• Select Your Topic Then Scroll Down
    Alcohol Bupe Benzos
    Cocaine Heroin Opioids
    RCs Stimulants Misc
    Harm Reduction All Topics Gabapentinoids
    Tired of your habit? Struggling to cope?
    Want to regain control or get sober?
    Visit our Recovery Support Forums

Harm Reduction The Pain Management Mega Thread Version 4

Status
Not open for further replies.
Can anyone here answer anything regarding buprenorphine hcl, SUBUTEX, and it being prescribed for chronic pain? Sub-question-what can you use for breakthrough pain since the bupe blocks all of the full agonists? I ask because two weeks after beginning subutex voluntarily, I broke my wrist and the bupe does nothing for the severe pain. My doc told me to take more but it didn't work.

Then there is the stigma of buprenorphine and docs in the ER instantly jumping to the conclusion that you are an opiate addict and treating you like an irritant. I had it with being on oxy for years and the tolerance getting out of control, the constant dosing, losing/misplacing pills or having them stolen. I was doing great until this injury and now the doc has to wait to hear from the ER before considering prescribing something for breakthrough pain?

What can he prescribe for breakthrough pain? Ibuprofen 600mg does little as do all Nsaids. If anyone is on Subutex and under the care of a PM doc, what do you do for breakthrough pain. 4-8mg bupe/day.

If this belongs in the bupe mega thread then move it please. I am in pain management which is why I selected to post here. I don't want the post to get lost in these huge mega threads but I don't know whether or not to begin a new thread.
 
I believe the only buprenorphine that would help for mild to moderate pain is IM Buprenex ampules (0.25 mg's)
and usually block pain for non opiate tolerant individuals.

Your Dr. is giving you failing advice telling you to up your dose
 
So I made it out alive. I don't even know where to begin. I still haven't broken down the experience. Things happened so fast, everything was such a blur. 5 days of torture. I hate to throw that word around but it truly was psychological and physical torture. I don't know if I'll ever be the same.

Some good things though: Shoulder surgery was very succesful, so hopefully I can use this arm again. Another good thing (maybe) is that I have a new pain doc. Since the other one was out of town during a period where I really needed pain advice, I was handed over to the local pain doc. He subsequently diagnosed me with a condition called hypogesia, or something to that effect, I can't remember the name of the syndrome. Apparently what it means is that no low dose of medicine, no matter how strong, will ever give me any pain relief. Even with no tolerance, to get actual relief I will need massive doses of something. To prove this, he gave me 200 mcg of fent for post op pain, and it did nothing. Then he gave me morphine, hydromorphine, oxymorphone, etc. all at high doses and nothing worked. The only thing that works with my condition? Methadone, the opiate that caused me to OD. So he did prescribe methadone as my main pain med, and told me to cross my fingers. For breakthrough pain he said that I can basically try whatever I wamt because at the doses he would prescribe breakthrough meds at, they wont work. Right now I have roxies and dillies and he told me to alternate between the two. At least he's proactive and willing to help me, and work with me. Unlike my previous doctor. Either way, I'm 26 and I'm going to be in untreatable chronic pain for the rest of my life. So can someone give me one good reason to not end it all? Methadone does work for my pain, but goddamn, it is a shitty drug.

There are many many threads about to be created about my experience, but not right now.
 
That sounds good, another member was recomending methadone for chronic pain. The problem is that meth blocks any other opiates from working but you shouldn't need them anyway. Meth is a very strong opiate and hopefully more doctors take an approach like this for long term patients.


The bup for pain question above, it helps slightly. I wouldn't call sub a useful pain management drug, its more about getting off full agonists. I was trying it for pain for many years and thought it was working until I recently quit. Now I feel the same without the bup in my system, and pain levels no different on nsaids than on subs. Its a very expensive experiment and there are a ton of real meds for pain that actually work. Use the subs when your pain improves and ready to get off full agonist meds.
 
Wow you are already on some very potent pain medications, i feel bad that you are still experiencing a lot of pain and don't know what to recommend to you at this point.
 
