Bupe Zubsolv and Percocet for Chronic Pain

[perkygay]

I hope I've found the right forum and am clear to post my own topic instead of being meant to be in a megapost. I read the rules and such but I'm on mobile so the site's a bit confusing and I may have missed something. And I'm sorry this is long lol but I just wanna give some background on my situation

Hopefully this is coherent as I'm writing this at nearly 3 am.

I've had chronic pain from a T5 fracture(2015, but it's permanent), sacroiliitis, fibromialgyia, just general high impact sport damage, chronic daily headaches and semi-regular migraines, and suspected endometriosis. I was on percocet for about a year and a half. My doc tried to wean me last fall but I tolerated it horribly, so last month he switched me to Zubsolv. He started me at 2mg but said I could take up to 4mg. I took 2 to start with but it did next to nothing so immediately the next day I upped it to 4 with still no greatly noticeable effects. I felt like I might as well have not taken it at all, if not for the withdrawals I'd have without it. He upped it and now I'm taking 6 mg and feeling its effects slightly but it's still not even close to a actually managing my pain. I don't believe my doctor would even consider the possibility of putting me on 8, as he was very reluctant to even prescribe the 6.

What absolutely baffles me is the morphine equivalent. He said that 8mg buprenorphine equals 200 MG of morphine! How the hell does that even work? I have a little opiate tolerance, as I used to take 20mg perc twice a day, but I'm pretty sure if I took that much morphine, I would die lmao

So I wonder, why are the effects so weak when it's supposed to be so potent? How and why is the pain relief so poor?

That's actually just an extra question, not what I came to ask lol. Anyway, what I read about buprenorphine & suboxone is that since it's an opioid that attaches slightly differently to your receptors, your body doesn't become as dependent on it as opiates, you can take less of it and still have a strong effect, and there's much less of an hyperalgesic affect. My doctor really sold me on it, but then at my next appointment he told me that in fact it is /exactly/ as habit forming as any opiate, and that it can reduce hyperalgesia but how much can vary, and then of course as I stated before, the lower dose does not give me more relief than a higher dose of another opiate.

I really only agreed to trying Zubsolv because I was under the impression that it would both continue to help my pain about the same amount as the perc, and mainly, make it easier to wean. But neither of those things are true; it seems my doc seriously mislead me. So I'm wondering, what's even the point?

I know there is a ceiling for it so I'm wondering if a higher dose would even increase the effects at all? What is the max dose prescribed before it becomes dangerous or just stops increasing in strength altogether?

I am allergic to all nsaids that I've tried so far, which has been several, including Toradol, which I mention specifically only because doctors have tried to give it to me despite my allergy because apparently it's slightly different than your average nsaid. I'm also allergic to acetaminophen, another reason I needed to get off the percocet.

So I'm super fucked when it comes to controlling my pain. I used to pop excedrin like candy, but somewhere along the way the allergies started and now I can't have a single OTC pain killer. Only two doses is all it takes to make me break out in a rash you would not believe. So the only things I can ever take now for pain are opiates/opiods, gabapentin(which is helpful enough to be worth taking), and tizanidine(which really doesn't help much, it just makes me sleepy)

I have also tried mj, medical grade, with no luck. It just makes me sorta tired and boosts my depression and anxiety. It feels like my body is like, sorta paralyzed and out of control; It feels like I'm mostly sober in my head but trapped in my fucked up body and unable to escape. It's overall a horrible experience, even when I only take a small amount. It's very disappointing, because I really looked forward to a safe, natural, and even fun analgesic, and then when I finally tried it, it just made me worse. Someday, though, I'd like to try different strains, but I can't really be choosey in a state where it's illegal lmao

I was really counting on the Zubsolv helping me wean and reduce my tolerance so I could eventually take opiates again at a lower dose (that doctors would be more agreeable to) and have them be effective. The issue is that the pain, while fluctuating and always increased by activity, is always there. I wake up with it, and I go to bed with it. It is debilitating, so managing it is the paramount goal in my life right now.

Will Zubsolv lower my opiate tolerance, or in fact raise it due to the high morphine equivalent? And if I end up changing meds again, how long after a Zubsolv do you need to wait in order for something like oxy to be able to attach to your receptors?

