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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Beckett on June 8, 2013, at 18:51:09
In order to get on Emsam, I need to wash out tramadol. All meds except tramadol have failed to treat my peripheral neuropathy.
So my doc might try subutex. This makes me nervous. But there is evidence that it treats nerve pain well.
Anyhow, there were those, what, two studies on Buprenorphine and depression. If I go for the subutex, dare I hope for a positive mood effect, or has it remained relatively unstudied for good reason?
Posted by baseball55 on June 8, 2013, at 19:46:34
In reply to Any hope with subutex?, posted by Beckett on June 8, 2013, at 18:51:09
suboxone defitinely helped my depression, but, as an ex-opiate addict, I didn't want to continue to take it. All opiates cause euphoria, so of course they help depression. But it's no less addictive than morphine or heroin and, while you don't build tolerance as quickly, you do build tolerance eventually. I never tried subtext. Just suboxone. I've had too many problems with suicidal ideation to have drug that you can overdose on.
Posted by Beckett on June 8, 2013, at 22:36:20
In reply to Re: Any hope with subutex?, posted by baseball55 on June 8, 2013, at 19:46:34
The euphoria you felt, was it like the lifting of depression? I haven't felt euphoria with hydrocodiene nor the tramadol I take, though the tramadol gives me a little bit of energy.
Maybe I am not a candidate for being helped mood wise.
I echo your thoughts on tolerance, etc. sounds like you made the right choice for yourself. I can't figure out another pain med that would allow me to take an MAOI.
Posted by europerep on June 9, 2013, at 7:49:07
In reply to Re: Any hope with subutex?, posted by baseball55 on June 8, 2013, at 19:46:34
> But it's no less addictive than morphine or heroin and, while you don't build tolerance as quickly, you do build tolerance eventually.
I disagree with that. If buprenorphine were as addictive as heroin, what would be the point in switching addicts to it? There are lots of reasons why heroin in particular is very different from other opioids, and I know lots of people (on the internet) who are totally crazy about heroin and despise practically every other opioid.
But, of course, buprenorphine *is* an opioid, even if it's an atypical one.
Posted by sigismund on June 9, 2013, at 13:46:33
In reply to Any hope with subutex?, posted by Beckett on June 8, 2013, at 18:51:09
What's the neuropathy from?
I noticed one Chinese researcher said that noni was 75% as powerful as morphine, which I imagine is a completely meaningless statement, as well as wrong, but it does help a bit. With mice, anyway, when they do terrible experiments on them, as well as with me, for staying asleep without being too uncomfortable.
I have not taken bupe but, compared to methadone anyway, it has a reputation for being less depressing. For me opiates have always worked initially for depression by taking away the feeling of comfortlesness. But evidently not with you, or perhaps what you describe as depression is something different from that.
There is a big difference between giving up say oxycodone and morphine. One is difficult, the other too much for most of us. I imagine bupe would be more like oxy in difficulty. Whether you will find it so good/pleasant/antidepressive once the whole tolerance thing happens, I don't know. FWIW, if I had significant pain I would go for it, especially if the pain looked like it was here to stay.
R Alpha lipoic acid is interesting stuff. Disturbed my sleep of course. I should take it just to help my body get rid of the mercury. I am keen on curcumin, the BCM extract, and take 1,200mg/d for my numerous complaints. I hope it helps. It sounds so good. And can't be worse than pharmaceutical NSAIDS. When put onto the skin of my knee the skin peeled after 3 applications, and I guess something similar happens in your gut.
Below is from LEF.
Nutritional Options for NeuropathyIf the cause of neuropathy is known and treatable, then managing the underlying condition is the best option. In many neuropathies, however, no specific cause will ever be identified. In addition, many of the causes of neuropathies are themselves not readily treatable. A number of supplements have been shown to interfere with the underlying mechanisms of a variety of forms of neuropathy.
Acetyl-L-carnitine. Acetyl-L-carnitine is known to have neuroprotective properties. Two recent studies found that acetyl-L-carnitine can limit neuropathy associated with some chemotherapy drugs (Ghirardi 2005; Maestri 2005).
It has also been shown to limit neuropathy associated with diabetes. In two randomized, placebo-controlled clinical trials, acetyl-L-carnitine, in daily doses of 500 mg and 1000 mg, was shown to yield significant reductions in pain (Sima 2005).
