Change of medication for chronic pain

[mindlink]

I have been diagnosed with rheumatoid arthritis (RA) and fibromyalgia (FM) for more than ten years, therefore experience chronic pain which has increased throughout the years.  About four years ago, I reluctantly filled a prescription for 10mg of Oxy three times a day, because I couldn't manage the pain with Tylenol#3s any more.  A year ago, the pain had increased to the point where I was prescribed three 20mg tablets per day.  I was so afraid of becoming addicted that I forced myself to reduce my own dosage to only 2 tablets per day, taking three Tylenol#3s at the same time to combat the breakthrough pain in between Oxy dosages.  The Oxy definitely helped me feel human again.  I have no complaints about its effectiveness. I do not experience euphoria either ... I'm just more myself.  

I also take Methotrexate injected once a week.  I'm 60 years old.

I am told by many other RA and FM sufferers that you can't be considered addicted to a narcotic analgesic unless you use it for psychological reasons rather than just enough to help with pain management.  In my experience, that's pure poppycock!  I had to stop taking the Oxy last year for a period of one week prior to surgery.  On the second day after stopping the Oxy, I was screaming in pain!   It was pain that I had never felt before; pain that was completely unlike any that I had experienced from my RA or FM symptoms. It was at that point that I realized I was physically addicted to the stuff.

Three months ago, I moved to Mexico to retire.  Befoe I left Canada, I was given a 3-month prescription for 20mg  of Oxy to be taken 3 times a day.  Remember, I mentioned that I have never taken more than 2 tablets a day, right?  So now it's four months later and I still have about 20 Oxy''s left.

My Mexican doctor says that physicians are no longer allowed to prescribe Oxy in this country.  Therefore, when I went to see him to renew my prescriptions today, he told me he would have to change my pain medication from Oxy to Temgesic (buprenorphine), which is the same as Subtex.

I am terrified that I will suffer the same withdrawal symptoms as I experienced before my surgery in Canada.  

How should I manage this change?  Can I substitute the Temgesic for one of my Oxy doses each day, thereby using half the Oxy I usually would?  Or would you taper off the Oxy altogether, first, before taking the first dose of Temgesic?  I'm asking you this because I have trouble explaining my questrion in Spanish, and haven\t got any acquaintences who have attempted to do this.

Sorry this was so long.  Any suggestions you may have would be most appreciated. I'm really desparate because of the language barrier down here.  Thanks so much!

[ohanamama]

How absolutely awful for you!  And how confusing, the interchangability of the term "addiction".  Of course, those of us who take the medication legitamately (sp?) understand that our kind of addiction is OK, because it's not abusive, we don't take more than we need, we don't get hight off of it, etc., etc.  But if we need to go off of it, we're not spared the horrible, painful, debilitating effects of withdrawl just because we took it for respectable reasons.  When I moved to Hawaii, I had a terrible time finding a doctor to write my Rx for Oxy at first.  Now I have no problem, but for a while, I had to go to emergency rooms to get my meds.  Don't go cold turkey, it's too painful -- I've been there.  Can't you find someone who can write morphine, patches, oxycodone (short acting), vicodin or something like that to help you titrate down and withdrawl from the Oxy?  Is there a drug rehab place -- how awful at 80 to have to go to drug rehab for a perfectly legitimate condition.  I'm just grasping at straws here because I don't want to see you in pain, or left to deal with this all alone!

[ohanamama]

Oh, dear, I said 80, but you're 60.  Will you ever forgive me!!!!!!!!   medicat  I'd think you could take both at the same time (cut down on Oxy, add Temgesic in.)  Just don't titrate the Oxy out of your system completely - that's just way too uncomforitable - before you start adding something in.  Good Luck!