I would not mind if I had to take oxy until I can get stronger and find another effective course of treatment. The worst side effect for me is constipation, but it's controllable. Otherwise it doesn't interfere with my life. But no, doctors are much more concerned about potential addicts than helping disabled people with their chronic pain smh

The hardest part is... well, I'm only 18. The things effecting me supposedly just shouldn't be, or should've been completely healed by now(wrt breaking my back & sports injuries). Docs see that, plus illnesses many people still think are totally fake anyway(like fibro and endo), plus plus allergic to OTC pain killers as an excuse that I don't have any other options than opiates, and by the time they enter the room for the appt., they have already made up their mind as to who I am and why I'm there.

The very last visit with my pain management doctor, he suggested seeing a psychiatrist to learn techniques to ~cope~. I've had lots of mostly terrible experiences with mental health professionals, but even aside from that, I'd really rather continue trying to find something that actually kills or fixes the pain instead of trying to accept it and just "deal" with it. I feel like by saying that, he's both confirming that he doesn't really understand just how much pain I'm in, and also that he's running out of ideas of how to treat me and that's very worrisome.

This is actually still far from my entire history of illnesses lmao, but I wanted to cover things that give context to the situation. I tried to narrow it to only the most relevant things but I'm sorry this is still so long. I'm also not sure if I'm allowed to talk about more than one drug in one topic so, sorry if that was a rule I missed.

Many thanks in advance to anyone who made it through this essay!

 

[LucidSDreamr]

What absolutely baffles me is the morphine equivalent. He said that 8mg buprenorphine equals 200 MG of morphine! How the hell does that even work? I have a little opiate tolerance, as I used to take 20mg perc twice a day, but I'm pretty sure if I took that much morphine, I would die lmao

So I wonder, why are the effects so weak when it's supposed to be so potent? How and why is the pain relief so poor, and there's not even an inkling of a high?

Ive been through years of chonic spine pain and spine surgery so heres my answers and two cents.

I'm not sure which conversion between morphine and bupe your doc was using. But I will tell you that while bupe is extremely strong by mass and long lasting, in terms of analgesia it sucks. 10 mg of hydro would do more for my pain than 2-8mg of bupe ever would, although it wouldn't last as long.

If you have legit breakthrough pain having you on bupe is stupid in my opinion. It will just jack up your opioid tolerance like a bitch and not provide you with the same analgesia that oxy or fentanyl would give...making it so that if you ever get switched back to oxy you will need so much more than they will give you that the pain will still be there.


You mentioned that you don't thing subs are as addicting. I disagree. suboxone is extremely hard to get off of. Put it this way. I cold turkeyed opiates two different times after years of dependency.

The second time I tapered down to 3 mcg per hour of fent then jumped off

The first time I tapered down to like 0.1-0.2 mg of suboxone per day then jumped off

coming off of the suboxone was much worse and longer lasting. These weren't awfult withdrawals due to how low I tapered. But i definitely feel like subs have a stronger grip on you dependency wise than full agonist short acting opioids like fentanyl



As for the optimum sub dose for pain, its 2 mg. At that dosage the ratio of norbupe (full opioid agonist) to bupe (partial agonist) is such that you get the most of the full agonist metabolite norbupe binding. Start going higher and the bupe/norbupe ratio becomes higher and bupe blocks all the norbupe from binding (since it has a stronger binding affinity) and you get shitty partial agonist analgesia.


I can't imagine being 18 and going through chronic pain with the state of pain treatment the way it is, no wonder they put you on such a shitty drug like bupe, they probably don't believe you. Have you had surgery? If its that bad I would reccomend it...even if surgery doesn't work, once you are in the post-op class of patients painkillers are much easier to get with surgery on your record...other wise they assume it must not hurt that much if you aren't willing to go under the knife.


also you may want to try adding lyrica into your regimen. It does help with the analgesia at a high enough dose.

 

[perkygay]

That's absolutely ridiculous. I knew it was clearly not a good analgesic the moment I started taking it, but I had no idea it was that useless. Then once I learned of the morphine equivalent, I also suspected that it might actually increase my tolerance instead of lowering it, and the doc was already resistant to my original dosing(10mg four times a day, but instead I took 2 pills for 20mg twice a day) so now I'm extra extra fucked if I ever need to be back on oxy because he absolutely will not increase the dose.

