Hey there. So as you acknowledge, this dubiously approaches medical opinion without ever even being in the same room as you - so no diagnostics, no dx. But a few passing thoughts:
Ok ok so maybe you've been railing shit a couple years longer than me, but have you been railing as mass of quantities? Ha ha
On peril of pressing you on a point you seem reticent to discuss, I'd possibly irrelevantly anyway ask, what is it you're using intranasally most?
Using anything, even pharmaceuticals, IN does increase risk of infection. Less so than IV/IM/SC, perhaps more so than PO, and a bit more than SL/buccal admin, to cover a ROA bases in comparison. What that comes down to is the nature of the tissues into which you're introducing the substance, per their ability to respond to - resist or be diffused by - said foreign substance and in particular any chance pathogens which are invariably present.
The physical and potential immune barrier offered by the sensory/mucosal membranes of your nasal sinuses isn't unsubstantial, and the risks of catching an infection through IN use aren't necessarily as instantaneously dire at first cp. IV use. But the whole point of IN use is that you're overcoming your body's barriers, the complex so-called the blood-brain-barrier in particular, to more effectively deliver a psychoactive substance - which in practice again invariably carries pathogens along with its vehicle to some extent.
A primary reason I ask what you're using most often is that some things are considerably more abrasive or alkaline/acidic, etc., and thus more likely to offer insult to the tissue exposed, i.e. break the sinus membrane and gain direct capillary/bloodstream access (and cause progressive damage). Although in practice here, even in best use/best case/seasoned to-the-face connoisseurs like us scenarios, you can reasonably expect that to happen every time to some extent whether you end up with total congestion from inflammation and bleeding/exudate or no such noticeable effects whatsoever. Hence the higher risk of infection inherent to the IN ROA (perhaps higher than per os, lower than IV), though I can't quantify that for you.
I.e. if you do get an infection - bacterial, viral, protozoan, or otherwise - I would most likely expect it would either stay local to the sinus tissue and you'd likely end up with change or loss of tissue integrity (inflammation, bleeding/exudate/pus, ulceration, localized pain; with that chronic exposure to substances, foreign particles, and pathogens, inevitably some of which are carcinogenic, you might expect nasal polyps or substantial structural damage to develop and with similar symptoms) or end up catching one of the common sinus/respiratory "cold"-like infections (norovirus, coronavirus, etc.).
With what you are specifically describing, those are both possibilities. It could be that there is no connection between your IN proclivities and this pain except overlapping in time.
Something to do with what you describe as chest-wall pain/issues? That is in fact a common later-stage development in the progress of untreated or chronic localized bacterial infection as it overwhelms local and systemic defenses, gains access to the bloodstream, and ultimately travels to and embeds in the tissues of the lungs: septic pulmonary emboli. Typically, pleural effusions - accumulations of more of that blood/exudate/pus trapped in the thoracic compartment formed as the lung tissue is destroyed whether by the infection itself, your immune processes, or necrosis from local blood supply disruption from damaged vessels - can ensue, competing with the space your lungs would be expanding into, leading to progressive respiratory failure. In the process, the pleural membrane that surrounds your lungs and facilitates smooth gliding along the inner chest wall during the expansion and compression of respiration can also be effected and thus infected. The pleura subsequently becomes an inhibitor rather than facilitator of breathing, stiffening or losing functional integrity, becoming a sort of pulmonary shell.
This all is a generally excruciating medical emergency, although you might not notice it until you very suddenly do. However, your doctors would have given your timeline and description, and I wouldn't expect this to be what's going on with you. But hey, you asked about potential chest/chest-wall pain related to long-term IN use, I had to give you an answer. Haha
So what would I nominate as a most-likely cause of this pain in your head/neck and upper thorax, if there is indeed a cause related to chronic IN use? Yes, ultimately more exposure to pathogens and the immune response to them, with you experiencing the effects of subsequent extensive lymphatic system function a la pain. It could easily be lymph involvement from other immune system insults, i.e. unrelated to IN.
