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IMDR06
IMDR06, Board Certified Physician
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Do you know how long Suboxone withdrawal can last Im looking

Resolved Question:

Do you know how long Suboxone withdrawal can last? I'm looking for a general range here so I can sort of say to myself "I know at the very least this will be over by _______ ." Also, does dependency on Suboxone, and the fact that Nucynta is offering such a large measure of relief (if only for a few hours) indicate that I will most likely be physically dependent on the Nucynta by the time the Sub. withdrawal ends if I keep taking it ever few hours? Thanks Dr. Chip. No better today, but no worse.

-Cara
Submitted: 4 years ago.
Category: Medical
Expert:  IMDR06 replied 4 years ago.
What dose of suboxone were you on?
Customer: replied 4 years ago.
Was prescribed 12mg per day but only took 8 the past month, then my pain mgmt doc advised (after I told him I wanted to get off Suboxone in favor of an as needed drug that actually helped with my pain) to cut down by half every day until I was off the Sub and onto Nucynta, which he prescribed (75mg). Of course then he promptly went on vacation and has absolutely no one covering his patients while he's away for 2 weeks.

I've been in withdrawal for 3 days and it's been almost 5 days since my last dose of suboxone (2mg). I'm sure it would have been way better to taper much much more slowly but that wasn't how my doc advised me and I made the mistake of trusting him. Now that I'm so far in I really want to see if I can go the distance without going back on the Sub and tapering slowly, only to find I still have withdrawal and go through this all over again. I take 1-2 75mg Nucynta every 4-6 hours. I am prescribed 1 Nucynta every 6 hours but since my withdrawal simptoms come back about 3 hours after a dose of Nucynta I called the Doc's office and the medical assistants said it would be safe to change to the current dose. If I were to find I needed more I might have to reconsider going back on the Suboxone because the last thing I want is to get physically dependent upon Nucynta, which would defeat the entire purpose.

Thing is, no two Sub. docs (be they pain mgt or alc/drug specialists) give the same info regarding its withdrawal potential, and with my pain doc out of town and my primary doc having had to literally google Suboxone when I listed it among my current meds, I was left with nothing but the internet for support and info. I read from several discussion boards and practically had to add anxiety attack to my list of symptoms when I read all these horror stories that would begin "it's been 3 months and every day is still worse than the last..."

I just need a light at the end of the tunnel here. I'm very strong willed, checked into detox the very day I realized there was a problem with the Norco I was initially prescribed for my chronic severe pain and never looked back. But as I've told friends, family and my fiance (with whom I live), the physical withdrawal sucks, but it is the psychological aspect that makes it a real nightmare because I can't look forward to a time when this will be over and I never know how much worse it's going to get.

Thanks,
Cara
Expert:  IMDR06 replied 4 years ago.
I am sorry you are going through all this. May I ask, what exact withdrawal symptoms are you having? Also, I suggest NOT reading chat boards, etc - people always list their horror stories and never the good stuff...

Dr. Sciberras
Customer: replied 4 years ago.
Thank you so much for your compassion. I have had a lot of bad luck with doctors over the past year and yet somehow all the docs I interact with on this site are not only qualified and helpful, but also incredibly generous with their time and patience.

I have had aches and pains and a general feeling of feverishness (without an actual fever oddly, I take my temp whenever the bad times hit), and very mild stomach upset - mostly just loos stool no real nausea so far. But the worst symptom BY FAR has been restless leg syndrome, except it's not just my legs. It feels like every nerve in my body is firing and my whole body is irritated causing me to flex all my muscles ever few seconds for attempted relief.

I asked a question toward the beginning of this ordeal and received a response from a wonderful doctor with whom I continued to communicate until yesterday. I hope this isn't breaking some kind of boundary, but in lieu of having to start from the very beginning, I'm going to copy and paste the thread of questions and responses with Dr. Chip so you can get a better idea of my situtation. Be prepared, it's long, but now that 150mg Nucynta and .125mg xanax has finally kicked in I should have a couple decent hours during which I can type back to you. Once it gets extremely bad, even a task as simple as typing is brutal. Ok, here's the scoop:
-------------------------------------------------------------------

I don't know if I should submit this to "Medical Experts" or "Health Experts" but please ONLY RESPOND IF YOU ARE A DOCTOR WITH A THOROUGH UNDERSTANDING OF THE DRUGS NUCYNTA AND SUBOXONE.