Oh no, I realize now that suboxone and bupe are as hard or even harder to get off of. I know now, but I didn't at first since originally my doctor explained it in such a way that made it sound like it caused less dependency. It seems that my doctor has just flat out lied to me, repeatedly. It's possible he's just ignorant, but in all likeliness he knew damn well what he was doing and he's just being negligent with my care.

Okay, alright... so if I'm understanding you correctly, higher doses of bupe are actually less effective as an analgesic? Yet another thing my doc was wrong about or didn't tell me. He upped my buprenorphine to 6 with the explanation that it would be /more/ effective. Goddamn it.

Also, what is norbupe? I know next to nothing about the biology of all of this, sorry lol

I was at different pain clinic to begin with and, if you can believe it, they were even worse. Extremely strict with the drugs, with pill counts and urine testing every single visit. The PA was a massive ass, and I was almost exclusively treated by her at my appts, with the actual doctor, who was equally awful, only occasionally popping in near the end of appts to repeat the same shit I'd already heard from the PA earlier that appt, and the appt before that, and the appt before that, and... You get the picture. They were rude and wildly unprofessional, including but not limited to multiple incidents of the PA "commenting" on my hair and clothing, and once the doctor just left early without notifying patients! They were condescending, they rushed the appts, and they clearly did not believe me. Their in house psychologist was pleasant enough, but was simply bad at his job.

One of their doctors who did procedures, such as my facet joint injection tests and SI join injections, was uncaring and caused me a shitload of pain during the procedures. I have a high pain tolerance, but the intensity of the pain he inflicted during those procedures (that were described to me as being "a bit uncomfortable") was unbelievable. If the PA and doc did believed me any bit before, they certainly didn't after the facet tests gave me no relief, in addition to my MRI results coming back nearly normal. After that they didn't explore any other options to fix or control my pain, other than PT, which I was doing at the time with minimal improvement. They gave up trying anything since they decided I was faking. Why bother treating a drug seeker who doesn't even have any pain, right? So, I didn't stay there very long before switching clinics.

So I went to the new pain management, and at first I really liked my doc. They weren't near as strict, with no drug counts(unless you needed a change before emptying your prescription) and less frequent urine tests. I was treated by the doctor at every appointment, he didn't rush me, and he was willing to put me on the muscle relaxer and increase my gabapentin. He continued my SI injections, which I received under sedation, something I wasn't even offered at the old place. He seemed to be genuinely interested in helping me, and he seemed to believe me.

After a few months with him, after I'd had a fair amount of sessions with their DO under my belt, he started weaning me off of my perc. Slowly and carefully, still seeming compassionate. But, since my original dosing wasn't even completely managing my pain, obviously lower doses were even worse. I reinjured myself in October of last year and he bumped my dosing back up from the weaned dose to 10mg three times a day. I stayed on that up until last month, not including unrelated hospital stays and a surgery(although the way they treated me regarding my pain management was abominable. They cut me off cold turkey while I was admitted, before the surgery, because it /might've/ caused my issue. That's a whole other can of worms, though)

I can't imagine being 18 and going through chronic pain with the state of pain treatment the way it is, no wonder they put you on such a shitty drug like bupe, they probably don't believe you. Have you had surgery? If its that bad I would reccomend it...even if surgery doesn't work, once you are in the post-op class of patients painkillers are much easier to get with surgery on your record...other wise they assume it must not hurt that much if you aren't willing to go under the knife.


also you may want to try adding lyrica into your regimen. It does help with the analgesia at a high enough dose.

I haven't had back surgery as there's no apparent reason to, that I know of. It's at least never been suggested, although that may be in part just because I'm so young. I have the sacroiliitis which is treated with injections and exercise(which my pain limits greatly), and then the permanent fracture site in my back, but to my knowledge there's nothing to do about that. When it happened, the doctor at the ER said that it could cause every now and then but likely wouldn't affect me at all after the initial healing period. Yet as I'm sitting here on the couch, typing this, it's just seering pain in between my shoulders and radiating up my neck, out to both my shoulders, and down my entire back into my tailbone. And this isn't even breakthrough pain, it's just standard.

My mom actually takes Lyrica and I've wondered about that before. I used to take Symbalta for fibro pain but I went off of it for a while when I was in and out of the hospital, and when I started it up just last week, it turned out that I'd developed yet /another/ allergy, so I can't take that anymore. I will definitely look into Lyrica some more.

