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Will Suboxone help bad Chronic Pain
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Will Suboxone help bad Chronic Pain

I am in a wheelchair and live in real bad pain daily it controls my life I been on pain meds since my carwreck at age 21 i am 47 now to begin was on low pain meds cause pain was not real bad a first it just started getting bad like 12 years ago . I been on 80mg oxyontin 2 x a day for 10 years it helps but still have pain.My question is about the Suboxone would it help my pain the doctor say i will keep getting worser with pain .I heard u could only take Suboxone like 9 months then it does not help pain .Is it something that you can stay on and does it help like other pain meds.I know since i been on pain meds for so long i have got hooked but i don't see a choose i have to take meds . Can someone please tell me about Suboxone.?
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There is a difference between being "hooked" on the meds because you're in pain and can't live otherwise and being "hooked on the feeling" of euphoria that some people get from pain meds.  You've been on pain meds for years, so I doubt you even feel anything but pain relief when you take them.  That's the way it is for most of us.  We are opiate tolerant and dependent.  Our bodies are physically dependent on the meds to function.  Big difference between that and addiction.
That being said, as far as I know, Suboxone is primarily used as a medication to help people get off of opiates, similarly to methadone, although methadone is an older and more widely used pain medication as well as used for withdrawls and substance abuse.
So I would recommend asking the Substance Abuse Forum Community about Suboxone.  Not because you have a problem with medication at all, just because they generally know more about the med itself.
I hope you get the pain relief you need soon!
The FDA only approved Suboxone for short-term use to help people detox from their drug of choice - 21 days.  It is composed of an opiate (brand name Subutex) and a partial opiate antagonist.  In layperson speak, the Subutex fills the opiate receptors in your brain, but the antagonist ingredient "repels" more opiates from jumping on the bandwagon.  

The negative consequences of taking more opiates on top of the Suboxone is that patients will actually experience precipitated withdrawal.  It's used for detox to keep patients from going into withdrawal and also to prevent those patients from "spiking" their dose in order feel the euphoric "high."  With suboxone on board and lack of withdrawal symptoms, the idea is that the patient can turn his attention to making the necessary life and behavior changes to avoid relapse when the suboxone is gone.  

I'm personally not convinced that suboxone is a good choice for chronic pain patients.  If you have a medical emergency and require surgery, you have to wait until enough of the suboxone is out of your system to avoid withdrawal.  Suboxone/ subutex has an extremely long half-life which makes it even more difficult to detox from than the patient's original drug of choice.  The longer you take it, the longer your taper and detox will be.  Subutex is an opiate and therefore it is a valid option for pain management, although I'm not aware it is commonly used for that purpose.  When suboxone came onto the market, some pain docs jumped on it thinking it would prevent addictive behavior from cropping up in their patients.  With no long-term study data available, I am for one am not willing to take it and be a guinea pig.

Suboxone is not a magic pill that will even prevent addiction or cure it.  It's a harm reduction tool to keep patients from going into severe withdrawal as well as keeping them off street drugs.  Addiction is a psychological problem wherein a person cannot control how much they take in spite of negative consequences.  Physical dependence is a normal part of opiate therapy.  A compliant patient who takes the meds exactly as prescribed is not an addict even though that same patient will experience withdrawal if the medication is suddenly discontinued.  If you are compliant with prescribing instructions, you are not "hooked" and you are not an addict.
Hi Angeldotcom,

Welcome to the Pain Management Forum. I am glad that you found us and took the time to post....but very sorry to hear about your long term chronic pain.

I too was in a very bad MVA and has suffered with extreme disabling chronic pain for years. I am not yet wheelchair bound. And luckily I am not on neatly the high doses of narcotics that you are on.

You've already obtained some good information. As Jadedsweetheart said there is a huge differance between dependancy and addiction. So you're "hooked" just means physically dependant. NOT an addict, unless you abuse your opiates and do not take them as prescribed with I doubt is the case.

Suboxone is normally used for ppl that are addicted to opiates. It can be used to  "start again"  at lower dose opiates in pain management. If I understand it correctly it's a short term fix but it may certainly be worth a try..

