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Question Regarding Legality of Suboxone for Pain

JRN00498JJRN00498 Posts: 4
edited 01/05/2016 - 6:44 PM in Pain Medications
I was on 24mg of Sunstone sublingual tablets, then the films, for a total of 9 years. When my insurance changed, and I could no longer be injected with steroids every 3 months, my pain doctor dismissed me for "failure to discontinue a controlled substance I had been ordered to discontinue." The entire nine years as a patient, the Dr, and his PA both knew that I was on klonopin for panic disorder, and I was ordered not to discontinue the klonopin by my psychiatrist.
So, my regular doctor sends me to a new pain Dr solely because he prescribes Suboxone. I've been seeing this new pain doc for almost 6 months, and he keeps prescribing Vicoprofen, then Norco, and now he has me on 20mcg patches of Butrans. I am getting zero relief from these patches. Some days I truly wonder if the patch is sticking to my skin sufficiently. When I was on Suboxone, I felt normal. Heck, I asked to try Suboxone back in 2008 when the previous doc said "after avinza, we are gonna have to start thinking about a fentanyl patch, or methadone." Both of those drugs scare me to death. Even hydrocodone annoys me because it doesn't last more than 3 hrs.

So, my question is this. I know there are others here who are on Suboxone for pain. What I am looking for is some literature regarding who can prescribe Suboxone, and if they can Rx it for pain. I found a couple of sites that said it could be written for pain management, but would be considered "off-label". My thoughts on that are, "so what! It's the only thing that has worked for me." While I was on Suboxone my pain stayed at a constant 2-3. Now I can't even sleep more than 3 hours without waking up and hurting and feeling horrible. On Suboxone I was able to work (at a bank, but it was work), since being off Suboxone I have had to file for disability, and it's been a horrible experience.

If anyone here can point me in the correct direction regarding literature on pain treatment and Suboxone, I'd be very appreciative. I see my regular Dr today just to tell him that this pain management with normal narcotics just doesn't cut it.

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Here are some questions that you should answer:

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Diagnosing spinal problems can be very difficult. In many ways its like a game of clue. Especially, when the diagnostic tests come back negative – no trouble found! Then its up to the patient and the doctor to start digging deeper. The doctor is like a detective. They need clues to help them move along. So, you as the patient need to provide the doctor with all sorts of clues. That is like it is here. Without having information about a condition, its impossible for anyone here to try to help.

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  • In 2001, I was diagnosed with DDD with hernations at L3/L4, L4/L5, L5/S1, S1/2. My latest MRI said there was a benign tumor in one of the vertebrae itself. There was mention of retrolesthesis at the SI1/SI2. The herniations from 2001, by comparison to my latest MRI, seems to have gotten significantly worse as I've aged. I'm only 35 now- this is the result of a motor vehicle accident (not at fault) as well as overuse syndrome while playing baseball and lifting weights at too early of an age.
    The title shouldn't read Sunstone, either. It should say Suboxone. The first pain guy I saw gave me some shots, did a follow up, and I never went back because he was gruff and scared me. The last group I was with was great, but seemed a little over eager to do injections. If I wasn't getting Facet injections and Sacroiliac injections, they were giving me trigger point injections. That group started me on Norco 10 before progressing me to Avinza 60mg. I was on Norco for about 3 years before they introduced Avinza, and I just could not tolerate the morphine. Made my stomach feel like a brick.
    I took the first and 2nd months worth of Avinza without complaining because I know Dr's don't like complainers. The third script they gave me, I took back to their office (I would see them 1 time every 3 months, and the scripts would be post-dated "do not fill until...."). I told the PA it made me sicker than it did me good. At the time, the group I was with was just starting a study of "Suboxone as a first line analgesic" and I asked if I could try it because the PA said after Avinza we would have to consider Fentanyl patches Methadone- both of which scare the living daylights out of me. To my surprise, I had great success on Suboxone, and assumed it would be my pain medicine from now on. Well, my insurance changed, and then they kicked me out for continuing to take my klonopin, which was also prescribed because I now fear a family member will die if they get in a car and go somewhere, afraid I'll be in another accident, I'm literally scared of everything, and my fear manifests as anger and I hate it. I know I am not a really nice person when I don't take my psych meds. Yet, after 9 years, they suddenly had a problem with it. I never missed an appointment, never failed a drug test- I was the model patient except for having the panic disorder that they felt should have been cured through psychotherapy.
    I'm on disability now and it's embarrassing as heck. I'm up nearly all night because of the pain, and if I do sleep, it's for 3 hrs on the dot.
    I'm sure I left something out. If u need more info let me know!
  • And for maintenence for those who have a history of addiction.
    When used in pain management, it is for those who have a history of addiction, and at times for ongoing pain treatment when needed.
    However, when it is used for pain, it is at a much lower dose, generally under 2 mg per day total. Taken at the levels you were on, is a dosing used for maintenence in treating addiction. Suboxone has a ceiling effect when used to treat pain, meaning that higher doses do not provide more pain relief. Suboxone contains the same medication in the
    Buprenorephrine patches, with the added naloxone, so going back on suboxone probably wouldn't be very helpful if the current bupe patches aren't working.
    Suboxone doctors generally do not treat pain, although some pain management doctors are able to prescribe suboxone for their patients, so you need to find a pm doctor with the DEA "X" certification for the prescribing of it.

