain?
PostPosted: Fri May 26, 2017 6:09 am 
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Thank you so much for your response, I really appreciate. I remember a time that my husband was on the Fentanyl patch with his first pain doctor. The doctor got sick so there was no one to help or replace. At the same time the ins decided to stop paying for fentanyl and we would have needed $1,000. By the grace of God I found a doctor within 2 weeks though my hubby was in very bad shape by then, I had to do all the talking. I asked for something we could afford if ins refused to pay again.
While still expensive ($170) methadone is, not as much as the patch.
I have no idea the cost of suboxone, this doctor says there is a generic. We have told the doctor repeatedly we don't want hubby on anything we couldn't afford if the ins decided to stop.

He sees a doctor who works with a prescribes pain medication is an addiction doctor. Perhaps he has become like a hammer and sees everyone as a nail. He "says" he has gotten everyone else on Suboxone. He feels there is no reason hubby can't switch once he weans him down from the I think 140
This last visit he began to encourage him to go in to the hospital for some kind of fast weaning and suboxone induction.

I don't think a a fast induction is a good idea. Has anyone else heard of this?
I have heard/read that methadone gets absorbed in to the fat cells and bones and is not a good medication for a "quick detox"

UPDATE: 5/26/17 I just remembered something. While talking to another pain patient he said that the new govt regulations or the Surgeon General letter to doctors stated that they wanted pain doctors to limit their prescriptions to no more than 100 MG per day. I wonder if this affected my husbands doctor.
I am now searching for pain management doctors in our area.

Again I appreciate any responses as I am lost here. I hope I posted this in the correct place


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 Post subject: Re: Suboxone for pain?
PostPosted: Fri May 26, 2017 10:31 am 
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No no no to fast induction. Methadone is an entirely different and harder drug to reduce on. must be done slowly or is pure misery. Also, need to get down to 30 -40 mgs to start bup. for some that takes months and months and months. down to 10mg is best and then need to be off methadone for days before starting bup. Use the search function on top. Type in methadone in keyword field and suboxdoc in author field. read each link. retry with same in keyword and leave author blank. So wish there is a specific write up here to point you to but I don't think there is one. This doctor has NO idea of the beast Methadone is to taper and then switch to bup. It gets into the proteins - muscles and even when someone has tapered low and slow, will still have some left slowly dissipating. the transition from methadone to bup is by far the hardest and some don't make it. Telling it to you straight. hard to hear but you need to know. Methadone is a good med but its a beast to stop and must be done carefully.

tragicom, nice post! and others are spot on w bup and pain. it was developed as a pain drug. and it does work for pain at micro doses when the person is opiate näive, meaning no prior exposure or only on opiates for short time/low doses at ~30mg morphine equivalent which is ~15 mg of methadone. Its safety profile and other benefits make it an attractive addiction drug. The higher doses in suboxone are for full mu receptor saturation and as a blocking effect of other opiates. Not sure why suboxone also works for pain in opiate tolerate folks but for some it sure does. Others get nothing from it.

You may be right on the 100mg letter. There's a big push to get chronic pain patients on lower doses or off opiates entirely. Why patient's are pushed to bup - is a question I can't answer. There are no medical indication/studies that recommend this that I can find. Some folks come here just dumped by their Dr's

I'm on the run but read and read here. best. P

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 Post subject: Re: Suboxone for pain?
PostPosted: Fri May 26, 2017 1:30 pm 
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Pelican, thank you so much for your information. I had a bad feeling when I first heard the doctor say that hubby could not remain patient on the dose he was on, that he would have to lower. Perhaps he thought hubs would quit him. But...we know how hard it is to get a doctor and how easy it is to dump a patient. He has been 100% compliant so there is no problem there.

I feel that doctors are being made to feel they are under a microscope and feel they can't help their patients. I am gleaning this from other sites where people are just being cut off with little to no explanation. Everyone is being made to feel it is their fault, that they did something wrong. 've heard of doctors once so kind and caring, now cold unfeeling as they fear for their careers. I think we are all in a bad place.

I ruptured a disc in my back, my leg was paralyzed, my family doctor would do nothing but send mt to a specialist. Thank God the specialist gave me something but I had to wait two weeks.

I have a family member that has been on Tylenol 3's and then Vicodin for probably 10 years. She has a bleeding condition, heart problem and can't take much for pain after 2 car accidents, neither her fault. Just last year, after Surgeon General letter came out, she was completely cut off. It is heartbreaking. I am trying to find her help now. She has tried a few doctors who advertised for pain but they were PT's, ultrasound guided injections. To me it is inhumane.

Again, thank you and everyone for replying to me. I appreciate the clue on how to search. I've been searching since Monday with just Pain Management or Methadone to Suboxone. Since I am so new I didn't realize I could search under Author.

