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Unread 10-16-2006, 02:27 AM   #1
Suture
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Default Can I ever take opioids for pain again? YES.

If anyone needs pain meds for serious surgery they CAN use opioids short term even if they have had a history of addiction.

Everyone on buprenorphine should read this paper, print it, and give it to your contact person in case of emergency along with the PCSS mentor’s brochure.

Acute Pain Management for Patients Receiving Maintenance
Methadone or Buprenorphine Therapy
(Ann Intern Med. 2006;144:127-134)

<center>http://www.annals.org/cgi/reprint/144/2/127.pdf</center>



Excerpt.
Misconception 2: Use of Opioids for Analgesia May Result in Addiction Relapse
A common concern of physicians is that the use of opioids for analgesia in patients receiving OAT May result in relapse to active drug use. However, there is no evidence
that exposure to opioid analgesics in the presence of acute pain increases rates of relapse in such patients. A small retrospective study of patients enrolled in maintenance
methadone programs who received opioid analgesics after surgery did not find a difference in relapse indicators compared with matched patients receiving maintenance
methadone therapy. Similarly, no evidence of relapse was seen in 6 patients receiving methadone maintenance therapy who were treated with opioid analgesics for cancer related pain. In fact, relapse prevention theories would suggest that the stress associated with unrelieved pain is more likely to be a trigger for relapse than adequate analgesia.
In a study by Karasz and colleagues, patients receiving methadone maintenance therapy stated that pain played a substantial role in their initiating and continuing drug use.

CONCLUSION
Addiction elicits neurophysiologic, behavioral, and social responses that worsen the pain experience and complicate provision of adequate analgesia. These complexities are heightened for patients with opioid dependency who are receiving OAT, for whom the neural responses of tolerance or hyperalgesia may alter the pain experience. As consequence, opioid analgesics are less effective; higher doses administered at shortened intervals are required. Opioid agonist therapy provides little, if any, analgesia acute pain. Fears that opioid analgesia will cause addiction relapse or respiratory and CNS depression are unfounded. Furthermore, clinicians should not allow concerns about being manipulated to cloud good clinical assessment judgment about the patient’s need for pain medications. Reassurance regarding uninterrupted OAT and aggressive pain management will mitigate anxiety and facilitate successful treatment of pain in patients receiving OAT.

See section:
Recommendations for Patients Receiving Maintenance Buprenorphine Therapy


of course they are talking about short term treatment of pain with opioids, it doesn't mean its OK to leave the dentist's office with script for 200 Oxy 80s. The article describes various ways that physicians should treat the pain of anyone on opioid agonist therapy.
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Unread 10-16-2006, 02:41 AM   #2
TIM
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Good information, also see our FAQ

What if I need pain medication for surgery, or acute pain?

Tim
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Unread 10-16-2006, 03:15 AM   #3
Robyn
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For the record, before my surgery I was given a prescription for 12 Dilaudid for post-op pain, with the agreement I would not accept any scripts from anyone else upon my discharge at the hospital.

Now, I don't know about the rest of you all, but if this were one year ago, that Dilaudid would not have survived to be around post-op. (I had it 2+ weeks in advance). I noticed other behaviors missing, too. So sometimes when we may feel there is no progress, there really is, we just can't step back to see it.

Dixie
(who hopes to turn in most of the Dilaudid to my doctor)
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Unread 10-16-2006, 03:47 AM   #4
OhioMike
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Suture, good information for all. Sometime back my GP and I discussed my Sub Therapy, what I would achieve through it and if in fact if needed for surgical reasons, I could take pain medications as before. We decided yes.

************************************************** ********************************************
Dixie Wrote:
Now, I don't know about the rest of you all, but if this were one year ago, that Dilaudid would not have survived to be around post-op. (I had it 2+ weeks in advance). I noticed other behaviors missing, too. So sometimes when we may feel there is no progress, there really is, we just can't step back to see it.
************************************************** ****************************************

Dixie, this is the beauty of Sub Therapy. It is also why myself and my GP came to the conclusion that if needed I could take pain medication again. With that said, you can bet that if this ever occurred that I would take some extra safeguards just to be sure. I came too far to take any great risks.

Mike
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Unread 10-16-2006, 01:07 PM   #5
kirk
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all the protocols call for ceasing the suboxone and just taking the effective dose of whatever pain med your dr. prescribes. not the same with methadone.it takes massive amounts of conventional opioid analgesics to reach desired comfort level; where with subx the dose necessary will be much less.
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Unread 10-16-2006, 03:42 PM   #6
easc
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From TIP40:
"...Little clinical experience is documented regarding the treatment of pain in patients receiving buprenorphine.Pain in patients receiving buprenorphine treatment initially should be treated with non opioid analgesics when appropriate..."

Further:

"...Patients maintained on buprenorphine whose acute pain is not relieved by non opioid medications should receive the usual aggressive pain management,which may include the use of short-acting opioid pain relievers.
While patients are taking opioid pain medications,the administration of buprenorphine generally should be discontinued..."



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Unread 10-16-2006, 11:43 PM   #7
Brett
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Suture,

I had a hard time with the small print on the links so if they question was in there, forgive me for asking,
In a situation of extreme dental pain, will short acting opiates help control pain even if the patient has taken bupe the same day? Will the short acting opiate still help with the pain?

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Unread 10-16-2006, 11:52 PM   #8
Suture
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Hi Brett,
It depends on the dose. At doses near or above 16mgs. The opioids would be blocked, some doctors say if you took massive amounts of opioids you can get some relief, but it would be a lethal dose for a opioid naive person. If you were at 2mgs or even 4mgs then the opioids would not be blocked completely so you might be able top find some dose that isn't ridiculously high that would work.

PS you can change the size of the type in the PDFs there should be a window with a zoom percentage in it, just change it to a bigger number and the type gets bigger.
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Unread 10-17-2006, 12:11 AM   #9
JAT
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Suture, well said. Thank you.


Best Regards,
JAT
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Unread 10-19-2006, 12:21 PM   #10
Pattiann
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I saw my dentist a month ago regarding two impacted wisdom teeth. He told me to stop the Sub 3 days before my appt that I could then take percocett for post op pain and as I healed I could return to the sub with no problem. I do not trust that the average dentist knows enough about sub. I am also terrified of precip w/d..I therefor have put this procedure off. Also, I can't imagine going three days with NO sub..I am on 2.5mg daily but I know I need that to have a normal day. Any sugguestions? Thanks Pattiann
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Unread 10-19-2006, 12:28 PM   #11
NancyB
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Hi Pattiann, Here's a thread that might interest you, where people are talking about just taking 800mg Motrin for oral surgery.
http://www.naabt.org/forum/topic.asp?TOPIC_ID=881

Hope it helps.
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