  • Funny you should mention the dose that I was on as being a maintenance dose for addiction. Honestly, I don't care if they treated me as as addict (without telling me) with Suboxone because it worked. However..... this is where it gets interesting.
    I won't name doctor names, or even the state I am in so as to keep this Dr's anonymity, but when the "pain management group" started, it was named "soandso Health Group For Management of Pain." The "group" was owned by two of the doctors who worked there: an anesthesiologist, and a psychiatrist. They were the sole owners, although several other Dr's practiced with them under the same "Group".
    Anyhow, about 3 years into my treatment, I began seeing more and more King Pharmaceutical reps, King Pharmaceutical brochures, and a few Ligand Pharmaceutical reps and their brochures. Then, when the anesthesiologist, who was the majority shareholder in the venture had to take time off for total hip and knee replacement, the King and Ligand reps quit showing up. Instead, I seemed to always find someone from Reckitt-Benckiser pharmaceuticals actually standing in with the dr, or pa. After about 6 months of the doc being post op (anesthesiologist), he had to sue the psychiatrist and broke off the partnership with him.
    So on the one hand we had a Dr who treated pain, and on the other we had a Dr who believed in "Buprenorphine as a first line analgesic for treatment of chronic pain." If it's okay, I can post the story written by the psychiatrist- and redact the names. If I post a link, everyone would see the Dr's name, and I don't want to do that.
    I guess I'm not sure why the low dose patches don't work worth a crap for me. I honestly thought life would return to normal after being back on some sort of buprenorphine. Needless to say, that's not the case.
    Also, I am going to update my "profile" and list what is written on my last MRI if that's OK?
  • History: Low back and left leg pain. History of multiple injuries in the past.
    Technical Factors: Long and short axis fat- and water-weighted images were performed.
    Findings: The vertebral bodies are of normal height. Mild loss of normal lumbar lordosis with subtle retrolesthesis of L4on 5, L5 on S1.
    Bone marrow signal is of normal intensity with hemangioma noted in the body of L3.
    Conus medullaris is of normal signal intensity and terminates at the L1-2 level.
    T11-12 through L2-L3: No comprehensive discopathy. No central canal stenosis, foraminal stenosis or nerve root compression. All disc spaces are well hydrated with maintenance of disc space.
    L3-L4 Mild disc dessication. Concertric disc displacementwith superimposed superiorly migrating right paracentral extrusion/free fragment with mild to moderate facet atrophy indents the thecal sac. Mildly narrows the right lateral recess with abutment and posterior displacement of the descending right L4 nerve root which is opposite of clinical interest.
    L4-L5: Diseccation. Subtle retrolesthesis of L4 on 5. Shallow pseudodisc of listhesis with annular rent and mild to moderate facet atrophy indents the the thecal sac and mildly narrows the right inferior neural foramen without nerve root compression.
    L5-S1: Moderate decreased disc height and desiccation. Endplate irregularity secondary to osteochondrosis with sterile reactive bony endplate changes. Retrolesthesis of L5 on S1. Pseudodisc of listhesis with annular rent eccentric to the left with mild to moderate facet atrophy results in the indentation of the thecal sac and mild to moderate biforaminal narrowing and abutment of the existing L5 nerve roots bilaterally and narrowing of the left lateral recess with abutment of the descending left S1 nerve root.

    1. Dominant finding is degenerative retrolesthesis of L5 on S1 with pseudodisc of listhesis with annular rent eccentric to the left along with facet atrophy resulting in mild to moderate biforaminal narrowing, narrowing of the left lateral recess with abutment of the exiting L5 nerve roots bilaterally and the descending left S1 nerve root.
    2. Subtle degenerative retrolesthesis of L4 on 5 with pseudodisc of listhesis with annular rent and facet atrophy which mildly narrows the right neural foramen without nerve root compression.
    3. Concentric disc displacement L3-4 with superimposed superiorly migrating right paracentral extrusion/free fragment indents the thecal sac, narrows the right lateral recess and abuts the posteriorly displaces the descending right L4 nerve root which is opposite the side of clinical interest.
  • All the Butrans patches provide doses under 2mg at a time (when you calculate the per hour release and account for the 48-72 hour half life). That means you are currently on around 1/12th of the dose you once were for 9 years... That's a huge drop.

    I would imagine it's pretty hard to find a Dr. to prescribe suboxone for pain given the touchy nature of the med. Since you got it once it's possible to get it again but it'd send a lot of red flags to go searching for a specific drug, especially that one and considering the fact that you've already been dismissed once for med issues. I'd settle for less if it were me. Methadone seems like the most similar med replacement given it's long half life and relative lack of euphoria, just like suboxone. If you've already taken suboxone there shouldn't be much reason to be 'scared' of those meds especially since bupe is considered to be one rung below fentynal in terms of effectiveness per mg. If anything suboxone should be scarier given the complexity of the way it works.
  • The patches are not going to give you similar feelings you are accustomed to, at the high doses of suboxone you were on for such a long time.
    I think if I were you, I would stick with the patches, and give your body some time to acclimate to this dose,and try to keep an open mind.
    The length of time and the dose you were on previously will likely give the impression you were being treated for addiction, and the added dismissal is going to work against you, so I would give serious consideration to sticking with your current treatment program and perhaps consider a consult or two with a surgeon to see if he thinks surgery may be necessary.

  • April468AApril468 United StatesPosts: 1
    I am starting suboxon for pain. This Friday!! I was on it yrs ago and I felt normal.  I could do the regular things I needed to do. But then I had to have surgery.  So back on the pain meds. I have begged my doctor to give them to me. I don't have the energy to do anything on the pain medication.  I have gained 55lbs. They had to go. 
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