In two related studies of diabetic nerve degeneration and neuropathy, acetyl-L-carnitine accelerated nerve regeneration after experimental injury. In the first study, diabetic animals treated with acetyl-L-carnitine maintained near normal nerve conduction velocity without any adverse effects to glucose, insulin, or free fatty acid levels, suggesting that acetyl-L-carnitine can hasten nerve regeneration in the context of diabetes (Soneru 1997). In another study, carnitine was shown to correct a number of nerve dysfunctions in animals with chemically induced diabetes (Nakamura 1998).
In a human trial, acetyl-L-carnitine appeared to help prevent or slow cardiac autonomic neuropathy in people with diabetes (Turpeinen 2000). In a large, multicenter human trial, L-carnitine improved nerve conduction velocity and reduced pain associated with diabetic neuropathy over a one-year period (De Grandis 2002).
Lipoic acid. As a powerful antioxidant, lipoic acid positively affects important aspects of diabetes, including prevention, blood sugar control, and the development of long-term complications such as disease of the heart, kidneys, and small blood vessels (Dincer 2002; Jacob 1995, 1999; Kawabata 1994; Melhem 2002; Nagamatsu 1995; Song 2005a; Suzuki 1992). It has also been shown to reduce pain associated with diabetic neuropathy (Halat 2003). Studies include:
Clinical trials of diabetics with symptoms caused by nerve damage affecting the heart showed significant improvement taking 800 mg oral alpha-lipoic acid daily without significant side effects (Ziegler 1997a,b).
In another study, 23 diabetic patients were treated with 600 mg alpha-lipoic acid, delivered intravenously daily for 10 days, followed by 600 mg oral alpha-lipoic acid for 60 days. At the end of the study, all participants showed significant improvements in cranial neuropathy, as well as improvements in both peripheral and autonomic neuropathy, which affects internal organs (Tankova 2005).
In another study, 26 patients with type 2 diabetes were given 600 mg alpha-lipoic acid daily for 3 months. At the end of the study, 20 patients experienced a significant regression of neuropathic symptoms, while 5 patients experienced a complete cessation of all symptoms. Alpha-lipoic acid was especially beneficial in women as well as thinner and younger patients (Negrisanu 1999).
N-acetylcysteine. N-acetylcysteine (NAC) is a powerful antioxidant and a precursor to glutathione, an intrinsic antioxidant. Animal studies have shown that NAC can inhibit diabetic neuropathy and protect against neuropathies caused by chemotherapy drugs (Love 1996; Park 2000).Curcumin. Researchers are continuing to discover the benefits of curcumin, which is the yellow pigment that gives turmeric its distinctive golden hue. In a study of inherited peripheral neuropathies, curcumin was shown to relieve neuropathy by causing the release of disease-associated proteins that are produced by a mutated gene (Khajavi 2005). Curcumin has also shown promise in animal studies of diabetic neuropathy and as a neuroprotective agent in central nervous system diseases (Osawa 2005).
Posted by baseball55 on June 9, 2013, at 19:33:26
In reply to Re: Any hope with subutex? » baseball55, posted by europerep on June 9, 2013, at 7:49:07
I disagree with that. If buprenorphine were as addictive as heroin, what would be the point in switching addicts to it? There are lots of reasons why heroin in particular is very different from other opioids, and I know lots of people (on the internet) who are totally crazy about heroin and despise practically every other opioid.
>
> But, of course, buprenorphine *is* an opioid, even if it's an atypical one.i guess I mean it's addictive the way methadone is addictive. You can get it legally, it stays in your system longer than short-acting drugs like heroin or oxycodone, but ultimately you're still addicted. When I used suboxone, I couldn't get off of it and became tolerant to it.
Posted by baseball55 on June 9, 2013, at 19:37:13
In reply to Re: Any hope with subutex? » baseball55, posted by Beckett on June 8, 2013, at 22:36:20
> The euphoria you felt, was it like the lifting of depression? I haven't felt euphoria with hydrocodiene nor the tramadol I take, though the tramadol gives me a little bit of energy.
>
It wasn't like the lifting of depression because I wasn't depressed then. It gave me energy and a feeling of well-being. Tramadol did not do that. Tramadol doesn't effect the opiate receptors that cause euporia and is less addictive. I cracked a rib soon after I got sober and both my doctor and my sponser (also a doctor) were okay with my taking tramadol.Of course you can't mix it with an MAOI, so maybe a low dose of subutex or methadone would help without causing euphoria and addiction.
