In a perfect world, an individual being treated for their opioid addiction would never have to encounter a situation in which they would need to experience pain. However, as we all know situations like these arise all the time whether they are planned (such as an elective surgery or dental work) or unexpected (such as a motor vehicle accident) and pose a challenge in regards to achieving adequate pain control. And unfortunately, there are no strong guidelines available to help with management and most recommendations are based on expert opinion and clinical experience. As a result everyone is going to be a little bit different in regards to their pain management plan and there is no right or wrong answer when it comes to selecting a plan.
What Are My Choices If I'm On Buprenorphine
For individuals maintained on Suboxone (Buprenorphine-naloxone) for their opioid addiction, the following acute pain management approaches are based on the current available literature, pharmacologic properties of Buprenorphine, and the published recommendations from the Center for Substance Abuse Treatment and the Substance Abuse and Mental Health Services Administration (SAMHSA).
* Continue your current dose of Suboxone and add an additional short-acting opioid on top of this such as hydrocodone or oxycodone for additional pain relief
* Continue your current dose of Suboxone or increase the dose temporarily up to a total of 32 mg per day and divide this dose to be taken every 6-8 hours without any additional opioid
* Stop your Suboxone 24-36 hours before your planned procedure/surgery in order to get it mostly out of your system and just use short-acting opioids such as hydrocodone for your post-procedure pain control
* Continue your Suboxone and following your procedure convert your Suboxone to Methadone 30-40 mg a day for pain control and titrate up by 5-10 mg as needed
* For all of the above approaches it is recommended to use non-opioid analgesics such as NSAIDs and tylenol if possible
Pros And Cons Of Each Approach
As mentioned, there is no right or wrong answer when it comes to selecting a plan for managing your post-procedure pain and everyone is going to be different. What often dictates the plan you select is the amount of expected post-procedure pain and anticipated time to recover. For minor procedures such as a single dental extraction or outpatient laparoscopic procedure, the post-procedure pain is often minimal and can just be managed by taking Ibuprofen and continuing your Suboxone (or temporarily increasing the dosage and frequency). For more involved procedures such as a joint replacement you will likely need to add an additional short acting full opioid on top of your Suboxone or come off your Suboxone completely and just use full acting opioids for a short period of time. The problem if you stop your Suboxone and transition to just using short acting opioids or Methadone afterwards is that when you are ready to get back onto Suboxone you'll need to go through re-induction which isn't the end of the world but can be difficult for some. Also, some individuals are afraid that if they start taking opioids again for pain relief this will lead to a full blown relapse which has been shown not to be the case but should still be taken into consideration when making a selection. Finally, some surgeons or dentists may be hesitant to even prescribe an opioid for post-procedure pain if they know you have a history of addiction which is why it is important for all or your providers including your Suboxone doctor to be in contact and on the same page prior to the procedure so that issues don't arise afterwards when its already too late.