Pain Relief In Buprenorphine Maintained Patients

[Tchort]

I found this while browsing, and thought it might be helpful to many of the posters and readers here. When I was maintained on Bupe the thought of needing pain relief for anything (surgery, broken bones, etc) terrified me due to the antagonist side of Bupe. I've seen some posters ask about this, but no real solid answers have been given (that I've seen). Anyway, Enjoy.

Analgesia in the Buprenorphine Maintained Patient

The Dora Weiner Foundation (DWF) and the National Alliance of Methadone Advocates (NAMA) have collaborated for the last year to obtain a determination of medical practice and art in responding to the questions of pain management and post operative pain management in the Buprenorphine maintained patient.

Following a series of discussions and communications that took place during and after the 20th Anniversary Conference of the American Association for the Treatment of Opioid Dependence (AATOD) between DWF's President Howard Lotsof and Rolley E. Johnson, Vice President Clinical, Scientific & Regulatory Affairs of Reckitt Benckiser, the manufacturer of Buprenorphine, Subutex and Suboxone; Reckitt made available a PDF file as an official response of their company from Tim Baxter, MD, Global Medical Director for doctors seeking information on the treatment of pain in patients taking Buprenorphine

The Dora Weiner Foundation and the National Alliance of Methadone Advocates proudly make that response of a generic letter available to doctors and patients in need of such information as an official Reckitt Benckiser document..

http://www.doraweiner.org/aatod_hrc.html#analgesia

Here is a link to the PDF file:

http://www.doraweiner.org/PAI2137_Pain_buprenorphine.pdf

 

[Unknown]

Buprenorphine can be "blasted" through (High dose morphine/hydromorphone) if one needs pain management. As far as buprenorphine and pain management, IMO, it sucks.

 

[johanneschimpo]

I broke 3 bones in my leg on bupe. It was too horrible for words. Several (and I mean several) hours later, the dilaudid broke through and I was OK though. Just OK, because I still had a high tolerance. At least I wasn't suffering anymore though. LOL, when they set my leg back into place w/o any analgesia I tried to kick the ER doc in the face with my good leg, thats how bad it hurt.

So anyway, what does that link say about pain relief in bupe patients? What was their conclusion?

 

[Tchort]

Common sense stuff really. Use of non-Opioid pain medications like Rx NSAIDs, 'regional anaesthesia', conscious sedation with Benzodiazepines, upping the dose of Bupe to an analgesic level, taking the patient off Bupe and transfering to a full agonist then transferring back to Bupe after treatment/pain is over, give a full agonist until the Bupe has been broken through.

That's basically it. But, it does establish for the first time a methodology for treating a Buprenorphine maintained patient. It is a short letter from a Reckitt Benckiser rep (company that makes Suboxone), but he does outline in which general situations the above treatments would be appropriate.

At least it should be read and/or saved/printed by every Bupe patient in case they find themselves in a situation where they need acute pain control, or continued pain management. Very few doctors are saavy on what to do about pain management for Bupe patients- and for that matter Methadone maintained patients (many of the above treatments are used for Methadone patients as well).

 

[johanneschimpo]

Wow, that all is very common sense. I mean really, Joe Greenlighter could figure all that stuff out.

 

[StaffWriter]

I was bitten by a dog on the hand (severe injury) and the bupe + tramadol didn't do shit. My doc took me off bupe before surgery and took Percocet, Vicodin and Dilaudid. The full mu agonist worked wonderfully. Fuck bupe for pain.

 

[Tchort]

The problem is that trying to explain to a doctor or surgeon what you need to be given for pain doesn't work well. After almost a decade in college and years of practicing medicine they don't want some 'dope fiend' telling them what to do.

A letter from the pharm. company that makes the medication you're on makes a much more convincing case for better treatment than your word