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Opioids Buprenorphine for chronic pain

Everyone is different for sure, but Buprenorphine did absolutely nothing for my pain. Not a damn thing. When I switched on Bupe from my 200mg/day Oxy habit even a highish dose of Bupe wouldn't dull the pain. The only thing that would is my usual Oxy regimen.

But, don't let that deter you. Everyone is different.
 
I ended up having another 2mg to see whether analgesia would increase. It didn't really unfortunately, not appreciably, but instead has made me feel kind of "spaced out" - I realise this is somewhat of a poor description, but it's about the best short description I can come up with. Itching has not increased, and mood is pretty much the same it has been prior to the 2mg topup. As a result, i'll be telling them that 2mg is where I want to stay, and I'll give this a go for a week or thereabouts to determine whether I want to stick with it or not longer-term. I'm not enthusiastic about the only other option (at least for now, until I have my pain clinic appointment) being methadone, but I may give it a trial if buprenorphine proves inadequate after this trial - if nothing else, it might give me an idea whether full agonists might be a viable treatment or not. I know morphine works acutely, but not having it multiple days in a row at proper doses i'm not sure whether analgesia continues. We shall see.

tricomb: I can't really take less than 2mg, since I am monitored while having it, unless I do my SL dosing in an intentionally highly-wasteful fashion (would this be worthwhile, you think? I can try!) - and I will be given no more take-homes, at least not for a few months I expect if I were to stay with it - the only reason I was given one today is so I could determine whether 2 or 4 mg was better for me. I'm glad you like the colour coding, I'll continue to use this format when I have more results not of an 'minor updatey nature' ;)
 
I would imagine 2mg would be better than 4mg but I really don't know. That's terrible about the supervised dosing, I bet buprenorphine could have been a much better option had you control over your dosing.

I hope that 4mg works better for you, work on your SL technique. Do not swallow the saliva in your mouth if possible, keep it all in your mouth for 5 minutes minimum, sublingual is a great ROA for buprenorphine once you have the technique down.
 
The effects have improved markedly over time. Now the analgesia is more like 50%. Not as good as say, 30mg intravenous morphine (which was more like ~75% ), but i've set the bar pretty high by comparing to that. Certainly one hell of a lot better than the codeine i'd been using before to deal with it - I didn't want to graduate to anything stronger regularly - nor could I have really, since I couldn't get anything prescribed to me and illicit opiates are really hard to get where I live, unless you live in the right (wrong?) circles.
On a pain scale of 0-10, 10 being the worst imaginable, 0 being no pain, i've achieved about a 4 point decrease, since i'd have said I was sitting around 7-8, and am currently sitting around 4 :) . This is much better :D i'm pretty damn happy! I sure hope 1) it continues to improve and 2) this level of analgesia is maintainable. Life could even be enjoyable!

Norbuprenorphine would seem to be a much better analgesic than buprenorphine proper. Now, I had expected this somewhat from the pharmacology, just not to the degree its occurring. Thanks CYP3A4 (also thanks liver for producing it), you're awesome for a change! I can definitely see how less is more, since at higher doses bupe will prevent the generated norbupe from binding. I'm guessing the receptor residence time is higher with bupe cf. norbupe too, further skewing the effects. I will be interested to see how just 2mg goes tomorrow, since I told them [the clinic] that I wanted to stay with 2. I wonder whether 2 will actually be more effective than the 4 I took today for the reasons given previously.

TL;DR: More colour-coded effects, with [+/-] deltas (how effect has changed) from last time:

  • Analgesia - 4 point decrease on 1-10 scale [+50%]
  • Feeling of generalised well-being [0]
  • Anxiety reduction [0]
  • Warm feeling in face[+20%]
  • Itching (puritis) [+20%]
  • Reduced pupil diameter (miosis) [+30%]
  • Headache IS NO MORE

All this is T+7/8 hours. (can't remember exactly when I first took it unfortunately)
 
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So my suggestion to split my dosing didn't go down well. My case worker told me that the clinic doctor shot down my suggestion saying it would have no benefit and that I should spend more time researching so I'd find this was the case. Well, I already did that, that's why I gave that suggestion. What a fucking dick. That is going to backfire on him a bit I think, since I'm going to spend the rest of the day researching journal articles that contradict his position.
 
The butrans patch has worked ok but I still have 2mg tabs for breakthrough. My plan is to get on just the patch but I have issues.

They say if it falls off to replace it. What country is it where one can just get replacements? Just kidding but my point is we get 4 in a box what do we do then? The doctor will not write for more then the 20mcg I'm on.

Why can't you re apply it?

It itch's like heck and I take it part way off the scratch-does this mean it is no longer working?

Whew!

Glen
 
Thanks Tricomb

I hate it too when I have to seek additional supply. I feel I have to please the doctor otherwise he'd cut me off. I know it is silly but he does always talk about taking less rather then more.

I am on a large amount 2mg X3 a day plus a 20mcg patch so I should be good this month.

I have issues with the patch liking severe itch. I partly remove it and scratch but fear that makes the delivery system shut down somehow because they tell you to replace it if it falls off. (that is another issue, how can we replace it and not run out?)

Glen
 
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