Going off butrans = major pain

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Regular Member

Date Joined Jul 2012
Total Posts : 50
   Posted 10/27/2012 7:53 PM (GMT -7)   
Hey all -
I have been having a lot of side effects from the butrans (itchy site reactions that seem to get worse with each patch, drowsiness, general detached feeling etc) and did not feel as though it helped all that much since I still had a lot of pain so we decided to go off it. I am only down from 15-10 mcg and had one of the worst weeks in a long time. I have taken 2-3 vicodin or opana each day and have to drop to 5 for this week and am nervous about it. The plan was for me to try suboxone again this weekend (made me very drowsy but helped a lot with the pain, we were going to try only doing half a strip in am and half at bed and see if it works better that way) but I forgot I was going out of town to visit my son so I cannot try it until next weekend.
I have an adopted 13 y/o son (moved it with me when he was 10) who has been struggling a lot lately and I had to move him to a residential treatment center in another state about 6 weeks ago. Needless to say, things have been a bit stressful for a few months. This was my first time getting to visit him and it has been great to see him but I was so nervous about getting on a plane last night with how much pain I've been in. Luckily it is only a 1 hr plane ride so it was over quickly but I was dying. Have to fly home tomorrow and while I am looking forward to being home I am not excited about the process.
Anyway, if the suboxone doesn't work we are going to try a different narcotic but I forget which one. In the meantime, I am praying the opana starts doing the trick. I had to leave work early on Friday b/c I just couldn't do it anymore. I know we've all been there! Hope everyone else is having a good pain level weekend.
Chronic pain secondary to back and shoulder injuries, left humorous pain after bone graft due to a cyst, gastroparesis, migraines, depression, dry eyes
Current meds: Butrans, lamictal, remeron, lunesta, vit d, domperidone, baclofen, nexium, omega 3, PRNS: zomig, imitrex, xanax, dantrolene

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Elite Member

Date Joined Oct 2008
Total Posts : 25347
   Posted 10/27/2012 8:46 PM (GMT -7)   
Thanks for the update. Sorry you are still going thorugh so much pain and stress in your life. Just keep one day at the time attitude, and don't get overwhelmed with everything going on.

I wish you the best, and hope you make some better progress with your pain control.

David in SC
Age: 60, 56 at PC dx, PSA 16.3
3rd Biopsy: 9/8 7 of 7 Positive, 40-90%, 4+3
open RP: 11/8, Catheter in 63 days
Path Rpt: 3+4, pT2c, 42g, 20% tumor, 1 pos margin
Incont & ED: None
Surgery Failed, recurrence within 9 months
Salvage Radiation 10/9-11/9, SRT failed within 9 months, PSA 4/12 = 37.x
Spent total of 1 ½ years on 21 catheters, Ileal Conduit Surgery 9/10,
7 other PC-related surgeries
Member of Prostate Cancer & Chronic Pain HW Communities since 10/2008
“I live in the weak and the wounded” – Session Nine (Movie)

Regular Member

Date Joined Dec 2005
Total Posts : 256
   Posted 10/29/2012 3:36 PM (GMT -7)   
To be totally frank, I really don't get why doctors (the only explanation I can come up with is that they would rather give buprenorphine than other meds, and yet they don't really know anything about what they're doing....but what else is new?! *sigh*) prescribe regular full-agonist opiate pain meds, like the vicodin (hydrocodone+acetaminophen -- don't even get me started on how bad ANY dose of acetaminophen is for people with an auto-immune disease, because it depletes glutathione, an essential element of a balanced/working immune system and actually these diseases have been successfully TREATED with intravenous glutathione as well as oral N-Acetyl-Cysteine, which is glutathione's precursor) and Opana you mention....simultaneously with buprenorphine.

Regardless of the dosage of the buprenorphine or the full-agonist med(s), this is a well known fact to anyone who knows the first thing about opioid pharmacology (and that should be ALL doctors, no less one who actually prescribes any of this stuff to anyone!): BUPRENORPHINE BLOCKS ESSENTIALLY ALL OTHER OPIOIDS!