Damn.....I would possibly try fentanyl? I don't like it but that stuff numbed my pain good and proper albeit with a ton of sedation. Another good choice to possibly try first is Methadone...Methadone has opioid AND NMDA action and is long acting and dirt cheap. I read a study of someone with severe intractable migraines who went from Morphine and Hydromorphone to Methadone at a resonably high dose, the study stated the patient went from constant pain to a 2-4 on the pain scale daily...for sedation they used Adderall XR....its difficult to get a doc to use amphetamines for opioid sedation but I've had it prescribed for that. For sedation modafinil is another option too, its also considered to have less contradictions with other illnesses but I'd have to look it up. Best of luck!
 
I like you already, offering to fly me up to alaska n shit! How'd you know what I wanted for my birthday this year?! haha, just playin. Nice to meet you, welcome to the BL pain management thread, I really hope we can get you sorted out so that your not taking 15 percocet a day, no matter how you slice that it's causing liver damage. Hopefully you can get switched to Roxicodone instead? Have you talked to your doctor? Surely they don't have you on 15+ percocet per day...? May I ask?

No I'm prescribed 8 a day of 10/325. And I posted a new thread asking about a drug switch my Dr wants me to make. To choose between fentnyal patch or morphine er's. Neither of which appeal to me.

In all seriousness I would be happy to help anyone one this forum plan a trip up here to Alaska. And I can set people up a lot of times with good deals on lodges etc. And Alaska isn't just for Summer, although I confess I'm not really looking forward to snow and ice which is only about 60 days away.

But there are some winter things to do that are cool. Pun interned. Imaging sitting in a natural hot springs fed pool when it's 50 below zero and the Northern Lights are DANCING over your head.

That's especially popular with some Japanese as it's
thought to be especially propitious to conceive a child under the Aurora Borealis.
<snip>

And I'd also be happy to help those who would like to come up to do some AWESOME Fishing next Summer. Or even for people who wish to hunt. But NOT for "trophy" hunters. Ted Nugent's an Asshole. But I'f you'd like an Alaskan experience and fill up your freezer, and maybe a neighbor's freezer with some Moose or sheep or Caribou etc. I can help set you up for the experience a lifetime. Personally for me it was the Rainbow Trout. I say "was" because I hurt so badly it's been a while since I could get out on a river.


Seriously, I'm really worried about this pending med change. I wrote about in my other thread.

<snip>


****Here is the text from the other thread I just posted. I am REALLY sorry about being so messy posting. I'm not thinking very clearly lately. I could have sworn there was a special place for chronic pain posts.*****

Today 18:15 Report Post

I've been treated by a Pain Clinic for a little over three years. Where I live there are only 2 other pain clinics and neither one would take me as a patient, not even to give me an epidural steroid injection. I have gone through drug treatment etc. but the last time was about 12 years abo, and basically since May 5th 1989 I've been clean with a few bumps in the road.

Anyway back in my early twenties I dumped a motorcycle and began a new and permanent phase of my life that included a lot of pain. At first I had long periods between surgeries where I was pain free and back then I used drugs almost exclusively for fun.

But I'm in my 60's now (my SIXTIES!!! Who'd a thunk it??) and in the past three years or so I developed chronic back pain. It's been the worst pain I've ever had and by far the most debilitating.

Long story etc...

I have been prescribed 2 10/325 generic Perc's 4 time a day for quite sometime. But now my Dr wants me to get off them and choose wither morphine sulfate ER 32MG bid or 25 mcg entangle patchs for three days.

Spending on just how bad my pain has been and whether I had to work my part time job or not I have followed the RX for the percs or sometimes save a couple of doses up to do orally all at once for fun. On the mornings I've had to work I have carefully planned it so I could take my normal dose just before leaving for my 15 minute drive to work. I work about 4 hours a day so it's REALLY helped.

