Suboxone and pain management

[jr31415]

Just curious about anyone's experience with needing pain control while being on sub.
Or tips, it seems like it could be a serious problem.

I went to hospital by ambulance last week from kidney stone pain. They gave me toradol anti-inflammatory which actually helped for like 30 min.
They could not give anymore of that med (it's kind of a scary drug) so they gave me 2 vicoden. I did tell the emergency ER doc I was on suboxone 6-8 mg daily (tapering from 20mg) and that 2 vicoden would not work but he refused any other narcotics. I took them anyway.
I felt decent enough to leave (in pain) and saw my urologist next week.
An oral toradol did not provide much relief on a flare up 2 days later. But it did causes heart palpatations. So that was fun. Same when they injected it.

But between the 2 flare-ups the 4 other days were full of waves of intense pain, little sleep and constant anxiety that the level 5 pain was about to jump to 9/10.

I went to my sub doctor (Clean Slate) and she was like "sure, have the Urologist call us, we have protocols for pain management" and "I'm surprised they wouldn't give you anything?" which seemed hopeful.....

The urologist was nice but had ZERO interest in calling the suboxone doc and gave me 5 perc 10 in case of a flare up to add to the toradol. So really if I had a flare-up I would have had to go back to the hospital and now know that there is noting they would have done that would stop that pain besides go back to the heart attack-odol which can't be used more than 5 days it's so toxic.

He had me come in to remove the stone the following day.
Filling the perc scrip the pharmacist was all "is this ok? Does your doctor know your on suboxone? We want you moving forward not backward....".

I was thinking "Its a frigging kidney stone you buttmunch, forward is getting this PAIN IN CONTROL!? You really think it's better to roll around on the floor screaming in agony for hours and hours but...yay, I'm super clean! If someone shot me in the lower back do I deserve pain control? Even if I'm in a suboxone program? Well kidney stone pain is freaking worse. My Uncle passed out last time he had a flare-up.

After the procedure I has intense back pain and they gave me 2 perc 10. I explained my suboxone situation and all they would do is add on an ativan.
Finally, by chance, an addiction doctor overheard and was like, there is no way any opiate will break through and I need to take at least 3 days off next time and he gave me some gabapentin, prednazone and more benzos and that was enough.

But this entire thing, while not that bad, felt like a big cluster-mess. Everyone had different opinions and no one was willing to entertain the possibility of even trying an injectable single dose opiate just one time to try to break through. When I told them what was up their faces glazed over like they were completely clueless. Pain control was not a priority there were clearly other concerns.

One person said "take 3 days off suboxone before the procedure", of course this was after I was done? I don't think 3 days would matter if they are only passing out 2 percs?

Years ago I got a dillaudid shot for a stone no problem. I cannot wait to be off suboxone. Getting pain control seems impossible on suboxone. A decent dose of dillaudid might help but being on Sub they don't even want to entertain serious opiates? If I didn't tell them I was on sub I seriously think I would have been better off?
Seriously if I had means I would 100% be buying opiates to use on the next flare-up. The system just doesn't work in this regard? When I came from the hospital the first time, if I was in the "hood" and such I would have hooked up so fast. Just to know you have the means to stop that insane pain would be such a miracle.
The ride in the ambulance was excruciating! Sharpest pain ever in the lower back and your ribs feel like they are going to explode.

Kidney stone pain is actually that bad. It's so bad that I'm now attempting to get off and be clean so those percs will work on the next flare-up.

 

[jdfisse]

It is unfortunate that so few doctors really have a deep understanding of buprenorphine. I am not a doctor and I am NOT advising you to do this, but I am advising you to run it by your doctor(s) next time. Buprenorphine has shown to have equivalent, and sometimes even superior, analgesic effects to other opioids. For analgesic purposes the dosing schedule would be split dosing, as the analgesia tends to be maximized over an 8 hour span. That is part of why the butrans patch was created.

 

[Amos2019]

I'm so sorry for what you went through, this really doesn't pertain to your drug question but I just wanted to give you some support here I went through kidney stones and I often make women very upset by letting them know that it is worse than childbirth . I hope you get your pain management under control I'm sorry the doctors treated you that way that is ridiculous!

 

[CfZrx]

Yeah, like J said, split the 8 mg into 4 2mg doses for better results. However, sounds like it's pain on a level that you need better stuff. You are the only one who can help you in this case it seems, unless you can find a doc. What about PST fellow BLers? Would that be good?

 

[cj]

Needing pain control is one of my biggest fears when it comes to maintenance

 

[CfZrx]

I in fact am in the middle of a pinched neck nerve and suboxone seems to be quite limited. However, pinched nerves are about the worst pain there is, and I recall even methadone didn't touch it last time with this same injury. I also take gabapentin. Wish the sub/GP combo worked, but alas I am in hell.

