Location: Dubrovnik, Croatia & Washington, DC area
Hi all, I am wondering if anyone has tried the buprenorphine patch for chronic pain?
A but of background... My wife and I have a vacation home in Croatia and often spend a lot of time there. I find it very relaxing... Anyway, I have always traveled back to the US for visits with my PM and other physicians. It turned out that I was in a lot of pain one evening while in Croatia. I had never experienced the "medical system" here and was hoping to ride it out. Unfortunately it didnt happen that way. I got very sore, began vomiting and going in and out of consciencness - scary. So the wife brought me to the hospital. We carry doc notes and such just in case, and they were quite helpful. They called in a neurologist (from home) at like 11 pm. They worked through things and eventually said I was anemic - hmmm.
Anyway, he was blown away at the amount of narcotics I was on for chronic pain. He quickly got concerned and wanted to call my PM in the US to find out what he was thinking... In the end they discharged me and gave me a bunch paperwork to give to my doc. This neuro wanted to switch me to this Buprenorphine patch and said it could cut back 4 or 5 meds I was on. I said no claiming the contract thing and and a bit shaken that this big balkan wanted to "cure me on the spot".
When i got to the US I gave my doc everything and mentioned this med, he said NO, only for addics - absolutely not. I was scared to bring it up again. But I often hear about it and wonder why such a stigma? I am not coming down on my PM, he is amazing. I can ask for anything and get it if needed. He has always listened and seemed to care. I thought his reaction was a bit strange though, anyone else experience this???
Buprenorphine (bup) is a mixed agonist/antagonist, very different from morphine and other "full" agonist narcotics. Full agonist drugs like morphine have no ceiling and doses can be raised to match the level of a patient's pain, or until the side effects become intolerable. With bup the dose can only go so high. Being a mixed agonist/antagonist, giving bup to a person who's been taking morphine or other similar drugs around the clock for a time will send them into withdrawals immediately. The bup wants to occupy the same receptor(s) that morphine wants and it kills the morphine therapy on the spot. In detox, bup is used to detox folks off of morphine like drugs. Since it is a partial agonist at the mu receptor (which is host to morphine, oxycodone and such) it is useful for pain management but its ceiling can become problematic. With meds like morphine the doc can raise one's dose w/o limit, whereas with bup there's a limit.
Lately, they have begun using buprenorphine like they do with methadone maintenance for addicts - the patient cannot get high off of regular narcotics while taking bup.
Most docs don't recommend buprenorphine for pain management because of the ceiling. If a patient can get by below the ceiling then it can be an excellent medication for pain.