The second candidate could involve serious structural damage from heavy use, which if profound enough could have implications as not just local but referred pain and/or painful/uncomfortable physiological compensatory changes (e.g. your sinus-related/neck pain lead to a bracing tension in your upper cervical/thoracic muscles). But you'd probably have noticed your face caving in by now. Maybe.
So, how would I advise trying to actually figure out what's going on here. Well, any doctor or NP should palpate your neck (at the top of your throat, along your jawlines back to behind your ears, down along the sides of and all around the base of your neck) for exactly such signs of notable lymphatic activity - swollen/hard lymph nodes, congestion along lymph tracts - on any general examination or physical. So, next time you're having this issue to a pronounced extent would be a great time to get that next physical. If you're particularly concerned, get seen at your convenience, and approach it as concerns over general allergy and sinus/respiratory issues like colds, congestion, and pain that eventually extends into your chest in a particular fashion.
Be prepared for an inexorable spiel on the merits of kicking the heavy smoking thing, which I will of course spare you. Aside from the obvious that ENT/neck/respiratory structures are particularly susceptible to the effects of smoking, and there is such a thing as e.g. smoking-related lung carcinomas that will burrow straight through that chest-wall.
Hey there!
Thank you for your tremendous amount of input! Some of that is even more scary than a partial lung collapse! (since these can at least heal apparently).
I guess I'll bite the bullet & say that I snort buprenorphine. For a few years it was the strips dissolved in nasal saline & then t switched to the orange hexagons. After a few years of those, I switched a brand that uses only bupe, naloxone, sucralose, cirtric acid and 2 or more not overly worrying ingredients (I can't remember what they were right now). Oddly some times it doesn't burn at all & some times it'll burn slightly. But it's nothing like snorting welbutrin or meth, which would feel like it would cause much more & faster destruction of tissues. I've always lived by the rule that if it burns, it's' gonna destroy your tissue because that burn is basically little cuts & scratches. But this form of bupe barely has any burn, but once in awhile they will & I don't know why. I've been through many different brands since this neck/chest pain thing started. But I only stick with one now that has the least amount of shit in it, at least that I can get, cause no body wants to give out just regular clean mono buprenorphine. No, it's gotta have naloxone & sweeteners & this & that. It's stupid. 8m of bupe is a tiny amount of powder & they could make these pills & things basically little tiny tablets that dissolve in an instant, but nope.
I would assume citric acid in the nose probably isn't good. I can't tell if it's really done a lot of damage but I'm sure it has done some. I never have any nosebleeds or anything. I get some congestion & blow my nose a lot. I always watch for the color of my snort & it's never yellow or anything, always clear. I do worry I have leaking cerebral spinal fluid either from snorting or from previous damage (I broke my nose when I was 16, so I have a deviated septum where my right nostril is a lot less open than my left one, so I tend to use my left nostril most of the time, but I switch it up). I was also punched in the face at one point & got a nosebleed from it. Shortly after that, I noticed that some times (but not all the time), if I just leave over, I can get a clear sticky liquid to drip out of my left nostril. It gets worse when I do actively snort stuff & kinda gets better when I stop for a bit. But this could either be damage leaking or a cerebral spinal fluid leak,. none of which are great.
I know those damn artificial sweeteners like sucralose are carcinogenic.
It's possible that the neck/chest thing has nothing to do with the snorting though, if you say you'd expect it to stay localized. I mean, I would think so too. I typically blow my nose at least 5 minutes after snorting. Some times it's a lot of powder that I snort & then other days, just depends on how much it takes to get me to where I don't feel like blowing my head off. But I don't see a route from my nose that would go right down into my neck without some of that infection still being in the nose or throat or something. It would have to be some how travelling through this tissues straight down into my neck, while never really giving me noticeable infections in my nose at all, which would be pretty weird. Unless it would be through the lymphatic system. But I never notice my lymph nodes being swollen either during these 1-3 day neck/chest pain/hurts when I take breath episodes. But I'll often have a fever with it. Some times a bad one where my whole body tingles & some times just a mild one.