Now in all my years of doping for fun and all my surgeries I had not had morphine until a couple of weeks ago when I was hospitalized. They kept injecting it into my IV but nor only didn't I get the slightest bit high it did NOTHING to help with my pain. The nurses were coy about the dosage never telling me the exact amount. But I was completely honest with them and my Dr and I spent a miserable couple of days in the hospital. When I got home and could take my perc's I felt better. I've never used Fentanyl before.

Originally my Pain Doc wanted me on oxycontins but the medicare Insurance company I had listed them as tier 3 or 4, I forget which but Perc's were a LOT cheaper. And I live very frugally these days.

But my new carrier would charge me the same for my Perc's the Morhine ER or the Fentanyl patch.

I think I'd rather keep things as they are. As my Dr won't write plain oxy script's limiting me to perc, I've hit the aceto wall.

From what I've been able to glean from a day or so of Googling the subject, my percs give a better high than either the Morphine ER or the Fentanyl patch. But I confess to being confused about how to best prepare either the morphine er or the fentanyl patch to get high as well as use for pain.

And I've read the fentanyl NEVER last three days only two. As it is now my pecr's don't last 6 hours, I get about and hour and a half of a high if I take 4 of the perc's and about 3.5 hours of pain relief.

Could you better informed folks tell me if either the morphine ER of the fentanyl would be a better choice for 1. pain relief and 2. a little fun now and then.


I know how to do a cold water extraction etc. but that isn't something I think wise to share with my Dr.

I've lost someone very close to me recently and I've had several other traumatic events in this past month so I'm really not happy about maybe losing the system I've had for pain relief as well.

I looked for the chronic pain forum but damned if I could find it so if this doesn't belong here could one of the mods please move it for me?

Thanks!
 
Last edited by a moderator:
Ya I agree morphine belongs in the 1850s battlefields but doctors still trying to use it. Having 5-10 minutes of relief is enough to get them out of your room and then it wears off and its hell for hours. Good luck with the switch. I would go for fent patch but it going to be a rough transition either way. Did you get any hardware installed in that moto accident? I wondering what I looking at down the road with my hardware issues. Alaska is my dream location. The mountains are sooo insane out there. Back when I was healthy and without hardware would have come to Alaska looking for the gnarliest terrain skiable which is everywhere in AK. Hows the work/job situation there now? I always wanted to move there but now I a bit crippled for rugged AK lifestyle. There was a time I was seriously considering it. I with that hunt only for neccessity, trophy idiots are real strokers. I suck at fishing, probably get better results by hand like a bear lol.
 
Dear Kenai, I was on morphine ER capsules with good results for several years to address my chronic-pain monkey; I also had morphine IR and one other migraine-specific med for breakthrough pain. Six months ago, I began tapering the morphine ER and gradually increasing dosage of Fentanyl patches. Currently, I'm using the 100mcg patch along with the BT meds. Have to say that it's the best pain mgmt solution I've had in many years. (Apart from the pain just leaving, never to return... but I stopped believing in fairy tales decades ago.)

Thought I'd mention this simply to point out that Fentanyl does work--and for the full 72 hours--for some people. Occasionally, if I think I'm putting the new patch on a few hours before the 72 are up, I leave the old one on for awhile longer, just in case there's anything left. The HR stories told here have completely turned off even the slightest urge to play around with the contents of the Fentanyl gel patches I have.

And I'm glad to learn that a real Alaskan (as opposed to $cam Queen $arah) is as repelled by the Nuge as I am!
 
Kenai, the fentanyl patches are far too dangerous to play with for recreational purposes. If you're going to be abusing them the morphine ER would be easier and safer.

Still, it's a bad idea to use your pain meds for recreational purposes. Once they stop working for your chronic pain you'll be in a very bad situation.
 