Suboxone is not used long term. It was never meant to be used for pain management. So it's not a drug that you could remain on for any substantial periods of time. I would imagine if your physician chose that route he would begin at lower dose opiates once you were through the process.

I am doubtful your physican would consider keeping you on Suboxone long term. I too don't think that it would be a good choice but I am far from a an expert or a physician. Do exactly what you are doing, gather information, research as much as you can so you may make an informed decision. Of course your physician will have the best answers for you you.

Though you are far from a substance abuser, the Substance Abuse Forum may have better information on Suboxone. You may chat with members that have actually taken the medication. So you may also want to post there too. Just click on the word Forums at the top, right hand side of this page. It will take you to an alphabetical listing of our different forums and communities.

If you have additional questions please feel free to ask. I am hopeful that you will become an active member in our community. We are here to offer you support and suggestions. Though we are far from "experts" there is a wealth of knowledge among our very compassionate members. I will look forward to hearing from you soon. Best of luck in your search.

Take Care,
Here is an excellent article I found on the use of Suboxone in pain management.
There was a study done on the effectiveness of the medication in PM Pt's.
I thought the statement ...
The pain takes on a psychological component over time;  it almost seems as if the mind is generating more pain so that the patient will take more opiates.  It becomes very difficult to treat the pain, as pain, addiction, tolerance, depression, and anxiety all become wrapped up together."

Was well said and true. With opiates you can keep taking more and the body will keep needing more for the same level of pain relief where the suboxone has a ceiling effect meaning it will work the same no matter if you up the dose or not.
Interesting article.

TRANSDERMAL BUPRENORPHINE EFFECTIVE FOR SEVERE CANCER PAIN Date updated: September 30, 2008 Content provided by Reuters NEW YORK (Reuters Health) – Transdermal buprenorphine appears to be effective and safe in a study of patients with severe cancer-related pain, European investigators report in the Journal of Pain and Symptom Management.

Dr. Philippe Poulain of Institut Gustave-Roussy in Villejuif, France, and colleagues compared transdermal buprenorphine 70 micrograms/hour with placebo in 289 opioid-tolerant patients with cancer pain requiring strong opioids in the dose range of 90-150 mg/day oral morphine equivalents.

The patients were enrolled in a 2-week run-in phase, during which time they converted to transdermal buprenorphine or a placebo patch. Rescue analgesia with buprenorphine sublingual tablets 0.2 mg was allowed as needed.

The researchers defined response as a mean pain intensity reduction of 5 points on a 10-point scale and a mean daily need for two or fewer buprenorphine sublingual tablets.

One hundred patients dropped out of the study during the run-in phase due to a lack of efficacy or because of adverse events, while 189 patients continued on to maintenance treatment. Thirty-one more patients dropped out at that time, most of whom were on placebo.

A response was seen in 74.5% of patients on transdermal buprenorphine and in 50% of patients on placebo.

“This result was supported by a lower daily pain intensity, lower intake of buprenorphine sublingual tablets and fewer dropouts in the transdermal buprenorphine group,” Dr. Poulain and colleagues write in the August issue of the Journal. “The incidence of adverse events was slightly higher for transdermal buprenorphine.”

Dr. Poulain’s group concludes that “transdermal buprenorphine 70 micrograms/hour is an efficacious and safe treatment for patients with severe cancer pain.” J Pain Symptom Manage 2008;36:117-125.

Opiate agonists have an advantage over partial agonists like buprenorphine in that the higher their dose, the higher their opiate effect.  Buprenorphine on the other hand has the ceiling effect– beyond a certain point increases in dose don’t cause greater analgesia.

The pain takes on a psychological component over time;  it almost seems as if the mind is generating more pain so that the patient will take more opiates.  It becomes very difficult to treat the pain, as pain, tolerance, depression, and anxiety all become wrapped up together.

Buprenorphine offers some advantages in that it causes less craving for the drug.  The tolerance for buprenorphine also differs in that it is ‘fixed’ at a certain level;  this probably is related to the lack of cravings for the drug.
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