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subutex to treat chronic pain
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subutex to treat chronic pain

I have an incurable, but not fatal, rare bone disease [polyostotic fibrous dysplasia] that causes constant severe bone & muscle pain, plus spinal myoclonus, & progressive degenerative C 5,6 disc Dz, migraines, daily HA's.  I've been maintained on oxycontin for several years & have never abused my meds.  My Dr retired and my new Dr wants to switch me to subutex.  My concern is what happens if I fracture a bone or need an angioplasty or some other emergency type of surgery as I will most likely be on subutex for the rest of my life?  My understanding is subutex blocks the analgesic effects of analgesics & anesthesia.
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82861_tn?1333457511
You're thinking of the problems with using Suboxone rather than Subutex for pain management.  The active ingredient in both of them is buprenorphine, a partial agonist synthetic opiate.  Suboxone also contains naloxone which is there as a deterrent to abuse like crushing and injecting the pill.  Without the naloxone present, you have no worries about your doctors needing to increase narcotics in an emergency or post-op situation.
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547368_tn?1332173665
Hi Ziggy,

Welcome to our Pain Management Community. I am glad that you found us and took the time to post.

Your assumption about Subutex is correct. Subutex  does block opiates. . It's because of the partial agonist quality. It attaches tightly to the pain receptors blocking other opiates from getting through. This will mean that an emergency situation could be vary painful for you.... at least that's my understanding.

I am hopeful that others will have more information for you. I KNOW you are not an addict but you may find information on the Substance Abuse Forum.

Personally I agree with you. I would not want to take Subutex for Pain Management...... although it is used more and more in that manner.

I wish you the best and hope you will share with us what you discovered.

Take Care,
~Tuck
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547368_tn?1332173665
I was writing and got interrupted while Jaybay posted.  I assume she knows more about this medication as I know little.

However I can't find information that says Subutex doesn't block opiates. I am still searching.

~Tuck
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82861_tn?1333457511
Tuck - the way buprenorphine works is that it latches on very strongly to some, but not all, opiate receptors in the brain but not with a perfect fit like other opiates.  I know of only one other opiate that will knock bupe right off its pins (I'm sure there are others) and take its place and that's fentanyl.  That gives it both partial agonist and partial antagonist qualities.  In case of any kind of emergency requiring in-patient pain management or anesthesia, there would be no problem.  ziggy - since you're concerned about this issue, make sure you talk to your doctor or even your pharmacist about it.

Because of its very long, 36-hour half-life, buprenorphine is often used to stabilize addicts as they work a recovery program.  Most addiction doctors prefer to prescribe Suboxone for that purpose due to the additional naloxone component to prevent injection abuse.  

Buprenorphine is also now available in patch form under the brand name Butrans.  Bupe alone is no better or worse than any other type of opiate for pain management other than it's a real bear to detox from.  Seems that meds with the longer half-lives are the ones that have the worst withdrawal effects.  You just have to taper super slow and be willing to feel sick and sleepless for a while knowing it's temporary.
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547368_tn?1332173665
Thanks Jaybay! I did know about the actions and uses of buprenorphine and  .... and the fact that Suboxone has the additional naloxone component to prevent injection abuse.  

I didn't know that Fentanyl could "knock bupe right off its pins."    You're right, there must be more  but I can't even find at you are saying about  Fentanyl on line.

I found this about buprenorphine: "These properties make buprenorphine an effective maintenance treatment for opioid-dependent patients. These same properties, however, can interfere with the management of acute pain in patients on maintenance buprenorphine therapy. We present a case of a young multisystem trauma patient in whom adequate analgesia could not be achieved due to buprenorphine treatment before and through the early course of admission. Discontinuation of buprenorphine allowed for appropriate pain management and successful analgesia. Further education of acute care clinicians about buprenorphine pharmacology and careful selection of patients for buprenorphine maintenance therapy are needed to avoid delays of pain control in trauma patients."

I am still looking! :o)

~Tuck

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