Discussions that mention suboxone

Pain Management board


There are many opiates that can be used:
Long acting or sustained release: morphine CR (Avinza, Kadian, MS Contin, Oramorph), methadone, levophanol, oxycodone CR (Oxycontin), oxymorphone CR (Opana), buprenorphine (Suboxone, Subutex), fentanyl transdermal (Duragesic)

In addition there are several short acting drugs: oxycodone, oxymorphone, hydrocodone, hydromorphone, tramadol, meperidine, propoxyphene, morphine, codeine, dihydrocodeine, pentazocine, fentanyl transmucosal (Actiq), etc

If he has tried a number and had intractable side effects then he may be a candidate for a pump. The only way to find out for sure if one is to have side effects with a pump is to have a intrathecal catheter placed for a trial. Most doctors do these as inpatients, but some now do them as outpatients for 4-14 days. Be careful not to let the pain doc do a "one shot" trial where a single shot of morphine or hydromorphone (dilaudid) is given...this does not tell whether there will be any significant and sometimes pump limiting side effects on day 2-4 of the trial.

There are two types of pumps: constant flow (Codman3000 and Medtronics Isomed) and programmable (Synchromed EL and Synchromed II). Both are very useful but the constant flow pumps rarely require replacement. The Codman is easier to fill, but has a bump on the top that can cause erosions of the skin. The programmable pumps require replacement every 5-10 years. The Synchromed II pump has available as an accessory a bolus device where the patients can give themselves a bolus or extra shot of medicine a couple of times a day, thereby eliminating all oral medications.
Both constant flow and programmable (can go up and down during the day to match your activity level through pre-set programming) contain freon gas that pushes against a chamber containing the drug. The programmable pump then uses a rotating pump to slow and control the drug delivery while the constant flow uses a coiled internal catheter, whose length determines the flow rate. The pumps explode during cremation, so removal is advisable after death if cremation is in the works.