Hi all! Difficult to know where to go and how to deal

[My_Life]

I am going to try and condense this best I can.

**I am in England so my meds may be different than other places (not sure)

I was on Fentanyl patches 37 mcg and 3 oxynorm 5mg per day for 5 years. I found that the tablets were becoming a problem in that I would save them for times where I felt insecure or needed a bit of courage.
I had weight loss surgery and have lost 230 lbs. I am in therapy as well for body issues and feelings of self loathing. Issues which need to continue to be addressed.


I weighed nearly 400 lbs and did not get that way for “no reason”. I feel I am very aware of what my addictive behavior is creating.

I have arthritis and joint issues due to the excess weight I carried. Because I had surgery on my gastric system-I do not absorb things as well and cannot consume anti-inflammatory. I do deal with chronic pain indeed.

I got hurt recently-last month I fell down an entire flight of stairs on my bottom. I hurt my shoulder and my tailbone. I went to the doctor and she said “But you are already on A LOT of medicine!”. To this I said true! I imagine you can’t just keep adding pain meds to my body!

At that moment a real fear washed over me. What if I get REALLY hurt or my joint issues progress. How will they be able to treat my pain if I am already on such heavy duty meds. I felt it was time to start coming off of these for a reassessment.

I asked her to stop prescribing the tablets first. She upped my patches to 50 from 37 mcg-because of my severe fall (pain). I agreed-apprehensively to up the patches.

Well-it only took two days to realize that was a MISTAKE. I felt HORRIBLE. Too drugged and at other times withdrawal symptoms! Weird! I also started to have crying jags and just feel OUT of it.
I researched and found out about Suboxone/Subutex (Buprenorphine).  I decided I could do the subutex (the nalaxone sp? Can cause gastric bypass folks some bad symptoms).

I went into the GP with my plan. She did not seem keen to put me on subutex as she didn’t feel addiction was the worry. She put me on BuTrans patches 10mcg. I decided to TRY them-with the HOPE that maybe some of the good qualities about the med (reducing cravings) would happen. She wanted to go with the patches because they do have some pain control effects.

Firstly-it took two days for me to realize she did not titrate me right! I was on 37 mcg  of fent-and she had me on what was equivalent to 6! I was a sick girl all weekend. Finally-I asked her to put me on Transtec 52.5 mcg Buprenophine. I got a script for that and 20 oxynorm whilst this took effect.

Did I do the right thing?? My biggest concern is STILL the oxynorms…or lack thereof since they became an emotional crutch. Can these patches ease some of that by working on the receptors the way the suboxone/subutex does? I know this is a MUCH weaker dose-but could it help me??
Or-should I throw it all to the wind and insist on the subutex and ultimate ceasing of meds for reassessment? Reality tells me that may not be possible due to the joint issues.

I am sorry this was So long-but I REALLY want to do the right thing and I have never been so afraid in my life. I am scared, and disappointed and feeling really fragile about all this. How did I get here?!


Where do I belong? Addiction meetings? Pain clinics? Therapy? (I am in therapy now). I feel I am just another casualty of the “fix it with meds” movement.

I want to feel good about myself and I do not want to worry over tablets. I want to keep my mobility and my hope!

Thank you so very kindly if you made it this far!

[namnam46]

My Dear,

We would LOVE for you to "stay around"!!

You, My Dear, ARE a member here on our Forum and we are VERY Happy that you wil be here with us!!!

I'm so GLAD that we were able to help you gain some Peace of Mind!!!

WELCOME.........Sherry

[My_Life]

Hello all,

Thank you so very much for taking the time and care in your replies. They have each helped me tremendously and given me some much needed clarity.

I do think I have been overly critical of my situation. I tend to do that. I also do think that it was time for me to drop the break through meds in my specific case-given the way I was beginning to see the trend in how I was using them.

It's just one of those things that will give me peace of mind for now. And-if in the future..I find myself beyond relief-I will know what works for me and go accordingly.