Ya its really bad having a high tolerance, then out of nowhere you really need pain treatments for whatever condition. I didn't realize he was just recreational with it. Sounded like he have some old and new pain issues but its up to him. If you to high with the meds they will bite you in the ass either way. Seems like methadone is more usefull for pain in tolerant/abusive types like me and alot of others. I trying to go without opiates for awhile but know the day will come when this hardware fails or somsthing else happens. Pain is inevidible, at least next time my tolerance should be low enough for standard meds to work. Morphine er ir give me a gallon of morph after last surgery and nothing. Maybe 5 minutes until it wore off. If it works for you thats great and wish you the best.
 
Kenai, the fentanyl patches are far too dangerous to play with for recreational purposes. If you're going to be abusing them the morphine ER would be easier and safer.

Still, it's a bad idea to use your pain meds for recreational purposes. Once they stop working for your chronic pain you'll be in a very bad situation.

I have researched it enough to decide I will NEVER try to monkey around with fentanyl. And I have found a LOT more complaints about those patches than the pills I'm taking now. And as I said a while back I was in the hospital and they gave me morphine through my IV and it didn't even TOUCH my pain. It was miserable, three times they injected that stuff into the IV and I got no relief at all. So I'm not anxious to trade my generic perc's for Morphine ER. My chronic pain issue has gotten more complicated over the years. At first it wasn't really chronic, Back in the 1970's one of my knees would go out badly and I'd need to use some pain meds for a week or so. But over the years I had a number of surgeries on my knees. Somewhere around 20. I finally ended up with an artificial joint on my left leg but now IT'S starting to hurt badly on occasion. And my right knee is the kind where the X-Ray Tech calls all his friends in to look at what some poor bastard is actually walking on.

But it wasn't until three years ago when my lower back went looney tunes that I began to experience what I think of as true chronic pain. There is no comfy position, no matter if I sit, lay down, or stand, it HURTS. I got an MRI and they showed me how the canal narrowed where they thought I had a pinched nerve. And I've got some bulging disks at L2 or something. And while there ARE some respites, for the most part it's continual. When I talked about recreational use what I actually did was save up some of my meds for the days when I have to go to my part time job. I HAVE to have that income, my SSDI just isn't enough to survive on and I've been DAMN lucky to work for a company that saw how the issue with my back affected me. They have seen how I've gone from hurting very badly occasionally to hurting very badly most of the time. And they have arranged for me to have a job with a chair and have even given me some latitude on the hours I work. So on the mornings I know I'm working I've sometimes used a double dose to get me through my work day. I'm always aware of the amount of acetaminophen I'm taking and don't go over that limit. And while I admit to enjoying it, I actually NEED that much meds to be able to handle working. Even though I get to sit most of the time I have to do a bunch of filing and THEN I have to stand and bend and stretch etc. I never thought I could use the phrase "pain in the Ass" seriously in a sentence. But that's the part that hurts the worst for me. My left Buttock just BURNS and the pain runs down my thigh. Sometimes my toes sort of tingle. By the time I' been there for 4 or 5 hours I'm toast. But Those hours are critical.

In the past the other meds my Dr mentioned would have cost too much even with my Medicare D plan. But these two the Morphine ER and the fentanyl patch cost about the same so I can't use that as an excuse to stay with what I've had. But I MUCH prefer to keep using the generic Perc's because I can safely increase my morning dose when I'm at work. I don't see anyway to do that with these other two. Especially the fentanyl. That stuff sounds NASTY.

As I type this I'm having to dissuade my Cat from taking the heating pad I'm sitting on for his own purposes.


I'm very grateful to the people who have taken the time to respond! To be honest I'm scared about having to change things. It hasn't been perfect but I've found a way to make it work for me.
Do any of you have a suggestion that might help me stay with the meds my Dr's got me on now?

Yah, I despise Sarah. I voted for her as Governor, but boy was THAT a mistake! And ted is just a pig.

Ya its really bad having a high tolerance, then out of nowhere you really need pain treatments for whatever condition. I didn't realize he was just recreational with it. Sounded like he have some old and new pain issues but its up to him. If you to high with the meds they will bite you in the ass either way. Seems like methadone is more usefull for pain in tolerant/abusive types like me and alot of others. I trying to go without opiates for awhile but know the day will come when this hardware fails or somsthing else happens. Pain is inevidible, at least next time my tolerance should be low enough for standard meds to work. Morphine er ir give me a gallon of morph after last surgery and nothing. Maybe 5 minutes until it wore off. If it works for you thats great and wish you the best.