That said, I see a pain specialist who is helping me ween off Suboxone (been on for 14 months, initially to help with physical dependency on hydrocodone - used strictly for pain - and continued for supposed pain relief properties for my chronic pain), and onto Nucynta. Theoretically I will eventually be able to take Nucynta as needed, and not every day like with Suboxone. Per the doctor's instructions, I stepped down from Suboxone by half every day until I was down to zero yesterday (starting from 10mg). This pain specialist - the best around - is a doctor you have to wait at least 2 hours to see, and then you get 5-10 minutes with at most, so when he responded to my question about whether this would be too fast a taper and would cause withdrawal, he said "you will have the Nucynta, which will help with the withdrawal."

The withdrawal hit hard last night with cramping, flu like achiness, restless nerves and stomach upset. I took one Nucynta since it had been well over 24 hours since my last Suboxone and within about an hour I felt MUCH better. I tried to reach my doctor after hours but not only was he not available to be paged, but it turns out he's on vacation for two weeks with NO ONE on call for him! The dosage I was prescribed of Nucynta is one 75mg pill every 6 hours as needed. In order to fight off the withdrawal from Suboxone, I've had to take one every four hours, and the last half hour is usually a tough time. I spoke with my doctor's medical assistants who were in the office today and one of them said not only should I not get withdrawal from Suboxone (yeah right, I knew this was coming based on every message board I've ever read with anecdotal posts from people like me going off Suboxone), but if such withdrawal is experienced, Nucynta shouldn't help because it's not an opioid. I've since researched online and found that while perhaps not strictly an opioid, Nucynta does have some opioid qualities. The medical assistants did, however, assure me that taking one Nucynta every 4 hours was safe. While not my primary question, I am wondering exactly how much/how often is safe since the withdrawal is getting worse.

It sounds like maybe the most logical approach I can take is to go back on the Suboxone (I have a month's supply) and ween much more slowly, waiting to taper completely until the doctor is back in town and I can speak with him directly. My question is this: HOW LONG AFTER TAKING A NUCYNTA IS IT SAFE TO TAKE SUBOXONE? The last thing I want is to have an extreme withdrawal reaction like what happens if you take suboxone within 24 hrs of an opiate, but I don't see how I could keep from taking either Nucynta or Suboxone for 24 hours since every time the Nucynta starts to leave my system (every 3-4 hours) the withdrawal symptoms come back worse than before.

Forgive my longwinded explanation, I just wanted to be as specific as possible since we can't speak directly. I would go to my GP but as wonderful a primary care physician as he is, he - like every other non-Suboxone prescribing doc I've encountered - had to look up Suboxone just to see what it was when I listed it among the medications I'm taking. For your information, I'm also on 20mg Lexapro, 1-2 mg Chantix (trying to quit smoking, not going so well since the withdrawal hit), 20mg prevacid, the Nuva Ring, Metformin 1500mg ES (for insulin resistance/PCOS, not diabetes), and Benicar for hypertension (hopefully I'll get to go off that when I'm smoke free).

Here are the questions I need answered:

- How long after my last dose of Nucynta is it safe to take Suboxone, for the Suboxone to work effectively and relieve the withdrawal rather than bring on extreme withdrawal?

- HOw much Nucynta is safe to take how often?

- Is it safe to take these two drugs together, or within hours of each other?

Thank you!
Cara

Optional Information:
Gender: Female
Age: 35

Already Tried:
See question.

OK--I work in this area. So long as you are in withdrawal for at least 24 hours after stopping the Nucynta, it should be OK to restart the Suboxone. If you still get sick after that, you'll need to wait, say, another 24 hours before attempting the Suboxone again.


Dr. Chip

You replied
Wednesday, August 11, 2010 7:57 PM EST

But so you're saying I have to wait 24 hours from the last Nucynta? I honestly don't think I can do that. I know I'll break down and take another Nucynta, and maybe another after that if it keeps getting less and less effective in helping with the increasing withdrawal, well before 24 hours. I took the last Nucynta 4 hours ago and this time it barely took the edge off, making me wonder if the withdrawal is getting worse and worse as others have intimated it did with them. I'm trying to clarify. Will it make me sick to take Suboxone before 24 hours from the last Nucynta? My doctor's assistants kept saying it's not a narcotic, it's not an opiate. So why would it make me sick to go back on Suboxone now?

