Author: txgemini
Posted: Thu Jun 23, 2011 10:26 pm
Skip to para. 5 if you just want surgery details. Bkgd:
I’d been on subox for almost 2 yrs from chronic sciatic pain from a past l4/l5 herniation. It was working fine but I had concerns about having w/drawal symptoms which I never experienced on Norco. I’d let my doc talk me into subox b/c he was convinced that I was hooked on the Norco even tho I’d been on 3/day for years, but since I couldn’t function w/out those due to pain, he said I was addicted. They said "stop the norco and start taking subox when you go into w/drawal." A week later I called and said I wasn’t in w/drawal but certainly in a lot of pain, and they said start subox. The first time I tried to taper, I experienced real opiate w/drawal for the first time and went back to him very angry.
On take 2, I was down .5mg / day when I herniated my L3/4 disc. My doc refused to change my med regimen to treat the acute pain. He said take more suboxone and then go off it 24 hrs before surgery, that they’d done it many times for their patients and everything was just fine. I had to wait a month for surgery and I got up to 5-6 mg/day w/little relief. Finally, about 5 days before, I went through illegal channels for Norco, stopped Subox and experienced mild w/drawal and total pain relief.
My surgeon hadn’t heard much about Subox but what he’d heard wasn’t good. I sent him that article I found in here about the research paper on subox and acute pain and asked him to talk to his staff about potential issues. He was very concerned and nice but there was only so much he could recommend, but he did get the pain doc to agree to let him handle my pain meds until I was fully recovered.
I went into surgery determined to never take subox again. I hoped I could somehow taper off the pain meds Rx’d by the surgeon, ending up free of everything. I was guilty about "cheating" but hopeful that it would make things easier during my hospital stay. As it turned out, I can’t imagine how much worse it would have been if I hadn’t.
I woke up from surgery screaming, to the shock of the surgical team. I was given Dilaudid and intravenous acetaminophen and it got me to just strong wincing. From that point, the doc had ordered 10 mg percocet every 4 hrs, which handled the pain fine, but I was constantly in w/drawal. The nurses would not give me any more percs due to APAP toxicity risks, and they wouldn’t give me any alternative. The reality is that once a doc writes orders nurses are legally and ethically bound to them, and many hesitate or are forbidden to call docs to modify meds for non-life-threatening situations. They probably won’t have been briefed on the conversations you had w/the docs, it may be really busy during their shift, they may have biases about pain meds or difficult patients. I was lucky to have sweet nurses who listened to my situation and did everything they could w/in their limits.
I talked to the surgeon before I left, and his team’s consensus was that I should not torture myself by trying to get off Subox and heal at the same time. They seemed shocked at my pain doc’s approach and advice.
WARNING: IF YOU HAVE OPIATE ADDICTION ISSUES, SOME OF THE FOLLOWING MAY BE TRIGGERING
Once I was home I managed my own dosing with the goal of managing both pain and w/drawal w/the fastest possible taper. I only needed a perc Rx for a week and one for norco a couple of days after that, and continued to avoid Subox. Two weeks later, it’s clear that my surgery has been successful – even the old chronic pain is gone – so there’s no reason to take ANY pain meds. However, even with NO PAIN I’ve had to go back on the Subox to avoid w/drawal. I’m on 1mg/day and planning to get off as quickly as possible. It’s so clear to me that this doc is in it for the $$ and has no interest in real pain mgmt, or in me.
I have a friend in the public health sector who has given me a promising taper plan, including supplemental meds (not controlled substances) which lessen w/drawal symptoms during the first 2-3 weeks I get to zero. I’ll post those results in a couple of months and I hope it’s a better story than this one.
If I had it to do over again, I would:
1. Demand treatment for acute pain sooner, with medical articles and references to back me up, and stop Subox as far in advance as possible. Possibly raise pain mgmt w/the surgeon earlier too.
2. Work w/the surgeon to come up with a plan in writing for the hospital stay, including contingencies for bad results, so that nurses or others "out of the loop" during planning have easy info.
3. Probably break the law if I had to. It’s sad how all the DEA, regulations, etc. have made good people have to do bad things to manage their own health.
I hope this helps you more than scares you. Speak up for yourself.
