Avatar universal

need help with suboxone, other thoughts for pain management.

     Hello everyone. This is the first time I have decided to post to a forum. I have suffered from chronic severe back and leg pain from a motorcycle accident in 2008. Recently, I got health insurance (after many years uninsured) and, after many MRI's and other tests, underwent a discectomy for these issues. It has, as of now, been considered a failed surgery by my Dr. I am in more pain now than before. He has talked to me about a spinal cord stimulator. This is an implant that scares me, but may be necessary. He recommends a tri-level fusion, but has informed me that there is a new trend with insurance companies denying tri level fusions. He has been unable to get one approved for over a year. This leaves the stimulator as the last chance for me.
     Here is one of my major dilemmas. After the operation, I wanted to get off of the meds. My Dr thought it was a little premature, but I am 12 years sober from all alcohol and drugs (opiates included) and didn't want to take the risk of having them in me. I had so much prescribed to me, (2 x 30mg oxycodone every 3-4 hours), for a couple of months, so I had to either taper down or use a Suboxone taper. Again, to reduce temptation, I chose the Suboxone taper. This also scares the hell out of me, as I have heard many horror stories in the rooms of AA about Suboxone.
     So here I am, on Suboxone, comfortable with withdrawal but still in a huge amount of pain. My Dr suggests moving up to 24mg a day, from the 8mg a day I am on now. This would be, in essence, changing my treatment plan from a detox to using the Suboxone for pain management. I struggle with this, but do realize I am not throwing my sobriety away. I would be using this medication for the right reasons, and it really has seemed like a big improvement in the pain level without having the effect of "being high".
     This is one reason I have decided to post here, as opposed to other threads I've searched. Anywhere else I look, it is mainly people talking about Suboxone as a method to get off of their drug addiction. I am in a little different boat. I am struggling with the idea of getting on more to address pain, but am fiercely protective of my sobriety. I am scared. Another reason I am worried is that I am unsure if I can continue to pay for health insurance, due to not being able to work with my back. 24mg a day without insurance would be impossible to pay for.
     To give a little background, I have done plaster and sheet rock for my entire adult life. That is out. I am, however, the owner of 2 sober living environments that help a lot of people and put a very small profit in my pocket. I am currently in school and am about to get my Bachelor's in human services, after which I will be going for a masters in social work.
     I am relieved to let this out. If no one reads it all the way through, I am still grateful for the chance to tell my tale. If people do get through my ramblings, I would be interested in hearing peoples' opinions. I don't really know what my question is, only that I am scared. I've worked very hard to succeed in recovery, and suffered horribly with this pain over the years. I am coming to a point in my life where I am considering using medication to address this problem, but am deathly afraid to have opiates in my system. There seems to be, for me, a very small chance of abusing the Suboxone. Without meds I can barely walk and I am young(ish), about to hit 40 and have a wonderful fiance with 4 great kids. We try to enjoy an active lifestyle. She is a personal trainer, and we both enjoy outdoor activities like fishing, bow hunting, small scale farming, etc.
     Again, I don't know what my question is..... just reaching out and putting my words down to see what other people might think, if they are strong or bored enough to make it through my ramblings. haha. I am also interested to know others' opinion about the spinal cord stimulator. Thanks again for the place to talk.

Best Answer
Avatar universal
Hi:  I read all your entire post.  I feel your pain as I have had failed back surgery and fibromyalgia which causes chronic widespread pain just about anywhere in my body.  I am in constant pain and although I have not had a substance abuse problem I fear that I might if they gave me enough to actually help.  It does not sound like I am able to be as active as you are, but I sure would like to be able to walk further without so much pain.  I just wanted to say that what you are doing is admirable.  I could not have gone to school with this daily pain and I applaud you.  It sounds like you could help many people when you get your degree because you have been there.  
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Avatar universal
Hi there- I came across your thread here while checking on something else and have some comments, if you don't mind.  

You chose a "suboxone taper" over a taper of your usual pain meds.  It doesn't sound like a taper at all, especially with the doctor wanting to increase you to 24mg!   Remember, SUBOXONE is an opiate as well. It's very difficult to detox from, it's not a good pain reliever, and is a HUGE money maker.

I would really think about this. Have you re evaluated your pain by going off all pain med?  If you're still in pain, I would consider going back on some regular pain meds, at the lowest dose possible. It will not effect your sobriety and would really be much safer for you.  In addition, 24 mg of sub is an enormous dose...Even 8mg is a lot. It would take a long, slow taper to get off of that amount. You couldn't easily get over it in a week...

Please do your research. I've never taken sub but have read about as much as I can find to be well informed. I've been a member of the Substance Abuse forum for 5 years and have learned a lot there, as well.

It's curious that you went on sub for pain management. To me, it doesn't make a lot of sense. As I said, it's a poor pain reliever yet still an opiate. I do think sub has it's place in addiction, when trying to get past a heroin addiction or large Oxy addiction. When used in a program of treatment, recovery support, etc...it can save lives. But, it doesn't seem appropriate in your situation.