From Dr. Chip:

Sorry for the delay. Nucynta is an opiate receptor agonist, so, in essence, it acts like an opiod whether it's called one or not. It may not make you sick to combine the two, and, any moderate stage of withdrawal may indicate that your body will accept the Suboxone without a problem. It's worth a try to take the Suboxone while you're experiencing any amount of moderate withdrawal, and, perhaps, at worst, the withdrawal won't be exacerbated, just not helped very much.

From Me:

Do you have any idea how long suboxone withdrawal can last (at most)? I made it through the night with Nucynta and Advil and haven't taken Suboxone so considering I know going off Suboxone gives me withdrawal symptoms, I'd like to see if I can make it through rather than go back and have to do this all over again. I'm just terrified of how long this could last. Some of the horror storries around start "it's been 5 months and every day is still worse than the last..." I will accept your answer after sending this, but I hope you'll be kind enough to answer this last question. There is a serious derth of good pain doctors with a knowledge of Suboxone - at least in my area - who don't qualify every Suboxone patient as an addict. It is nice to get the straight story from someone who knows what I'm taking about. Thanks for your previous answers. -Cara

Dr. Chip:

OK. I run a drug and alcohol rehab, so I'm "tuned in." Let me ask first, why the switch from the hydrocodone to Nucynta?

Me:

OK, (and btw I would have "accepted" your answer already but I'm afraid it won't let us keep replying. I will definitely pay you for your time) First I was on Norco 10/325 for about three years for chronic back pain (2 herniated discs and bunch of other stuff revealed via MRI) as well as extraordinarily painful menstrual cramps (maybe due to ovarian cysts, maybe not). I never abused it and because I didn't take it every day I didn't become dependent....until May/June of 09 when I had a bout of pain that lasted weeks and weeks and I was taking the pills every day. Then I noticed I was going to run out of pills so I tried to go without for a couple days despite my pain. That was my first experience with opiate withdrawals, and it was rough. I immediately went to an outpatient detox where they recommended I take suboxone to help with the withdrawal. After about a week the doctors at that clinic said I could either taper off the suboxone or continue using it for my pain. I was scared of having nothing for pain but OTC meds that had never even touched the pain, so I went with continued use of Suboxone.

Between June 30th 2009 and about a week ago I was prescribed a dose of 12 mg suboxone per day. I didn't always remember to take all of it but I NEVER went over that amount. After suffering a pinched nerve in April I acknowledged what I had already begun to suspect, that the Suboxone didn't do much for severe. I never wanted to be on something every day anyway. My fiance and I want to have kids in the next year or two and that gets pretty complicated when you're on suboxone (i know about subutex but I just wanted off the roller coaster). I found this pain specialist who prescribed suboxone (not for me, but I liked that he had an understanding of the drug) who helped alleviate my extreme nerve pain with an epidural, and then suggested Nucynta as a way to get off Suboxone since that was what I wanted. As I said previously, he indicated that if I went down by half every day, the first day I took zero Suboxone I could take a Nucynta and that would alleviate the withdrawal. It did at first, and then it didn't work as well yesterday. This morning it has been over 6 hours since my last Nucynta and I am feeling a bit better overall with the withdrawal stuff (less of that achy, I-want-to-jump-out-of-my-own-skin feeling), but I have a MASSIVE headache which I know for sure is from the Nucynta. Occasionally I got similar headaches from the Norco back when I was prescribed those. I've taken two anvil for the headache, not wanting to take more because my liver's probably already working double time with the Nucynta.

Full disclosure: I did my share of doctor shopping when I was on Norco's because most doc's I saw assumed I was drug seeking rather than pain relief seeking. I never took them for anything but pain. I went to AA and NA meetings regularly for about 10 months after getting off the Norco and it was helpful for a time, until it just didn't speak to me. I did have a sponsor, but I gotta tell you she was more screwed up than me. I'm a huge believer in support networks and if I thought I needed more help I would absolutely go back to meetings. I don't have cravings for any type of high. I just want to control my pain without getting physically dependent on yet another drug and have to go through this all over again. Another big reason to go off the suboxone is I'm so tired of being treated terribly by doctor after doctor after counselor after medical assistant (I've been to a total of three Suboxone docs, including the one in the treatment center. The second kept moving her office and seemed sketchy so I switched to a clinic with a longer term rep.) who not only pigeonhole me as an addict, but as such, treat me as someone who is constantly on the take, always looking for a way to do something criminal. It's insane! I have had a zillion urine tests and ALWAYS test clean because I don't mess with drugs. I don't even like to drink so that's not an issue either. Smoking's my only vice but I have found that trying to quit that while suffering withdrawal is just too tall an order.