[nick30]

NO, YOU CANT TAKE BOTH AT ONCE

[sandee1818]

If you take these two drugs at once your going to be very ill. To even start on the suboxone you need to have ALL of the Oxycontin OUT of your system.
I would advise seeing or even calling your doctor as he KNOWS this and can help you, Do not quit the Oxycontin cold turkey, it is dangerous to do this, while your only taking 2 a day that is way it is meant to be taken every 12 hours. Some have to take three a day buy it is suppossed to last 12 hours.
Your doctor needs to go over all this with you, did he just hand you the suboxone and give you NO instructions?
When taking this medication you CAN NOT take any kind of narcotic! So if it does not help your pain you can't take other narcotic medications.
I would suggest going back to the doctor and discuss your options as far as this medication and your pain control. While some say it does control their pain it is not meant for pain control.

[sandee1818]

When a Pt is taking a medication daily and have been for any length of time it is NOT advisable to stop taking that medication abruptly. That's very reckless and dangerous.
Your body becomes accustomed to that medication and when the body no longer gets it a lot of things can happen to endanger your health. Never stop taking your medications without first speaking to your doctor at length about it.

[Mollyrae]

I agree with Sandee. You need to get back in touch with your Physician so that he can go over your Meds with you. People have gone cold turkey in stopping that Oxy but it is not recommended. I am confident that your Doctor in the States will provide you with some type of relief. Is it possible that your Doctor in the States can talk with your Doctor in Mexico?? This might solve any question that the new Doctor might have.

I really feel bad for you. Please take care and I hope that you can solve your issues.
All my best,
Mollyrae

[Tuckamore]

Hello Mindlink,

I am so sorry that this has happened to you. You should not go cold turkey. This can be dangerous. Sandee is correct in her suggestions.

Subutex (buprenorphine hydrochloride) and Suboxone tablets (buprenorphine hydrochloride and naloxone hydrochloride) is approved for the treatment of opiate dependence. Subutex and Suboxone treat opiate addiction by preventing symptoms of withdrawal from heroin and other opiates.

I have not heard of this drug being prescribed for pain however I am not a physician or a pharmacist. According to my research this drug is used only in patients that are addicted to opiates.

Please see another physician. I don't know where you are in Mexico but is it possible for you to go to the States for treatment to return to Canada? If this is not possible there are physicians in Mexico that speak good English. I encourage you to find one.

My Uncle retired in a border-town in TX. He and his wife have seen a physician in Mexico that speak good English.

Please let us know how you are doing and good luck.
Tuck

[Mollyrae]

Just a note:

Suboxone has been used in the treatment for pain but just recently. There are conflicting reports as to the effectivness of Suboxone when treating for pain. Some Physicians think that the drug is a good alternative for Mild pain management while others do NOT recommend it at all. If you google Suboxone you will get conflicting reports.

Like I and others have said, go back to your original Physician. It is in your best interest at this point.

[mindlink]

Thanks so much to both of you.  While you both gave me caring and knowledgeable advice, you opposed each other, so I'm a bit confused now ;-)  The reason I can't discuss this with my doctor is that he speaks very little English, and I speak very little Spanish.  The technical terms confuse us both.  Hmmmm.  Maybe when others reply, I can sort it all out.  Thanks again!

[sandee1818]

The subutex is a drug that some PM doctors are using for pain management but I assume your doctor gave it to you to get off the Oxycontin.
Do not take the drugs together, if your going to take the subutex then you need to be off the oxycontin completely. When those who use subtext the doctor usually recommends the pt be off all narcotics for 72 hours. There is an excellent ask our pharmacist here at Med Help also that can answer any questions about this.
I would try and find an English speaking doctor or even hire a translator there to go with you. Call one of the visitors groups there and they can give you information on hiring a translator.

[sandee1818]

Does that answer your questions?If not please list your questions so that I can answer them properly. I believe your original question was can you alternate or take the oxycontin and subutex together and the answer is no. No you have to be off the oxycontin completely before taking the other medication. As I said most doctors want their Pt's off all narcotics for 72 hours before even taking the medication Temgesic ( subutex).
The Temgesic will block all effects of the oxycontin and will make you feel very ill.
Also as I said we have " Ask the Pharmacist" here at Med Help if you feel you need more information too.
Please let me know if this answers any questions you have.