That's why it's used for treatment of recreational opiate abuse-addiction, after all! And it's even better at this than methadone (which unlike buprenorphine, I've actually tried myself and am not a fan of for several reasons including the fact that like buprenorphine, it blocks other opiate meds that many docs prescribe alongside it for pain....you may THINK the other medication is helping, but it almost certainly isn't or at least its effects will be dramatically decreased), which is part of why it's becoming more favored for addiction-treatment maintenance or tapering than methadone, even though switching to methadone is relatively simple while a switch from full agonists to buprenorphine means going into full withdrawal first or the buprenorphine will PUT you into "precipitated" withdrawal that is even worse!

This is why docs are supposed to be trained in giving it for addiction, yet foolishly, they usually aren't required to have any special training to prescribe it for pain.

So: odds are, if the vicodin and opana did you any good whatsoever while you are on buprenorphine, you are not remotely going to get the same effects at a given dose that you would if you took the full agonist pain med(s) alone.

I am not a big fan of the whole concept of using buprenorphine for pain, even though it may very well be better than nothing -- I have no first hand experience with it, and if I've learned anything during my 12-year chronic illness/pain medical journey (more like running the gauntlet), it's that you can't claim to really understand something unless you've been through it yourself.

However, there are many good scientific/pharmacological reasons to believe it is an inferior pain medication -- starting with the simple fact that it is not a full opiate receptor agonist like other pain medications. It is what's called a "mixed agonist/antagonist" and that means it is inherently inferior for pain, as well as likely to produce more side effects than any full agonist other than maybe Tramadol (which I loathe, but that's another rant entirely).

Particularly if, like you, someone were to try taking it alongside full agonists. So your patch issues are readily explainable -- I had some degree of them with multiple brands of fentanyl patch, and testosterone patches, but particularly the solid-polymer type fentanyl patches and I think the "butrans" buprenorphine patches are a similar design -- and your side effects don't sound terribly unusual to me.

Aside from my rant against buprenorphine, take heed of the fact that science says, with great confidence, that vicodin and opana are probably not going to help (and may actually be making things harder, though probably not much if at all) with your butrans taper until you're entirely off the buprenorphine and have been for at LEAST several days, possibly up to 1-2 weeks.

I may have to give the disclaimer than "I am not a doctor," but sadly through just a little effort to educate myself about this part of pharmacological science (among other things, but I've particularly focused on this topic since it is such a key part of coping with long-term severe chronic pain and dealing with doctors' massive ignorance in this area even more than most which is saying something)....in all humility, I know a lot more about this than most doctors seem to. Both from much first-hand experience and lots of reading up, Googling related terms, etc.

Clearly your pain management is not being very well handled, and you are almost certainly quite right to be getting off of buprenorphine as quickly as you can stand to taper it. But if I were you, I would try rapidly dropping the full agonists (in your case, vicodin and opana) and saving them for when you're done tapering the butrans.

If the difference between patch dosages is too big for you to switch down relatively comfortably, you may want to try talking to your doctor about the other forms of it (that would also get rid of your patch-irritation issue) which are generally sublingual, as in absorbed under the tongue. There are tablets and rapid-dissolving films.

Few doctors have any experience with their patients doing things, but with the oral forms, you can split the tablets into pieces and either oral form can be dissolved in a known amount of water to split the doses by measuring out what you need with an oral syringe and placing the water under your tongue in much the same way you'd use the un-dissolved forms -- just don't dilute it too much or it will be hard to absorb the right amount in the same way/at the same speed you would from the un-dissolved form.

Having had to taper off of various pain meds several times over the years, I don't envy what you face. Particularly with the conflict between buprenorphine and the other meds. But if it were me, I would do things in the way I described above -- don't take the full agonists until you're either completely done with buprenorphine, or at a minimum, very close to it. Any significant dose of the former WILL block the latter from binding to your opiate receptors, greatly if not entirely.

I hope this information is beneficial to you. I am happy to throw in more of my two cents if there is anything further I might be helpful with; I'll be watching to see if this post jumps back to the top of the heap because there are new replies.

Post Edited (ReactiveConstellationNE) : 11/3/2012 12:23:44 AM (GMT-6)

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