Wow, sorry once again for my lack of brevity. I guess it's just so rare to get to communicate with an actual doctor who seems to genuinely want to help and listen, rather than just box me up into some category and put me away, not to be dealt with until the next urine test.

OMG, you asked why the switch from HYDRO to Nucynta, not Suboxone! Oy Vey, forgive me, I'm working with very little sleep here. The answer is that the pain specialist seems to think Nucynta isn't AS physically addictive as hydro, and he says in his experience (or more aptly his patients') Nucynta can provide a similar level of pain relief. Ok, in lieu of writing the Great American Novel here, I'll stop typing and await your response. As I mentioned before, this highly reputable (and highly arrogant, but hey, it's the American health system, I'll take what I can get) pain specialist is on vacay for two weeks with no one on call for him. I have a therapist (cognitive behavioral, with lots of ADD/ADHD experience...did I mention I have intense ADD? Like you couldn't tell from my writing style, lol!), who I will see this afternoon, and perhaps she can recommend a course of action. But right now, if I can make it through the withdrawal I don't want to start this whole cycle over by going back on Subox UNLESS you think weaning super slowly would avoid most of the withdrawal, or if you think there is a real medical need for me to wait until my doc is back in town (provided I could even get in). Yeah, I guess I was just kidding about finishing this message a couple paragraphs ago. Sorry :)

Dr. Chip:


No problem with the novelette, and we can continue on this for as long as you like, or, if later on, you have other questions, you can just address them to me. First--my definition of addiction is loss of control. The alcoholic says, "I'm not going to drink," or, "I'm only going to have a couple today," and, then, they break their promise to themselves. Same with addicts, and if the broken promises accumulate, they have a problem. It doesn't sound like you fall in that category. Weaned slowly, there should be little or no withdrawal from Suboxone. The problem with genuine pain patients who are not addicts but who don't want opiates is what are the alternatives, and, hopefully, Nucynta will work for you (I would be a little concerned that, just like Suboxone, Nucynta may be relatively contraindicated in a woman who's planning to become pregnant, so you should check with an OB about that). The point about withdrawal is that it always everntually ends if you can hold out, and meds like clonidine and modest doses of a benzodiazipine may help. BotXXXXX XXXXXne--the alternating of Suboxone and Nucynta is worth a try, and if, after restarting Suboxone after going into withdrawal from Nucynta, all's well, then no harm's done. This is more of an educated hunch--like most of the practice of medicine--let's try this and see if it works--didn't?--OK let's try this........If that hasn't covered everything, don't accept my answer--just continue with the dialogue.


Dr. Chip

Wow, you're the greatest, Dr. Chip! If it weren't for the fact that your advice comes from an obvious understanding of these medications, I would seriously question your credentials because your attitude, the time you're willing to give me for such a low cost, and your compassionate approach is the antithesis of every experience I've had with doctors over the past couple of years. Ok, so here's what I'm thinking. Right now I have no withdrawal symptoms. I took one 75mg Nucynta a few minutes ago because if the good morning I'm having takes a turn for the worse, I'll still need to drive to my therapist in an hour and a half and that will be right in the window of Nucynta's effectiveness for me. With the support of my fiance, Ben, I have pretty much decided to stick it out as long as the withdrawal doesn't get much worse. It had been almost 8 hours between doses of Nucynta before I took another so I am cautiously hopeful that the worst is over. Do you know anything about the likelihood of becoming physically dependent on Nucynta? The pain specialist seemed to think it was a better option than Suboxone, but I can't remember if that was just because it actually helped with pain or if it's not as addictive as well. ------------------------------------------------------------------------------- Yikes, I meant to send that before my therapy appointment and even though it's been a bit better today I crashed as soon as I got home and just got up and dealt with a bit of life before I realized I never sent this. I'm sorry, I promise not to bail without paying you for all your help and time. I have taken 1-1.5 Nucynta every 5-6 hours today and once it kicks in I feel much better for about 3-4 hours. I just keep praying that I'm over the hump and some fresh hell doesn't await tomorrow. I really thought I was done with all this last year. Lovely. Anyhoo, get back when you can, but nothing urgent this second. I'll edit if anything big comes up. Thanks a million Doc, I mean it. -Cara