Thank you so much for your comprehensive reply, I really appreciate it.

 

[aspiringchemist]

I was born with congenital defects to my lumbar spine causing sacroiliitis, issues with facet joints, severe degenerative disc disease, severe arthritis, and some bulging discs in L3-L4 region.
I am in my late 20's and have multiple imagines, xray and mri, going back a decade.

I've tried the various injections. The docs will not give me opioids due to my remote history of abuse, also likely my age as well.
I was an IV opioid addict about a decade ago - heroin and morphine mainly.

Being young and in chronic pain in today's climate is a very poor position to be in. I have fought tooth and nail to get help and typically end up with an opioid dependency diagnosis and a doc who won't Rx anything. I've gone through multiple doctors and always feel judged, labeled, and disbelieved. They cannot deny the back pain as the images clearly show malformations, however, they all downplay it. I've had some pain docs go as far as to tell me that there is no way I would feel pain from my spine.

good luck in your continued fight for appropriate care.
Too bad marijuana doesn't work for ya, but it's just another barrier to recieving pain mgmt (due to UA) so you're a step ahead without it in that respect.
Though I do believe it is highly medicinal, pain relieving or not.

Low dose bupe can be beneficial due to the long duration of action, but as others have stayed, it provides poor pain relief in general.

norbupe is the major active metabolite of bupenorphine with a high affinity for mu receptor and partial kappa receptor.
the more you bump the dose up, the more the antagonistic properties present, leading to less pain relief.

and yes, the way things are today, doctors are in fear of their licenses. The DEA has waged war on narcotic and benzodiazepine prescribing.


gabapentinoids are said to be highly beneficial for neuropathic pain. Cymbalta is in a different class of medication than Lyrica.
Gabapentinoids include:
- gabapentin (Neurontin)
- pregablin (Lyrica)
- phenibut


I do not receive pain relief from gabapentinoids, though many do and they work great to synergize/potentiate opioids.

have you looked into kratom at all?
This helps many people in their search for pain management.

My wife was finally successfully diagnosed with endometriosis some years back after years of agony. I'm sorry to hear you may struggle with this disease. It is truly painful. I watch her suffer monthly, she too recieved oxycodone TID for this; of course, this is now discontinued and she does not have any pain medication.

 

[LucidSDreamr]

I hate to say it. but how bad the situation is for chronic pain patients...if you can get legit non-fentanyl heroin and have the discipline to not abuse it and only use the amount to treat your pain...its a better way of life than going with the system. been there done that. I finally found a legit highly skilled doctor that believe me (after surgery), he gave me fent and experimented with injections till he found the angle that gave relief...the injections hit or miss and have to be perfect....they take trial and error on the part of the doctor to find the right spot.

its up to you to get educated on spine anatomy and injections so that you can give the doctor input on a "scientific" level...most of them are too busy or just don't care enough to accomplish success with injections on their own, its really up to you to find out exactly what they are doing, learn the language the anatomy etc....its what helped my doc finally get the right spot. I had had so many injections over a decade that never did a damn thing...and finally me and my doc were able to find the right way to do it...he wouldn't have accomplished it without my input and research either.

btw...weed never did anything other than amplify my pain. I have wrist problems also and on the occasion i smoke the pain flares up like clockwork

 

[CfZrx]

Many thanks in advance to anyone who made it through this essay!

Hey PG, my pain dude tried to get me approved for expensive Butrans. My insurance said no, so he tested my DNA and found that I would have a hard time metabolizing methadone. This meant that 5 mg 3X day would eliminate my pain. I'll be damned! It works so fuckin good. I used weed with it for awhile and that was Paradise for my pain at least. Like u I didn't relish the buzz from THC much. I quit the weed because I work in the substance abuse industry and can't be baked while facilitating groups etc... Try to get into a methadone program is my advice. Then try to let them give you your doses twice a day since Done only has about 6-8 hrs analgesia. good luck young PG.

 

[CfZrx]

Even dosing once a day is enough though. I found that once the Done soaked into my bones and every other cell of my body, the general level of pain lessened substantially. I can get good pain coverage even if I just take my 3 5mg pills all at once around noon It's a wonder drug.