Yes-my therapist does know about this as well. I think mostly it was me who was really feeling concerned. I take pain management very seriously and having chronic pain-I do not want to see anyone get caught up in using their meds incorrectly or getting into a situation where they could be let go by a practice (I have read some stories like that here).

I want to do what is best and responsible for me and my life-that is just how I am.

So-for now..I stay on the Transtec patches and no oxynorm (which to those of you who don't know is oxycodone). One day at a time-and an appointment on Tuesday with a wonderful osteopath!! YAY!

You made my weekend and I shall stay around if that is OK!

Cheers and have a lovely weekend!

[mellie4]

Hi.  Welcome to the Pain Management Community.  Everyone here is a chronic pain patient, and there are no physicians on this board, but it's a great community to share information and get support.

It sounds as though you certainly have a lot going on.  I'm not really sure what you're asking really.  Have you talked with your therapist about any of this?

I'm on the Fentanyl patch, too, mine is the 75 mcg. and I change it every 48 hours and I find it gives great pain control for SOME of my pain but not others.  I take oxycodone for BT pain.  I don't know what oxynorm is; I've never heard it before.  Do you take it for BT pain?

You mentioned saving it for when you're uncomfortable in certain situations.  That's not the proper use of your medication, and I know you're aware of it since you asked if you should be looking at an addiction board.  I don't know the answer that.  Only you do.

I don't know much about suboxone, but I do know it's very hard to get off.  You will probably find more information on the substance abuse board.

I'm hoping you'll get more responses as the day goes on.

[namnam46]

Hi My_Life,

I want to welcome you to the Pain Management Forum and let you know that we are glad that you found this Forum. I need for you to understand that there are NO Doctors on this Forum ONLY CP ( Chronic Pain) Patients that help each other through our OWN expertise and experiences with our own CP conditions.

First, I want to CONGRATULATE you on your FANTASTIC accomplishment in your weight loss!! What a WONDERFUL achievement. You should be VERY proud of yourself.

I'm VERY sorry that you are having this DIFFICULT time right now in trying to decide what you need to do about your meds.

I, too, amd on the patches. I am on 62 mcg's. I take Percocet 10/325 1/2 to 1 tablet every 8 hours 3 times a day for BT (Break Through) meds.

I understand how you would be concerned about your BT meds and saving them for when you were insecure or needed a bit of courage. I would be VERY concerned also if I started to do that.

Again, CONGRATULATIONS on seeing that there was a problem there. You are a VERY astute Lady!!

I DON'T have any knowledge of your other meds that you mentioned here other than having seen others post on here about them.

I'm, also, glad to see that you are in Therapy. No matter what is happening in your life, whenever you have CP (Chronic Pain) issues being able to have Therapy is ALWAYS a great advantage to us. Especially, after achieving the phenomenal weight loss that you have. I KNOW that it's VERY difficult to get your mind wrapped around the fact that you are NO longer that person in that OTHER body. I lectured for Weight Watchers for 8 years after I had lost 62 lbs. back in the 1970's and 1980's. I know what happens to you when you have achieved ANY weight loss but in your case it's a GREATER change than any of us can imagine. You are DEFINITELY on the righ track there!!

I WISH that I knew something about your Transtec 52.5 mcg Buprenophine BUT I don't. I'm sure that someone will be along in awhile that CAN help you as far as tht med goes.

I think that it would be beneficial for you to talk with your PM (Pain Management) Doctor OR the Doctor that prescribes you your Pain Meds and tell him of your concerns.If nothing else, talk to your Therapist about this and maybe he/she can give you something that will help your anxieties. I don't know if you already have something for that or not.

I think that you definitely need Pain Management and you need to remain in your Therapy. I don't know if you need Addiction meetings per se as I would think that those problems should be able to be covered in your Therapy sessions. I think that would be something that you and your Therapist would be able to decide.

I'm sorry that I can't be of anymore help than this BUT there will be others along that will have MUCH more knowledge than I have!!

I wish you the VERY best and I hope that you wil stay in touch with us and keep us updated as we are ALL very concerned about you and your pain........Sherry

[Jaybay]

Buprenorphine is the generic name for Subutex.  The Butrans patch is the same chemical as subutex.  It should help both your pain and the cravings whether in patch or pill form.