I just Googled Nucynta and it's listed as a Schedule II narcotic--on an "abuse potential" level with Percocet, Methadone, Dilaudid, etc. I am assuming that, for that reason, yes, it can be addictive--although, since I don't think you are an addict with the "gene" as I call it, you won't abuse it. As an opiate, though, withdrawal is a possibility. The Suboxone's Naloxone additive makes it relatively abuse-proof and also probably doesn't allow the "high" that opiates give addicts. In essence, you're trading one opiate for another, so if the withdrawal part bothers you, the potential is still there. At the same time, it's no fun to be in pain, so taking a pain medication is no sin for those with legitimate pain problems. Your option is nonnarcotic pain medication if the withdrawal potential worries you, and that might not be enough relief to make life worthwhile. I'm leaving the office for home, but, in an hour, if you have more to ask, please do.

Me:

Thanks Dr., I'm still waiting for it to kick in now. After about 6 hours without, it seems to take a bit longer to help with the withdrawal (meaning the longer I wait in between Nuc doses the longer it takes to work again). My hope is that since it's not necessrily an everyday type drug - as suboxone was prescribed to me - I'll be able to use the Nucynta as needed for severe pain, which hopefully won't last so long as to cause physical dependency. For instance, if I get another pinched nerve, I would try to get in for an epidural as soon as possible, and only use the Nucynta subsequent to the shot. On the other hand, if the withdrawal lasts much longer it will have been who knows how many days of the Nucynta every 4-8 hours and perhaps that's enough to cause the dependency I so despise. With Norco, I get it. I only ever took it for severe pain, but it had some euphoric effects in addition to the pain relief (not as euphoric, I'm told, as it is for people abusing it without any pain). I've never indulged in a mind altering substance I couldn't stop using on my own (yes, I experimented a bit many years ago in college, but soon tired of the party lifestyle in favor of an actual life), but I still made sure there were other people in my life with whom I checked in on a regular basis regarding the use of such a heavy duty drug as hydrocodone. I'll never for the life of me get why every doctor I saw for suboxone treated it as such a defcon 5 situation since it tastes horrible, didn't do much for my pain, and had absolutely no euphoric effects, unless you count the euphoria of taking away withdrawal. I always ended up feeling like I had to work so hard to prove I was doing nothing wrong that it almost felt as if I was. Of course I understand that this attitude is passed down from the DEA, whose control of Suboxone seems outlandishly hypocritical given how easily people seem to be able to get the whichever opioid they got addicted to/dependent on in the first place. The especially degrading part was that even if the doctor/assistant/counselor/urine-test-giver had reason to believe I was a full blown addict who only ever took pills to get "high," wouldn't the fact that I was on Suboxone indicate a serious resolve to be free of the drugs? Sorry, I could go on all day about the mistreatment I, and others like me, endure just so they can do the right thing. It never seemed to count for anything to any of those docs that I didn't run out of money, get in trouble with the law, or lack a source for the hydrocodone. I checked myself in the very day I realized there was a dependency, KNOWING I would have no relief for serious pain beyond OTC meds. Anyway, I can't thank you enough. I'm going to try to get through this with a minimum of Nucynta and hope I don't have to go back on the Suboxone and start this whole thing over again. You have MORE than earned the money I'm paying, and believe me I'd pay more if I could. I hope there's a way to get you again if I have more questions in this vein, but since I feel I might be (crossing my fingers, knocking on wood, throwing salt over a shoulder and spitting twice) out of the woods, I can't in good conscience keep you "on call" with no payment. I will definitely be leaving you very positive feedback so that others know you are not only an extremely qualified professional, but maybe more importantly a real Mensch (high compliment in Yiddish, though not the prettiest sounding word). Thanks again for everything, and I hope not to have to be in touch soon, lol! All My Best, Cara

Dr Chip:

Thanks for the kind words, and I'm glad you didn't think I was mishugina (got no idea how it's spelled) or a nebbish!! Seriously--let me know how you do, and if you have any other medical questions, just call on me. You're right, we don't make a lot of money on JA, but I do it more for the "fun" of it, if you will. I fully agree with you on the whole drug thing--the federal government should get out of us M.D.'s hair and let us do our job, and it's the bad apples out there that make it hard for the good apples like you to get good pain management and relief. I take comfort in my pain patients that thank me with tears in their eyes for giving them back their lives by making them hurt less. I also think addiction is a disease, and I've worked in that field for years--it's
a much more difficult disease to work with than most, but the rewards can be astronomical. Take very good care of yourself. Chip

Me:

