... She has a problem this week with her siatic nerve. Besides bed rest for two weeks, should I ask her prescribing doctor to up her subutex. She is in horrific pain.
I cant answer your question, but I'll be real interested to watch the responses. I also have sciatic nerve pain plus 7 other pinched nerves in the leg area and fibermialgea. I've been on a heavy pain med regimine for 7 years and that has come to a fast halt, so now I'm fighting to find a doctor who is willing and able to put me on the sub program. I'm seeing one on the 18th of April. I've been trying since Oct. to see a doc. that can prescribe this for me. I was #40 on a waiting list and also on a cancelation list. I had no hope for the waiting list. The nurse admitted that could be a year or more, but fortunately there was a cancelation and I got a call. Now I hear that they don't automaticaly prescribe this. I guess you have to meet a certain criteria. That scares me to death because if I cant get this help, I'm done. I've suffered so much since Oct.
but the thing that keeps me going is the idea there may be light at the end of the tunnel with this program and also some friends helping me now and then with a pain med or two, just at the time I feel I cant take it any more. I'm 61 yrs old but I live with my mom, and your letter reminds me of her. She is so worried also. I'm sure your daughter is younger, but my surgery came when I was 54 that caused all this. I never knew what a pain med was till all this, plus the grief I was going through at that time also because my husband passed away at the same time, and I noticed how the pain meds were helping me in that area alittle and I swear, I grabbed hold of that like a life line, which it actualy was. Now I'm paying, but I wish I knew the details on getting in this program. Mabe you could give me some info on this. I really dont know what all this is or how it works. All I know is that its supposed to help and Ill do any thing, but live the rest of my life like this. I havnt even been able to open my mail since Oct. 2010. So good luck to you and your daughter. I know what she's dealing with as far as the sciatica goes. And its hard on you also, wanting to help and not knowing how. I too am a mom. I didn't mean too make this all about me and I'm sorry I couldn't help you but I related to your letter so much. I'll be watching, and mabe you can give me some insight on what I should do.
Thanx for your time.
probably the best thing to do is give the doctor a call and inform him of how long this has been going on and then he will be able to decide what is best to do, he may need to see her and evaluate her and give her something that she may be able to tolerate with the subutex, but I think with it going on for a while he needs to know about it and then he can possibly see her and make a decision. best wishes,
First, let me explain that there are three forms of buprenorphine (the active ingredient in Subutex) that are prescribed for different purposes as follows:
Treatment of opioid dependence (tablet); for the relief of moderate to severe pain (injection); management of moderate to severe chronic pain in patients requiring a continuous, around-the-clock opioid analgesic for an extended period of time (patch).
Then the treatments have different dosages. The dosage for injection is as follows:
Moderate to Severe Pain
Injection Adults and children 13 y of age and older
IM/IV 0.3 mg deep IM or slow IV (over at least 2 min) injection at up to 6 h intervals, as needed. May repeat once (up to 0.3 mg) 30 to 60 min after initial dosage, if required. Single doses of up to 0.6 mg IM may occasionally be necessary and should only be given to adults not in a high-risk category.
Dosage for the patch is:
Transdermal Initiate with 5 mcg/h in opioid-naive patients. Dose may be titrated to the next higher level (max, 20 mcg/h) after a minimum of 72 h. For nonopioid-naive patients whose daily dose was less than morphine 30 mg orally or equivalent, initiate treatment with 5 mcg/h. For patients whose daily dose was between 30 and 80 mg of morphine equivalents, initiate treatment with 10 mcg/h. Buprenorphine 20 mcg/h may not provide adequate analgesia for patients requiring more than 80 mg/day of oral morphine equivalents. Each patch is intended to be worn for 7 days.
And the dosage for opiate-dependence is as follows:
Tablets Adults (16 y of age and older)
SL 8 mg on day 1, followed by 16 mg on day 2; from day 3 onward, patients should receive buprenorphine/naloxone at the same buprenorphine dose as day 2. Usual maintenance dosage is buprenorphine 12 to 16 mg/day. Treatment should begin at least 4 hours after last use of heroin or short-acting opioid, preferably when first signs of withdrawal appear. Titrate dose to clinical effectiveness as rapidly as possible to prevent unnecessary withdrawal symptoms and patient drop out during induction period.
With all that being explained please note that the dosage of buprenorphine for pain is much lower in the form of the injection and the patch while the fodage for opioid dependence is higher and in subligual pill form. Also, please note your daughter is on the maximum dosage of buprenorphine.
I share all this to say finally that I would not recommend any higher dose of buprenorphine then the 16mgs she is on now.
May I recommend that your daughter try some physical therapy (PT) for the sciatica pain. They will perform necessary stretching and strengthening exercise plus application of heat and/or ice to alleviate the pain. You will have to have a doctor's order to get a PT appointment. Otherwise there are other pain medications that are not opiates that may help the nerve pain such as Lyrica or Cymbalta. You would have to discuss these with the doctor in order to get a prescription.
I have written a book here, but I thought I needed to explain everything to you. Hope this helps,
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