Thanks for the reply Rod. I didn't do a very good job explaining my situation. Recreational use is NOT my main concern. I have a new counselor who gave me a book to read last week. The Title is "Living Beyond Your Pain"Using Acceptance & Commitment Therapy to ease Chronic Pain".

I'm NOT impressed with what I've read so far. I know there are people who choose to just live with it, but as long as there might be a substance I can use to "ease Chronic Pain" I'm all for it! Nobody gets out of here alive anyway. SO I am not that concerned with being addicted if I'm certain the pain I'm experiencing isn't going to vanish after a miracle surgery. I've talked to a bunch of folks that had the various spinal surgeries for conditions similar to mine and the general consensus hasn't been very positive. Plus I can't afford not to work my part time job for a month or two while recovering. I'd end up homeless.

Jesus Benny! My last leg surgery left me hurting so badly they put me in a sort of rehab hospital instead of discharging me home. That first night I went out in my wheelchair into the alcove where patients could smoke and actually looked for a way to end it. That's a shitty place to be in. The next morning I told the DR exactly what had happened and he upped my meds. I eventually got to go home. Your a young guy! I'm in my 60's but there's a decent chance during YOUR lifetime alternative methods for chronic pain will be developed. Don't give up. Please.

What are "BT Meds"?

Yeah, I'm one of the guys that drives the TSA people nuts cause of all the hardware, plates, screws etc. I carry around with me. I grew up in Colorado and skiing was MY sport. It's one of the biggest regrets I have that I can't ski again. You find a way up here and I'll do my best to get you into some fish. It really is a spectacular place!

Yes, I understand what your saying. And I'm having a hard time dealing with the realities before me. I very much appreciate your taking the time to address that part.

Kenai, the fentanyl patches are far too dangerous to play with for recreational purposes. If you're going to be abusing them the morphine ER would be easier and safer.

Still, it's a bad idea to use your pain meds for recreational purposes. Once they stop working for your chronic pain you'll be in a very bad situation.

I don't "know" anyone on these Forums, But you and Rod have high post counts so I PM'd Rod and was going to send it your way as well But have to wait 3 hours because of a spam filter or something.
I am truly frightened by what's going on in my life right now. Even when I double up the dosage of the Perc's it doesn't last for 4 to six hours. And this back pain is by far the most DEBILITATING pain I've ever experienced. After an MRI they showed me a short film. It shows the canal and the narrowing is obvious even to a lay person such as myself. And I've got some bulging disc's etc.

Anyway it HURTS.

Of the three med plans, the perc's the fent, the Morph ER, which one would be most likely to actually relieve the pain for the times they claim to be efficacious.

The reason I say I'm frightened is because I DEPEND on the income, however small, that I ean from my part time job. My SSDI covers my rent anda little of my other costs but I HAVE to work and earn supplemental income Or I will become actually homeless. In Anchorage, at the beginning of Winter that is not an exciting prospect.
panctemps2013.png


It looks like I'm going to have to choose between occasionally getting high when I go to work, or maybe just be ABLE to get to work. Getting old is not for sissies etc.

Guy's and ladies, I'd like to thank those of you who have taken the time to reply to me. I realize how garbled I am right now. And I VERY much value people with the experience you have (my guess using your post counts) taking the time to respond.
 
Last edited by a moderator:
What are "BT Meds"?

"BT" Stands for "Breakthrough"--the idea being (to my non-scientific mind) that you take a stronger but slowly released medication like MS Contin that should ease pain continually, and take shorter-acting medications like Percocet or Oxycontin for pain that breaks through those stronger meds.

Also, a tidbit my last doctor gave me--you have to wait at least two hours between doses of the "breakthrough" meds because it takes at least that long for your body to metabolize the drugs.