Hi Dr., it's been incredibly bad this morning. way worse than it has up til now. ONly this second am i able to type and i'm rocking back and forth as i type - on 150mg Nucynta and whatever half of .25 of Zanex equals. I am extremely concerned about what happens in 4 hours when everything comes crashing down again. I don't want to risk overdose by taking too much Nucynta, and of course it's so new there's not a ton of info about what that dose might be or if I can even be mixing it with a small amount of Zanex. I found out Nuc has sri properties with seratonin and norepinephrin and i also take 20mg lexapro daily. this is something my happily vacationing pain doc knew, so I'm praying there's not problem there, or higher potential for overdose. I would very much like to avoid the emergency room because I can't imagine what they would do other than treat me as an addict, IF they even had anyone on staff who knew shit about these drugs. I'm sorry to keep bothering you, it's just that I can't handle telling the whole story again. Please reply as soon as possible. I wrote this yesterday when I was feeling better than today: I tried asking this exclusively of you but got another expert instead. I'm sure she's qualified but it's so physically and emotionally draining going over all the same info with someone new, plus I've developed a report with you. Sooo, IF YOU'RE NOT DR. CHIP PLEASE DON'T RESPOND. THANKS! Do you know how long Suboxone withdrawal can last? I'm looking for a general range here so I can sort of say to myself "I know at the very least this will be over by _______ ." Also, does dependency on Suboxone, and the fact that Nucynta is offering such a large measure of relief (if only for a few hours) indicate that I will most likely be physically dependent on the Nucynta by the time the Sub. withdrawal ends if I keep taking it ever few hours? Thanks Dr. Chip. No better today, but no worse. -Cara
Expert:  IMDR06 replied 4 years ago.

Nucynta does not cause physical dependency as much as opiates like Norco do, which is why your doctor probably started you on it vs. something else.

 

The withdrawal symptoms should be ending by now as it has been 5 days since you last took suboxone. however, your brain chemistry may have not had a chance to catch up yet, especially the GABA receptors, and hence thats why you feel like you have "restless body syndrome." Requip could help with those symptoms but I know your doctor is away. He/she must have a covering doctor while out, it is the law.

 

Nucynta combined with Lexapro can increase the risk of something called serotonin syndrome, but it is something very rare and usually genetically pre-determined.

 

if you are still having withdrawal symptoms, i would treat the symptoms with medications that target those specific symptoms (i.e. imodium for diarrhea, xanax for anxiety, etc) and just take the Nucynta for pain. i also am thinking perhaps the withdrawal symptoms you feel now are psychologically mediated, as 5 days into it the symptoms should have subsided. i know you read soem bad stuff online and that can play a role on your subconscious.

 

i did not realize this question was for dr. chip solely, if you are not satisfied with my answers please feel free to opt out and request him exclusively.

 

dr. sciberras

Customer: replied 4 years ago.
Nope, not mental. Totally, completely, physical. Not even physical brought on by psyche as I was shaking in my sleep, plus the symptoms didn't subside as they had with the same dose of meds the day before. I read the horror stories days ago and still seemed better the second day. While I understand that discussion boards are not the greatest place for info, I find it rather ridiculous that doctors continue to disregard such a large amount of anecdotal evidence indicating that Suboxone withdrawal can last a very long time.

While I certainly appreciate your time and effort, I am very disappointed at your conclusion because while arrived at with the best of intentions, it rather marginalizes my situation. I am not in a depression, nor have I ever had symptoms come OR go based on the opinions or experiences of others. I understand it would be no weakness or fault on my part had this ever been the case, but it simply is not what is going on. I thought the pain would never go away this morning, because I had taken the recommended dose of Nucynta and had I been experienced psychosomatic symptoms, they likely would have gone away by the time I presumed the meds would kick in.

Again, I thank you for your time, and I mean no disrespect to you personally, Dr., but of all the difficulties I have experienced in our health system, by far the most frustrating, exasperating, and more than anything disillusioning issue is that of doctors taking what they have read about drugs/disease over the word of otherwise honest and trustworthy patients.