Bless you all
Dee


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 Post subject: Re: Suboxone for pain?
PostPosted: Wed Jul 05, 2017 4:17 pm 
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Today my husband is down to 120 mg. His doctor said that he is going to place him on suboxone in two months. This is crazy to me. The doctor (Maryland) said there was a change in the laws effective July 1st. I am looking all over for help, did find some articles about the suggested rules from the CDC becoming mandatory as different states apply the recommendations. I see that Maine is drawing a very hard line. In the comments sections of many of these articles people are saying their doctors are reducing their pain medication by 50 or 65%. Some have been cut off completely and don't know what they have done.
We were told hubby would need to get down to 30 mg before switching over. Today the doctor said it is taking too long and he is switching him.
I fear for his life right now.
Thank you all for commenting. I am very lost right now, not sure what to do. Perhaps a methadone clinic would work to wean him down? I don't know.


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 Post subject: Re: Suboxone for pain?
PostPosted: Thu Jul 13, 2017 1:09 am 
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Dee, two months doesn't seem like enough time to go from 120mg of methadone down to 30mg, which really is the optimal dose to switch from. His doctor seems to be a butthead. (And yes, that's a technical term!) Switching from a high dose of methadone to even the highest dose of buprenorphine is going to cause your husband a lot of discomfort. Because buprenorphine has a ceiling limit on its effects, it will not initially work as well as the higher dose of methadone.

The likelihood that your husband will die from the switch, even if it's too abrupt, is very low. What will happen is that your husband will have uncomfortable withdrawal symptoms for a few weeks until his body adjusts to the lower dose. The first thing your husband should understand is that he should wait several days to a week after stopping the methadone before he starts the buprenorphone. It's quite likely that his doctor will tell your husband to wait 24 hours before he inducts on the buprenorphine, but that would be inadvisable.

Your husband's doctor should prescribe comfort meds for your husband for the time of transition. Including:
1. Clonidine
2. Possibly a benzo (but he needs to be careful not to depend on them for more than a few days!!)
3. Gabapentin can help
4. An anti nausea medication.
5. A sleep aid.

Additionally your husband should have immodium on hand.

I hope your husband's doctor changes his mind about the super fast taper, but if he doesn't patience will be required!!

I wish you guys well on your journey!

Amy

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 Post subject: Re: Suboxone for pain?
PostPosted: Thu Jul 13, 2017 9:56 am 
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Dear Amy, thank you so much! I am very worried. I don't think this is right. Everything I have read says you must be on 30 mg and stable before switching.

I appreciate you taking the time to write to me. Your assistance is invaluable.

So much has happened. I am having trouble understanding how the doctor can do this to a pain patient of 12 years. I tried to remind him of all the problems my husband has. I was told by his receptionist, everyone is being cut off, no one cares. I am horrified by what is happening.
He is on the methadone because that was the cheapest drug the doctor could find.
We had gone through an episode where the insurance refused to pay for Fentanyl and it would have been $1,000 so I asked the doctor to please prescribe something we could possibly afford if ins wouldn't pay, or if there was a mistake some where down the line.

I am continuing to try to see if there is any help out there but I am seeing many many pain patients who are also being cut off. It seems to be a witch hunt. (Sorry if I am repeating myself, I do that when stressed)
Thanks again


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 Post subject: Re: Suboxone for pain?
PostPosted: Thu Jul 13, 2017 11:33 am 
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You're very welcome, Dee, and I wish I could help more.

You are correct that this is an intolerable situation. I wonder if you might consider writing to your congressional representatives about this situation. That's exactly what I would do. It might make a difference if enough folks in your situation push back.

Here is a link to find out the contact information for your members of congress:

http://whoismyrepresentative.com/

I really think that you should consider finding a methadone clinic who can help your husband taper lower. Maybe with his track record and a letter from his doctor they might consider giving him "take homes" much earlier than with an addict. It's worth looking into.

Amy

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 Post subject: Re: Suboxone for pain?
PostPosted: Thu Jul 13, 2017 12:41 pm 
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Dee

Just thinking, had you been able to private pay / self pay for fentanyl, and hubby stayed on fentanyl, at that clinic, it too would have been cut way down and him switched to bup. Fentanyl is also long acting, not as long as methadone and not as tough a switch but tough and long and he'd still have problems with a rapid drop. I know this from experience.

This is for a later time period in the future. Just hoping hubby has less pain than you/he think bc some of us did have far less than we thought. I was a pain clinic patient from accidents/multiple surgeries and was shocked at how little pain I had after stopping my doc. My bup Dr said she too heard patients were surprised when off full agonists, much less pain. Some controlled. some not controlled on bup.

Not sure what your resources are. It might be that a well timed hospital stay could be really helpful. Timing is crucial - to catch when to best switch from Methadone to bup so the max comfort meds and support are available at the most needed time. I'm aware of one hospital setting where over 7 days they used meds including higher dose valium (a benzo) for days to extend time before bup induction. Very helpful. Then tapered valium down w a 15 day script after discharge. we don't usually suggest benzo for outpatients bc folks can ramp up to long term use which can be nasty to get off of. I know this from experience too.