I wish you all the best!  If you want other opinions you might consider posting on the SA forum; it's up to you.  Take care~
Helpful - 0
1855076 tn?1337115303
I would encourage you to listen to Vicki.  She knows her stuff!  She helped me tremendously when I was trying to sort some things out.  I'm surprised your doctor even offfered this as an option for pain control.  Or maybe I'm not.surprised at stuff like this anymore.  Money and greed will sometimes cloud a.person's judgement.  Just do your homework.  I put my pain management team  on a bit of a pedestal.  I asked lots of questions and their answers were reassuring.  I went on Fentanyl along with lots of other meds.  Luckily I learned a lot here and when they suggested methadone.I knew.I wanted.no part.of.that.  Being on that high of a dose of subs is a.crazy high dose.  Best of luck.
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Avatar universal
     Hello thank you for the comments. I did want to clear up a few things. I am still on the 8mg a day. I am still deciding what I want to do. I am very aware of the dependency issues Suboxone will create. I work in the recovery field and have for a very long time. That is why my prejudices with Suboxone as an opiate addiction prescription are causing me to hesitate.
     I am certain that the pain I feel is not precipitated by the medication. My spine is literally falling apart. I saw my Dr the other day and he is now considering the surgery a failure and is discussing a spinal cord stimulator as a possible last ditch effort, since insurance companies will no longer approve tri-level fusions.
     So the choice to jump from 8mg to 24 mg is a decision of pain management. It is a very high dosage of Suboxone for addiction treatment, but not very uncommon for pain relief. The drug buprenorphine, Suboxone's opiate ingredient, has been used for chronic pain relief for decades, mainly in the UK. Suboxone was introduced to the US around '92 for opiate treatment only, but many Drs are beginning to use it for its original use.
     So it is certainly not for a lack of research that I am struggling with this decision. In fact, so far the Sub has been a more effective pain reliever than pain managements more "traditional" meds, (vicodan, perc, etc), and has FAR less abuse potential. This is just a fact. The whole act of taking opiates by popping a pill is habit forming alone, let alone the high and withdrawal symptoms. There is also a tolerance issue with traditional opiates, that does not seem to be so with the Subs.
     It is a struggle. And I am not trying to shirk anyone's advice, only to make the best decision with eyes wide open. I am worried. It is more than likely that, if I want to find a way to be able to walk and work and enjoy my life, I may have to be dependent upon medication; a fact that has worried me for many years. I am, however, a little more at ease with the Suboxone due to the few benefits I have mentioned here. I know that the withdrawal would be, although much less than traditional opiates, horrible. The sad fact for me, however, is that I may need this stuff for a very very long time.
     I appreciate the, and welcome more,  comments. It is a struggle, but I needed to reiterate the difference between tapering and pain management, both of which Buprenorphine are used for. For now I am staying at the dose I am at. Especial if I decide to have the Spinal Cord Stimulator put in by my Dr. I tell ya, I've always said that I would not change my past, because it has all made me who I am today. However, if I could go back to the day when the a#%hole ran me over on my motorcycle because he didn't see me, I'm fairly certain I would take a different way home.
     Thanks again, guys.
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Avatar universal
From everything I've ever read and everyone I've spoken to, the withdrawal from Sub is worse than traditional opiates; regardless of it's intended use.

I believe 8-24mg is a lot, as well. It's up to you and I understand your concerns; especially if this is long term treatment.  People who use methadone for pain management have these same concerns, although the drugs are different.

Also, why Suboxone and not Subutex?
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Avatar universal
     Well I think addicts always think that whichever detox they are in is worse than all others. Its just the nature of the beast. Methadone is certainly worse than other opiates, but Sub isn't. It is much much longer, which is very trying, but the symptoms aren't nearly as acute.
     I think Suboxone over Subutex only because that's what the Dr prescribed. I know the only difference is the Naltrexone. That is the ingredient that precipitates withdrawal and keeps people from abusing the Suboxone.
     I do appreciate peoples' responses. Thank you. I am taking it slowly and not moving up in dose yet, as there may be another surgery which may help further with the pain and numbness in my legs. I really hope so. Any other comments are greatly appreciated. This is tough for me, as I said, because I have been completely drug and alcohol free for over 12 years. Taking these may be a necessary evil, as my quality of life has gone to hell in the past few years. I just want to do it with the safest, and least amount, of medication possible. I was able to walk and work up until last fall. I went on a fishing trip in Canada. It was very demanding physically. When I got out of the river one day, my legs were very numb and tingly. It has just spiraled downhill ever since to where I cannot stand for more than 10 minutes without extreme pain and numbness. UGH... This is the only reason I am considering any form of therapy. Before this, and after my motorcycle accident, I suffered in a great deal of pain, but just dealt with it.
     Again, thanks guys. I will continue to do my best and hope to find some relief soon, for both my and my family's benefit.
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Avatar universal
If I may offer my opinion. Before you decide on ANY medication change, I would get another surgical opinion. Maybe even 2 more, just for good measure.

Its not a good idea to take one surgeons word with out another one to back it up. Seriously. And if you still have insurance, they will usually cover a second opinion. It may be why they wouldn't approve the surgery in the first place. So before upping or changing your meds, get another surgical opinion.I wish you the best of luck! Please keep us updated.
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Avatar universal
Thank you Trixy, you have a very good point. To clarify, the insurance company did not reject me from getting the operation,, the surgeon told me that they have not been allowing tri level fusions for almost 2 years now. they have found an excuse to get out of paying for them across the board, leaving the spinal cord stimulator as a last resort option. I did see my surgeon the other day, and he wants to wait a few more months to see if I will heal more. You are right. I think I will get a second Dr to look at what is going on. Thank you.
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