Thank you,
Cara
Customer: replied 4 years ago.
Relist: While I'm sure she is very knowledgable and I certainly value her time and effort, This doctor's answer is based on assumptions that are simply incorrect. I applaud all of the health care professional who practically volunteer their time on this site (since their fee is exponentially lower than that of an office visit). That said, I wish more doctors gave credence to patient provided information over info from a book or pharmaceutical marketing materials..
While I'm sure she is very knowledgable and I certainly value her time and effort, This doctor's answer is based on assumptions that are simply incorrect. I applaud all of the health care professional who practically volunteer their time on this site (since their fee is exponentially lower than that of an office visit). That said, I wish more doctors gave credence to patient provided information over info from a book or pharmaceutical marketing materials.
Expert:  IMDR06 replied 4 years ago.
I am sorry if you disagree with my online evaluation (which of course in person is much preferred) but I also feel you should not make assumptions that what I advise is something I read somewhere and not have experienced. I am a licensed suboxone provider and detox physician (in addition to all the other hats that I wear) and have seen issues similar to yours often. I will opt out.

Dr. Sciberras
Customer: replied 4 years ago.
Please accept my apologies if I jumped to an incorrect conclusion, Dr. You'll forgive me if my experience over the past year on Suboxone has somewhat jaded me because of every experience I've had with the prescribing physicians and assistants either not listening, or listening and then completely disregarding what I have to say.

There just seems to be such an incredible disconnect between Suboxone prescribing doctors and the actual people who've had to suffer withdrawal from Suboxone. I imagine it is because the widespread use of the drug is somewhat new still, but I can tell you that today, day 5, has been the worst yet in terms of real physical withdrawal.

I am in contact with another expert, and will continue to do so, however if you can trust that what I'm saying is accurate and have any advice to give on the subject I will certainly accept your answer and submit payment. If not, please know that I am sincerely XXXXX XXXXX the time and energy you have given to this matter.

Thank you,
Cara
Customer: replied 4 years ago.
Btw, if you can tell me what medication helps the worst symptoms of all - feverishness and intense restless body - I will accept that answer as well. Thanks again, Cara
Expert:  IMDR06 replied 4 years ago.

Requip will help with the restlessness but you will need a prescription from the doctor. combine tylenol and motrin for the fevers. you can use your xanax for the restless feeling, although i like Requip better in this scenario. there is nothing over the counter other than mild stuff like chamomile tea, etc. - you need something much stronger i believe. perhaps if you are having such withdrawal symptoms you should go to a detox hospital where they will put you to sleep until the symptoms are over.

 

Dr. Sciberras

IMDR06, Board Certified Physician
Category: Medical
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Customer: replied 4 years ago.
Thank you Doctor Sciberras. My fiance (with whom I live) and I have pretty much come to the conclusion that until/unless the 2 Nucynta and .125mg Xanax every 6 hours or 1 Nuc every 3 hours stops working, I'm going to try to stick it out. I would be THRILLED if I thought a hospital would choose sedation until the worst is over, but outside of those specialty clinics that have people RAPIDLY detox while under sedation (somewhat controversial and I understand why, sounds very rough on the body), I fear a hospital wouldn't take that approach. I've had such challenges with doctors either not having enough knowledge on Suboxone (excluding, of course docs like yourself who are licensed to prescribe it), or who dismiss me as an addict and truly don't seem interested in helping much.

Tonight I had a little fever (99.5 but I'm usually 97.5) and the advil helped quite a bit with that, so I'm pretty much down to the restless bod. I've never heard of the drug you mentioned but will definitely look into it and if I'm not markedly better by monday morning I will get in with my PCP and hope he will help me with something for that symptom. I'll definitely mention Requip to my PCP, as I'm assuming based on your preference that perhaps it's less addictive than Xanax. I've only ever taken the smallest amount of Xanax because I'm quite sensitive to it and the LAST thing I want is yet another physical dependency to have to kick.

Incidentally, not that it should matter, but I'm not sure I shared the fact that this all started with using Norco AS PRESCRIBED for 3 years. I never abused it, only took it for severe pain, but last June my back got so bad I was taking it almost every day. The first day without the norco after being on it for so many days in a row (upwards of 3 10/325 pills per day) proved to me I had a physical dependence because there were withdrawal symptoms. That very day I checked into an outpatient detox program where I was prescribed Suboxone. After the week of ambulatory detox I was given a choice by the doctors: I could ween off the Suboxone then, and possibly have no recourse the next time the pain hit other than OTC meds, or I could stay on the daily Suboxone (12mg, tapered to 8mg over several months until last week when I weened entirely too quickly I now believe) for possible pain relief benefits.