I'm on a fast run thru here. these are incomplete thoughts but its what I have for now. Pel

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 Post subject: Re: Suboxone for pain?
PostPosted: Thu Jul 13, 2017 7:38 pm 
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Hi Dee,
I don't have any good advice for you, just wanted to wish you luck and give support.
Your husband may find that Suboxone provides enough pain relief for him, he won't know until he tries. I do get significant pain relief from it, but some people do not.

The transition from Methadone is obviously the hard part and that Doctor should not be rushing him off the Methadone. He needs to look at your husband's individual symptoms and progress rather than just setting arbitrary timelines.

I think that it is a shame that the opioid crisis in the country is effecting chronic pain patients that were stable on their medications and not misusing them. I feel like at least in this country, we just go from one extreme to the other and make laws based on sweeping generalizations.

All that said, I guess you have to problem solve now. Amy and Pelican are good at problem solving and gave you good info. Hopefully some others will be able to help you too. I just wanted to stop by and say I empathize with you. Best of luck!

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 Post subject: Re: Suboxone for pain?
PostPosted: Fri Jul 14, 2017 8:38 am 
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Thank you so very much for your message. I have felt very alone trying to help my husband. It appears that every death from Heroin/Fentanyl is lumped in with prescription abuse. My husband has so many things wrong with him I have to write it down to keep track of it all.
He is doing his best however his knees have begun to give out. They both need to be replaced however no one will do it until he loses weight, it is a vicious circle, pain in knees, weight gain, more pain..
I can see why people in pain are being drawn to do things they never thought they would.
It's very sad to me that the pain patients have become the scapegoats for all that is wrong with the opioid crises.

Thank you again.


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 Post subject: Re: Suboxone for pain?
PostPosted: Fri Jul 14, 2017 10:37 am 
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My mother, bless her heart, was diagnosed with RA a bit ago. We always knew she had arthritis but never dreamed it was that bad. But she's had so much pain gradually getting worse and worse. My mom is around 66. She doesn't take anything for pain and she desperately needs it but she refuses because she always said that during childbirth pain medication made her very sick and she's afraid to ever take it again, she's really old school in her thinking. Anyway I've watched her grow worse and worse to the point of not being able to walk down the stairs at times, not be able to get up whenever she's bent down putting things in the fridge and she isn't able to even drive at times now because of her pain. Her fingers are starting to look pretty crooked too, I can tell she's in pain pretty bad.

I've been begging her to ask her doctor for pain medication, even if it's just 5mg hydro or tramadol. She won't and one of the main reasons, besides fearing it'll make her sick or 'feel funny' is because all of the stipulations ppl on pain medication have to go through. She'd have to go to the doctor a lot more often, getting drug tested probably too, there's just extra things she's just not willing to do in order to ask for pain meds. So I do understand how that could be unfair to ppl who truly need help with pain. I also understand why they do that but not everyone is abusing pain medication and some ppl truly need it to live a quality life and ppl like my mom would rather just live with her pain than go through the hassle. I wouldn't be like her obviously lol but she's very set in her ways.

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 Post subject: Re: Suboxone for pain?
PostPosted: Thu Jul 20, 2017 5:48 am 
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Thank you all for replying.

I wanted to ad, the fentanyl my husband was on was back in 2008.

I was explaining that he is in awful pain but I asked the doctor to place him on a pain medication that we could afford to pay for in the event insurance failed us.
The doctor, back in 2008 placed him on methadone as it is good for pain and long acting.

My main concern is the doctor telling him that he would induct him from the 120mg in 60 days. I knew that could not be right and I appreciate everyone' comments/support.

This may be a problem I can't fix.

He may have to go to a methadone clinic. I'm very worried about him. I am feeling pretty alone however all of you have helped me immensely.

In the meantime my husband is reducing his dose. I hate to see him in pain. He really needs his knees replaced and his back fused, but surgery is not an option.

I can't remember if I mentioned this. I called the doctors office to see if there was a non narcotic medication to help with pain, like neurontin or lidoderm patches. His receptionist told me there was nothing and no one cared if he was in pain. They are blaming the DEA guidelines.

Thank you again, D


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 Post subject: Re: Suboxone for pain?
PostPosted: Thu Jul 20, 2017 6:38 am 
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Hey Dee19 - Thank you for getting back to us. You may not realize it but there are more people that have read your story and care about how your husband is doing. We've all known suffering to some degree, but your husband has really been through what seems like an unfair amount of physical and mental torment. All of this worrying about what's going to happen and what will insurance cover... it's a lot to take in. I hope you're doing what you can to take care of yourself too.

Your husband is one of the people that really need some strong medicine. I feel like he's being punished in part because of the opiate crisis in this country, and that is not fair at all to either one of you. I'm really sorry you're having to carry so much weight on your shoulders. It's just heartbreaking to read from my perspective. Regardless of how tough it is or how hopeless you might feel sometimes, please know you have friends here that honestly care about what happens. And thank you for taking the time to keep us posted. We're all hoping for the very best!!

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