Brief Answer: Yes, it has analgesic effects. Detailed Answer: Hi, Welcome to Healthcare Magic! Your doctor has correctly informed you that Suboxone will help in pain. In fact, buprenorphine, which is the active ingredient in Suboxone, was first marketed as a pain killer only. It was only later that its benefits in people with opioid dependence were noticed and it began to be used for that as well. The other point that I wish to make is that please do not expect too much from Suboxone. It does have analgesic effects but I do not feel it will help you to the same extent as morphine and percocet. Since you have developed tolerance to opioids and buprenorphine is also an opioid, some of that tolerance extends to buprenorphine as well. However, since other medicines are no longer working for you now, it does make sense that you go on Suboxone. It may not be as good an analgesic as morphine but it will certainly be safer than morphine for you. Hope this clears up things for you. Please feel free to ask in case you need any clarifications. Best wishes. Dr Preeti Parakh MD Psychiatry

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Brief Answer: As below. Detailed Answer: Hi, I too fear that Suboxone alone may not be sufficient for you. I guess because of your history of kidney disease, your doctor would not be willing to advise non-opioid analgesics as well. Please discuss this with him if he would consider allowing a minimal use of other analgesics like naproxen, ibuprofen etc or not. The other option is the use of steroids. These can even be injected inside the joints directly if joints are painful, and provide excellent pain relief for a few weeks. These are indicated in arthritic joints. If oral medicines are not an option, ask your doctor for ointments containing analgesics which are applied locally. There are also other methods like ultrasound therapy, acupuncture, acupressure etc which, if accessible to you, may help you. Relaxation exercises and meditation are also known to help. I hope you get well soon. Best wishes. Dr Preeti Parakh MD Psychiatry

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Brief Answer: As below. Detailed Answer: Hi, Yes, it is common knowledge that buprenorphine has a very high affinity for opioid receptors. In fact, this is the basis of its success in opioid dependence treatment. If people on Suboxone take heroin, they are unable to get a high because buprenorphine has a very high affinity for opioid receptors and does not let heroin or other opioids bind to them. There is plenty of research in support of this. Lyrica can be started if you have neuropathic pain. It works very well in reducing neuropathic pain and can be combined with Suboxone. Regarding returning to Percocet and morphine, you must remember that buprenorphine is also an opioid and has cross tolerance with other opioids. When you stop buprenorphine, you will have the same withdrawal symptoms as with other opioids. You will need to wait for buprenorphine to leave your body completely before you start any other opioids. Even then, your body will show at least some, if not as much as previously, tolerance to morphine and Percocet. Usually a period of more than three months is needed for receptor densities to change. I understand that you have many reservations about starting Suboxone. In my opinion, you should go for it thinking that you have nothing to lose. If it doesn't help you, you can always return to your previous regimen. Best wishes. Dr Preeti Parakh MD Psychiatry

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Brief Answer: All the best! Detailed Answer: Dear Prof Bonacci, Many thanks for your kind words. I am glad that you have access to occupational therapy, physical therapy and good nursing care, in addition to a good doctor. I really hope that things get better for you. In the last few decades, there have been so many developments in the health sector and now there are many options to choose from. For example, if Lyrica is not of much help, then there are other medicines that can be tried. A few years ago, one did not have much of a choice. I hope that you too will benefit from the expanding knowledge and eventually things will get better. But for that, you will have to take the risk of trying new medicines. And I am sure that you will have the courage to do so. All the best! Dr Preeti Parakh MD Psychiatry

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