Take away the mistreatment I received by 3 different sets of doctors/doctors assistants/councelors who constantly acted as if I was on the take, and I still wanted to ween from the sub so I could have real pain relief on the rare occasions when severe pain was involved. I made this final decision after suffering a 2.5 week struggle with the worst back and arm pain I had ever experienced due to a pinched nerve. The Suboxone did nothing for the pain, even in conjunction with advil or alleve, but of course I couldn't take an opiate while on the Sub. Then there's the fact that my fiance and I would like to get pregnant in the next year or two which gets complicated (I know about Subutex, but still I just wanted off of a drug I had to take every day that had no benefits except warding off the withdrawal its consumption created in the first place.

Please forgive my rambling, I have severe ADD/ADHD (different psychiatrists have diagnosed one or the other, but always at least Attention Deficit) and with the extreme discomfort I've been suffering, it's difficult for me to edit my thoughts at the moment. I have a question about Requip. Does it interact negatively with any of the following: Lexapro 20mg, Metformin 1500mg ER (for insulin resistance and polycistic ovaries, not diabetes), or Benicar? I'll look it up myself but I take more stock in an answer from someone who's actually worked with the drug with her patients.

Again, I apologize for jumping to the wrong conclusion, and will leave positive feedback at the end of our thread to offset any damage my earlier statement has on your justanswer rep. Thanks again for your time.

-Cara

Thank you for your continued replies. I will accept the answer you just gave, and will readily pay for any subsequent advice you may have or think of. I feel a bit better about staggering the Nucynta (75mg every 3 hours) for now. Having consulted the matter with another Board Certified Dr. who prescribes Sub and runs a drug/alc rehab clinic (so has knowledge regarding such withdrawal), I think the level of Opiate tolerance my body has demonstrated this week, coupled with the fact that no drug or combination of drugs I have taken since this began has made me even remotely sleepy, let alone depressed respiration or any other sign of potential overdose, as long as I don't increase the dosage of anything (except adding 2 advil every 4-6 hours) I will hopefully be safe from overdose. If
Customer: replied 4 years ago.
Uggh, why won't this thing let me create paragraphs on the first shot. I usually go back and edit and somehow when I do that it puts in the line breaks. I guess because I accepted your answer it's not letting me edit the above novelette, so I apologize for the difficult read. Thanks again!
Expert:  IMDR06 replied 4 years ago.
Hi, Requip will not interact with the meds you listed and it is not addictive. It is commonly used for restless legs but it has offlabel uses as I described as well.

I strongly suggest you find an osteopathic physician who specializes in osteopathic manipulation and craniosacral therapy. They know safe and gentle techniques to help your chronic back pain. My D.O. Changed my life. You can find one in your area by going to www.do-online.org or www.cranialacademy.com. Best of luck!

Dr. Sciberras
IMDR06, Board Certified Physician
Category: Medical
Satisfied Customers: 2053
Experience: Internal Medicine Physician and HIV Physician
IMDR06 and 5 other Medical Specialists are ready to help you
Customer: replied 4 years ago.
Thanks Doctor, I can't seem to remember which offlabel uses Requip has, could you elaborate? I hear you on the D.O., I recently moved to a small town to live with my fiance and found a great D.O. who is my primary care physician. I also found a phenomenal chiropractor with whom I've been making quite a bit of progress.

I suffer chronic pain from two separate issues. THe first is multiple disc herniations which can lead to sciatica, as well as other nerve interaction. When I got the terrible pinched nerve this past April I found my current pain management specialist who supplemented the treatment I was getting with the Chiro with a targeted epidural which really did the trick. So I've been ok on that front for a few months, aside from the daily back pain I live with by only taking OTC drugs. The other pain comes from excruciating menstrual cramps, which I am lucky enough to suffer only about 3-4 times a year since my OB/GYN has me on continuous birth control until there is breakthrough bleeding.

So as you can see I don't GENERALLY need to be on pain meds every day. In the case of the pinched nerve it might have been helpful to be able to take opioid pain relief because since I was on Suboxone and that wasn't an option, I was left having to take Prednisone and Methylprednisolone for more than two weeks, resulting in a number of rough side effects. One of the worst side effects was acne breakouts, and that, coupled with a lower immunity brought on by all the stress and pain I had recently endured as well as a predisposed vulnerability to Staph caused a never ending case of Staph Auralius (i'm sure i spelled that wrong), or in my case, Staph in the form of folliculitis. I have yet to get rid of that loveliness btw. So all in all, I believe if another bought of extended severe pain occurs, a drug like Nucynta could help quite a bit.

Ok, that's all for now. Thanks again for your help!

Cara

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