Suboxone is buprenorphine with naloxone.  The naloxone is a partial opiate antagonist which, in very simple terms, means that if you take another opiate it may cause you to go into precipitated withdrawal.  If you use buprenorphine (subutex) alone, this reaction will not occur leaving you with no consequences of taking additional opiates.

Opiate therapy for people with addictive personalities is the greatest difficulty a physician can face.  You are to be congratulated for recognizing that your behavior indicates a problem and that you're doing something about it.  Good for you!

Most recovering addicts will tell you that aftercare in the form of therapy or a 12-step program is absolutely necessary to prevent relapsing into the same behavior that got you into trouble in the first place.  Give it a try!  Can't hurt, might help.  :-)

[Tuckamore]

Hello My_Life,

Welcome to MedHelp's Pain Mangement Forum. I am glad that you found us and took your time to post detailed information. It is not too lengthy.

You have faced many issues in your life so very bravely. You should not be so hard on yourself my dear. You should be very proud of your accomplishments. You have a lot of insight into what makes you tick. Many of us don't. You are actively working on solutions which is often very difficult to do. How very wonderful and you should be commended. Congrats on your weight loss.

You've done your research which is also good. Educating yourself before making decisions is the best rout to follow in my opinion.

I don't beleive that the US uses Buprenorphine in a transdermal patch for pain control. It may be that we do but I have not heard of it that form. As you know Suboxone contains buprenorphine as well as the opioid antagonist naloxone to deter abuse. Burprenorphine is more commonly know in the US as Subutex. It is primarily used in treating opioid dependence here. I am not real familiar with it in pain management. According to what I have read, Burprenorphine helps prevent withdrawal symptoms in someone who has stopped taking narcotics. Sorry, I am far from an expert and do not have a lot of knowledge in medications to help with withdrawal symptoms.

I think you may be overly concerned with your former dosage of opiates. You were not on high doses of opiates. Granted we should all take the least amount to control our pain but you may have been exactly there. When you suffer with chronic pain there are no great choices. Opiate therapy comes with some consequences both good and not so good. We have to weight the pros and cons on an individual basis and determine what is best for us.  I think that is exactly what you are wisely attempting to do.

We must rely on the input of medical personnel that we trust. Your physician has indicated that she is not concerned with addiction in your case. This should be reassuring. She knows you far better than any of us do. On the other hand I certainly understand you concern with opiate therapy. Again we all have to make choices.

Do you know that studies indicate that less than 4% of chronic pain (cp) patients ever become addicts. Some studies by well know research centers put that percentage even lower at less than 1%. While it's true that addictive personalities are more prone to drug addiction, they key word here is prone, that does not mean that every addictive personality will become addicted to opiates. There is a huge differance between addiction and dependancy. I am addicted to nicotine. I am not addicted to alcohol, food or opiates. Yet because of my addiction to nicotine I may be considered to have an addictive personality.  

Where do you belong? I don't beleive that to be addiction meetings. If I am reading your post correctly, you are currently in therapy. Again going back to relying on those we trust in the medical community, I would discuss your concerns with your therapist. Let him or her help you find the answer that is right for you.

Chronic pain to some degree is an angry, controlling and selfish beast. Personally my CP will not allow me the choice to function without opiates. Believe me I have tried long and hard for years to not be on opiate therapy. However the extreme CP won over and I barely function even with opiates. I do not have the liberty of a choice. So again I beleive it is up to each individual to a degree. However when CP is severe and robs you of any semblance of a  "normal"  life style we have limited other choices. Only you know your pain levels.

I sincerely hope that you will find an answer that you are comfortable with. Draw on the wisdom of your medical providers. You are always welcome here. This community has many kind and supportive ppl. We come from a variety of backgrounds and experience. We are here for you. Please feel free to ask additional questions an post again.

I'll look forward to hearing from you soon. You have many challenges. Don't forget to be kind to yourself.  

Take Care,
~Tuck