Posted by jono_in_adelaide on June 10, 2013, at 22:01:26
In reply to Re: Any hope with subutex?, posted by baseball55 on June 9, 2013, at 19:37:13
According to the Australain data sheet for Temgesic (the form of buprenorphine used as a painkiller) in controlled trials it was no more addictive than codeine, despite being as potent an analgesic as morphine.
Now I know drug companys like to stretch the truth a bit, but I think that buprenorphine must be significantly less addictive than morphine/heroin to get past the drug regulatory authorities
Posted by Beckett on June 10, 2013, at 22:09:30
In reply to Re: Any hope with subutex? » Beckett, posted by sigismund on June 9, 2013, at 13:46:33
I have idiopathic neuropathy in my feet and ankles. Tramadol ER works just fine for it. I've been off Emsam for over a year. No AD. Trying to see if I can reset after years of ADs. But it's been a wicked year and I don't know. I think of going back on Emsam. I'm not sure what would be best. I''m very hesitant to try subutex. I don't imagine it will help my depression.
Thanks for the info from LEF. I will look into it. One doesn't want neuropathy to progress.
Posted by Beckett on June 10, 2013, at 22:10:46
In reply to Re: Any hope with subutex?, posted by jono_in_adelaide on June 10, 2013, at 22:01:26
Hope you are doing well on Nardil.
Posted by Beckett on June 10, 2013, at 22:11:50
In reply to Re: Any hope with subutex?, posted by baseball55 on June 9, 2013, at 19:37:13
Thanks, Baseball.
> > The euphoria you felt, was it like the lifting of depression? I haven't felt euphoria with hydrocodiene nor the tramadol I take, though the tramadol gives me a little bit of energy.
> >
> It wasn't like the lifting of depression because I wasn't depressed then. It gave me energy and a feeling of well-being. Tramadol did not do that. Tramadol doesn't effect the opiate receptors that cause euporia and is less addictive. I cracked a rib soon after I got sober and both my doctor and my sponser (also a doctor) were okay with my taking tramadol.
>
> Of course you can't mix it with an MAOI, so maybe a low dose of subutex or methadone would help without causing euphoria and addiction.
Posted by brynb on June 13, 2013, at 5:00:49
In reply to Any hope with subutex?, posted by Beckett on June 8, 2013, at 18:51:09
Hi Beckett-
I'm on Tramadol too (for a similar problem) and because it helps my mood, and I've found it easy to taper off of. Some docs use Clonodine to help with getting off Tramadol.
I've tried Subutex and Suboxone as well (for depression and help with benzo withdrawal) and found both to be just ok at best. Someone on the thread compared it to methadone for opiate addicts; this seems to be the case. I think most people build up a tolerance pretty quickly on Sub, whether used for pain or mood.
Good luck with your decision. I'm interested in hearing how you do if you stop taking Tramadol. Curious: how much Tramadol do you take (and do you take it daily)?
-b
Posted by sigismund on June 13, 2013, at 19:34:36
In reply to Re: Any hope with subutex?, posted by brynb on June 13, 2013, at 5:00:49
> Someone on the thread compared it to methadone for opiate addicts; this seems to be the case.
I would be surprised if it were quite so bad, but then I have never even tried it. But from what I have heard......
Posted by baseball55 on June 13, 2013, at 19:49:19
In reply to Re: Any hope with subutex?, posted by sigismund on June 13, 2013, at 19:34:36
> > Someone on the thread compared it to methadone for opiate addicts; this seems to be the case.
>
> I would be surprised if it were quite so bad, but then I have never even tried it. But from what I have heard......When I was on suboxone, the prescribing doc said he believed (remember this is still a relatively new drug) that suboxone would prove impossible to withdraw from after long-term use, like methadone.
Posted by sigismund on June 13, 2013, at 20:06:53
In reply to Re: Any hope with subutex?, posted by baseball55 on June 13, 2013, at 19:49:19
Methadone is pretty terrible to withdraw from. Not impossible. Around 6 months of real difficulty? Not recommended.
Posted by brynb on June 16, 2013, at 16:44:26
In reply to Re: Any hope with subutex?, posted by sigismund on June 13, 2013, at 20:06:53
> Methadone is pretty terrible to withdraw from. Not impossible. Around 6 months of real difficulty? Not recommended.
I've heard the same. I didn't have trouble tapering off Sub, but my biochemistry seems to be different than most with opiates/oids. I do know several folks who had a hell of a time coming of Suboxone, tho'. (Not unlike Methadone.)
This is the end of the thread.
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