You mentioned "the pain in your ass" (ha)--I realize that much of your pain comes from musculoskeletal stuff but maybe you have nerve damage too and possibly some other type of medication that focuses on reducing nerve pain might help? A lot of people here take Gabapentin. I've used it, didn't like it. I take Topamax now and have really seen some benefits. I HATED Cymbalta. But, both Gabapentin and Topamax should be covered by Medicare.

I'm using "maybe" and "possibly" here because I'm not a doctor or a nurse..don't even play one on TV, but I have been through my share of surgeries and chronic pain and have also done much reading and had many, many discussions with all my doctors and nurses.

One more thing--your doctor should be able to give you a long acting medication like Morphine ER in ADDITION to Percocet for breakthrough pain. It just finally dawned on me that you're afraid they will take away the Percocet altogether. They won't. What I told my doctor is that my pain is constant, sometimes debilitating and even with the Morphine, I was still in pain (which was true), so she prescribed Percocet for breakthrough pain.

Dude. You sound like a tough guy (meant as a compliment). But, you can only handle so much. The doctors don't know how you feel or what your pain is like--stand up for yourself and make sure they understand that while the Fentanyl or the Morphine will take the edge off, it won't allow you to live your life.
 
Last edited by a moderator:
I was switched from fent patches to oxy for breakthrough and methadone for round the clock med. I'm surprised at 2 things. The methadone has been shockingly effective even after tolerance to the narcotic effects have developed. The other surprise is how compliant I've been. This combo actually works and covers 60-70% of the pain. So even though I start to hurt before my next dose, I will wait so that I can maintain this effectiveness. I'll wait to the exact time for my next dose.

I'm so glad my normal pain doc was out of town. I'm actually impressed and happy with my new guy. My meds still need tweaking, but for the first time I feel like I'm on the right path.

Today was a bad day overall though. A tiny hole, absolutely tiny hole, opened up along my new scar and blood just poured out non-stop for 4 hours. I had literally no way to get to the ER, and it finally stopped when someone got home, thank god.
 
Kenai_Kings, I can totally relate to your "pain in the ass". Before my first back surgery, I had excruciating pain in my right butt, and my lower right leg. At first I had no idea that the pain was related to my back. I remember telling my doc that I didn't care what they had to do to get rid of the pain, even cut the spot out. For me, my only option was surgery (I was losing the ability to walk). I know that for many people surgery is not a good option. Anyways, just wanted to say that I know how painful back problems can be, and I hope your new meds work well for you.
 
Benny--glad to hear the new meds seems to be working AND that you have a pain doc that is on his game. That is good news. Methadone scares the shit out of me. I have never taken it, but have read a lot about it. My pain doctor suggested it for and I said, no way. I guess what scares me is the "what happens if I have to go off of it".

Sucks about the incision opening up. :( I remember right after I got home after my lung surgery, my incision opened up and you could actually hear AIR coming out of the space when I breathed. It was gross and weird and scary.
 
Thanks for your reply and kind words! I'm taking Gaba. For the past couple of months. I got no benefit I could see but discovered if I took 600 MG at bedtime I went to sleep easier.
 
spinal injections ?

Anyone have advice on avoiding "injection clinics"? :?:?
About to be in pain management again.

A couple years ago, with a different doctor, was pretty straightforward, and the doctor suggested an injection to me for my spine (i guess they make a decent extra profit), and it isn't really something that fits my health problem(my dural tissue is messed up, not sure how cortisone injections will be helpful/ and not a fan of having shit injected into my spine), and he was cool about me telling him that I'd prefer not to do injections.

The place I just talked to locally asked me if I would have a problem that they are an "injection clinic" and that they do x-ray guided injections...
They sound pretty into that spinal injection stuff. Good to know and cross them off the list. Now a little worried that everyone locally will be pushing injections.


Any experience with spinal injections and how much they typically insist on doing them ?
 
Status
Not open for further replies.
Top