I do some times stick to sublingual & plugging when I get anxious & worried about what damage I could be doing, but bupe does almost next to nothing through these routes for me for some reason, so I get no craving relief, no withdrawal relief & then I can't function as well. Where as if I just take a bump of it, I'm full functional within 20-40 minutes. I don't even get a "high" or anything, maybe a little some times even after a decade, but it mostly just allows me to go about my day without severe back pain & fibromyalgia pain better. And it'll pin the hell out of my pupils some times way worse than full agonists, and I'll feel completely normal. lol Why sublingual & plugging isn't working for me is a mystery. Fuck, I'd rather be on an opioid that worked orally, so I could just swallow the fuckin' thing (like tramadol or methadone). But alas, bupe does not work orally. But I live in a country that hates opiate addicts & just wants them dead rather than giving them different options.
Unfortunately my insurance only pays for a physical once a year, but I can always call & make an appt. I have a lot of doctors & many of them are terrible at what they do. And of course you can't challenge them because "they went to school". About 2-3 winters ago, I had a strange 7 day low grade fever with zero other symptoms. Just a slight fever. So I finally went to ER on the 7th day (and of course my fever broke in the waiting room) and they took pictures of my chest & shit & said everything looked fine. And then sent me home with nothing. Then called me the next morning & said they had 2 other doctors go over my x-rays & saw something "weird" (their exact words) on my x-ray & that I should go to my GP and have him do another one. Well they didn't explain what they meant by "weird" and when I went to my GP, he didn't wanna do another x-ray & just assumed it was a "pocket of infection" that some how got into my lungs. So he put me on prednisone for a week. And it did work, I started feeling better & actually developed a cough for a few days & cleared some shit out of my lungs. But no one has ever bothered to look at my chest again since to see what exact that "weird" spot was. A week after that, I developed a heart arrhythmia too. Saw a cardiologist for that. THEY also said they saw a weird spot on my heart on my echocardiogram, but said it was "probably just an imaging artifact due to subdiaphragmatic activity."
So it's like I keep getting told "yeah there's something weird there, but it's probably just this or probably normal" about a lot of things, which is why I often get left to asking people around the world if they might know what's going on with me. Cause doctors are idiots. Not all of them, but some of them. And some times it's not even their fault, they just see too many people a every day & of course they are gonna miss some things.
I should mention though that usually after this chest/neck episode thingy is over, I go back to feeling pretty much normal. I am getting older as well, middle aged now, so, my body probably isn't as resilient as it was once. It's also completely random. For a few years I got it every other month or two months. Then I went almost a whole year or more without it happening at all. And then it just started up again in 2025 & again a few weeks ago.
I guess my plan is that the next time it happens, I'm just gonna go to the ER & demand that somebody tell me wtf it is. Cause if it's any of these things that people have mentioned here & it's been going on since 2021, then that's pretty damn serious & I don't know how any of my doctors haven't caught onto it with all the stuff I've had done (physicals, exams, xrays), always cleared on everything. Although I kind of did this when I had that 7 day fever & got told to my face that I looked "fine". And then got the "we saw something weird" phone call the next day. So I dunno wtf is wrong with our healthcare system if nobody's noticed yet that I have some kind of lung damage or face damage or something going on.. lol
I think you could also be right about the lymphatic system response being the cause of pain as well, I've just never noticed much lymph node swelling when the neck/chest thing is actively happening. But it would make sense because there are a lot of of lymphatic structures there. I'm sure there could be some route where pathogens can enter my neck through my nose without giving me any sort of noticeable nose infections ever. I dunno though.
I appreciate your response.
Just an extra/off topic-slightly on topic thought I had, but I've continously read that buprenorphine immediately degrades when exposed to acids. Yet they put citric acid in every brand name & generic brand suboxone. Wouldn't that make the bupenorhine unusable? or is citric acid not "acid-ey" enough?