[mindlink]

thanks sandee.   In my earlier post I indicated that I have to get off the Oxy because I am running out of the tabs that I brought from Canada and it is not available to me here.  The doctor said he was prescribing the Temgesic as a *replacement* for the Oxy, because he couldn't prescribe Oxy under the new law.  Hope that clears up my motives.

[mindlink]

Also, I will try to find someone who can translate, but I'm in a very remote part of the country, so that may be very difficult indeed.  Thanks for the suggestion.

[HACIMROXY]

Any chance in going back to the Canadian dr for help?

[mindlink]

Nope, I gave up my CDN medical insurance for Mexican insurance.  I live here full time.

[Mollyrae]

I am sorry for the confusion in my earlier post. I was just stating that Tuckamore had never heard of it being prescribed for pain but it has and just recently in the States.

The Suboxone will make the transition easier for you to stop taking the Oxy and quite frankly, that is how it should be done. Never cold turkey.

I hope that you can find a Physician in Mexico who can prescribe that medication that you need and one who understands English. Please take care and good luck with everything.
Molly

[mindlink]

thanks Mollyrae.  Scares me, though, that you have to suffer withdrawal from Suboxone (temgesic) too, once you decide to find another non-narcotic pain reliever.  It's just a vicious circle!

[Tuckamore]

I too am sorry that I confused you too. I am glad that Sandee came to your rescue.

My major suggestion was to find another physician. I understand that you are in a remote area of Mexico but can you not travel to a larger city to locate a physician that can speak English? I would be very concerned in all areas of my health care if my physician and I could not communicate. The language barrier could be even more serious down the road.

According to a good source (two actually), Oxycontin is available in other areas of Mexico. Whatever you decide to do I wish you well. Please be cautious. And again I am very sorry I confused you.  

Best of luck and take care, Tuck

[sandee1818]

Tuck gave you some excellent advice. Although you may be able to purchase the medication you need in Mexico w/o a prescription I strongly advise you not to do this as it could be packaged/marketed as a specific medication that doe not mean it is that particular drug. It could also be stronger than the dose it is labeled as. It is just extremely too dangerous to go this route.
If you contact the visitors information center they can and will set you up with a translator. This is the best thing for you to do as Tuck said it creates a huge problem for you when you can't communicate properly with your doctor and dangerous/

[ChronicPain1]

I'm sure someone said it, but your fears of addiction aren't 100% correct. There's a fine line, and difference between addiction and dependence. Some classify them as the same, but I do not. Dependence will happen to anyone taking these meds for any period of time, it's normal. When you're taking Oxy's it blocks the pain, and reduces your body's natural pain fighters which may explain why your pain was worse after.

I used to feel the same, worried about addiction. However, I know I'm not now. I smoke cigarettes, and I AM addicted to that. I've stopped using pain meds for days and weeks and have dependence side effects, but I don't become angry, shaky and hostile like I do with nicotine.

I'm sorry to hear about your pain but know you're among people with similar problems!

[NautyOne]

I am very familiar with Mexico, and that is a bold faced lie this doctor is telling you.  Oxy is not banned in Mexico.  I just don't understand if you live there full-time you don't have an english speaking Dr.  Most hospitals and clinic's do have English speaking or bi-lingual staff, unless you are in a really remote area.  You need find another doctor....quick.

Temgesic will take away the withdrawal, but not certain about the pain.  

I wish you the best.

luv,
Nauty

[jtssteph]

I was given suboxone for pain management. It has done NOTHING for the pain. And nothing for me except put me out about $1000.00. It make me nauseated, tired, and cranky.

I'd truly try to find another doctor down there that will prescribe you the mediationyou need. Good luck

[mindlink]

Muchas gracis, Amigos!  I'm visiting an English-speaking doctor today.  (Yaaaay! It took me a while, but I found one!)  My Spanish is okay for regular, everyday communication, but not for something as serious as this.  I just hope the guy takes ME seriously, and doesn't think I'm just another addict.  Wish me luck.

[nick30]

GOOD LUCK AMIGO

Nick