 

[Nicomorphinist]

There are some narrowly-defined cases of chronic or recurring acute pain where buprenorphine would help, basically being a partial agonist of mainly one type of μ opioid receptor and a silent agonist of the other two types of μ opioid receptor as well as an antagonist of the κ and δ opioid receptors, apparently a silent agonist-antagonist of ζ opioid receptors with no activity of any type for other systems which would help strengthen and broaden the analgesic effect: nociception, NMDA, σ receptors and so on.

Against the backdrop of this in the United States, comes now the news that pain specialists but general practitioners especially are telling their patients that their options are methadone formulated for pain control, buprenorphine skin plasters, or Suboxone (and ostensibly Subutex). . . this is apparently the last-resort political expedient that is being used when arsehole regulators are breathing down their necks.

It all reminds me of once when I ran out of hydromorphinol and morphine in Westchester County, New York . . . and even with more than 120 pages of documents including a letter in re narcotics from the Österreichisches Bundesministerium für Arbeit, Soziales, Gesundheit und Konsumentenschutz and plenty of documents which indicated tact the documentation that I had about being on 260 mg of MST Continus/Vendal q6h and injections of hydromorphinol for breakthrough pain . . . they gave me shot of ketorolac (Toradol) in the arse cheek and there was some relief of the arthritis component of the pain (hence a standing order I have at the local apotheke back home for two boxes of Toradol ampoules or phials, 23 gauge 33 mm needles and 3 cc syringes) then the nurse comes in with a single purple Tylox tablet (paracetamol with oxycodone) and a script for three more 5/325 mg tablets of that same formulation. What a joke -- I could have shoved them up my arsehole for all the good they did.

 

[CfZrx]

Yeah? So they are taking everyone off stuff like OxyContin and Dilaudid in favor of Sub, BuTrans, and Methadone? what a cool symbol you found ζ !!! Doc offered me a shot of Toradol too. It's funny when they act like it's some great narcotic,lol. I said no because I've learned that the better I feel, the worse I will feel later. Rather just approach this pain with consistent stuff like Sub. Once my pinched nerve settles down which should be in a week (right guys?) the sub is excellent at tackling my normal chronic pain from arthritic type (spondylosis wtf that is lol) issues.

 

[Nicomorphinist]

Yeah? So they are taking everyone off stuff like OxyContin and Dilaudid in favor of Sub, BuTrans, and Methadone? what a cool symbol you found ζ !!! Doc offered me a shot of Toradol too. It's funny when they act like it's some great narcotic,lol. I said no because I've learned that the better I feel, the worse I will feel later. Rather just approach this pain with consistent stuff like Sub. Once my pinched nerve settles down which should be in a week (right guys?) the sub is excellent at tackling my normal chronic pain from arthritic type (spondylosis wtf that is lol) issues.

I hear about that kind of thing happening the States more and more -- what is unclear is whether it I the insurance companies, clinic management, regulators, the doctors going down that road

There must have been some memo about trying to palm off Toradol as a narcotic . . . there was a smart aleck arsehole junior detective type doctor at an urgent care clinic I went to in 2008 with a bad flareup of be neuropathy and other trouble in and around my back, including an active case of reactive arthritis on top of permanent damage from tubercular spondylitis from 30 years before and I informed the nurse that I actually get a script for all four forms of it (tablets, cream, suppositories, ampoules) and that I am enthusiastic about that shot but in order for it to work, they must mix in dantrolene, hydromorphone, dexamethasone, and lignocaine . . . they were pretty good about it after I subtly made clear that I knew all about drugs and so forth. When I went to the emergency department with intractable shingles pain a long time ago,, they tried that but I called their bluff after they had been trying a number of things including topical C-Jam mixed with lignocaine, tetracaine, mepivacaine, and prilocaine applied with an atomiser and then aciclovir and ketamine with a brush, then a dose of hydromorphone . . . the next time I went in with this problem, a nurse who was confused by the notes first put me into a K Hole inadvertently and a couple of hours later I am given an oxymorphone-based speedball subcutaneously -- it actually did the trick . . .

 

[CfZrx]

Here I am with a pinched neck nerve realizing that I posted about the exact same problem in 2019. SO it has been 2.5 years since it hit! Haha, the historically accurate nature of Bluelight. Again, SUb is not cutting it, and my doc thinks a good old steroid injection must be done before raising my Sub dose. SO that will be a waste of effort. I have to do it though. If I am oly going to be raised a couple mg it won't matter. Maybe doubling my dose will feel nice?