Frequently Asked Questions

On the first office appointment the Doctor will do a history and physical exam. If Suboxone is right for you versus other forms of treatment, you will be scheduled for Suboxone treatment following verification of treatment information and appropriate laboratory studies.

It is important to be in mild-to-moderate withdrawal when you take your first dose of Suboxone because if you have high levels of other opioids in your system, Suboxone will compete with the other opioid molecules and make you profoundly sick.

The doctor will give you your first dose in his office. After that, he may have you either stay in the waiting area or have you take some time away from the office and return about 1 ?? hours later. At that point your doctor will assess your withdrawal symptoms. He may have you take an additional dose of Suboxone.

The doctor will ask you to return to the office over the next several days to one week, in order to assess your symptoms and adjust your dosage. Once your correct dosage is established, you should feel good. This will begin the maintenance phase of treatment.

In this phase, your condition is considered stable (your withdrawal symptoms are relieved and your cravings are decreased or are gone altogether). Your doctor may be able to see you less often. He will discuss counseling options. He may request urine samples. He will evaluate you for withdrawal.

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The International Association for the Study of Pain defined Pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. A less wordy definition of Pain is an unpleasant sensation. What is important to realize is that sometimes what is painful to one person may not be to another.

Pain can be divided into two classifications: Acute and Chronic.

Chronic pain is pain that can continue on for years after a problem has resolved or an illness has healed. Chronic pain can develop following an acute pain event, but it may also start on its own and gradually increase in severity over time. Unlike acute pain which indicates there is ongoing tissue damage or repair, chronic pain does not indicate there is ongoing tissue injury or destruction.

Examples include: arthritis, muscular pain, old bone fractures, shingles (injured nerves), etc.

Pain is perceived through complex pathways leading from our skin and other body areas to our brain. Many different chemicals and electrical signals modulate (affect) each other at multiple sites before the impulses reach our brain.

There are two basic types of pain, nociceptive and neuropathic.

Nociceptive pain is produced through the stimulation of nerve receptors in our skin, muscle, fascia, and organs. The pain signal is produced by the nerve receptor usually responding to potential or true tissue damage, and the electrical signal then travels to the spinal cord where it interacts with other electrical signals coming into the spinal cord. Then, the signal is sent up to the brain where we perceive the pain. If the pain signal can be blocked before it reaches the brain, the pain will not be perceived or felt. Examples of nociceptive pain include broken bones, muscular pain, internal organ pain, arthritis, and headaches. Common pain sensations include aching, throbbing, soreness, sharp, and stabbing. Medications such as NSAID???s (Non-Steroidal Anti-inflammatory Drugs) and opioids are usually effective for controlling this type of pain.

Neuropathic pain can occur following a nerve injury or irritation, such as with shingles, amputations, multiple sclerosis, spinal cord injury, pinched nerves, etc. Neuropathic pain involves the spontaneous production of abnormal pain electrical impulses without an appropriate stimulus to the nerve receptor, that leads to the perception of pain. In other words, pain impulses start spontaneously in the middle of damaged nerves, and the pain signals then progress to the brain. Common pain sensations include burning, extreme sensitivity, lancinating, and electric shock type sensations. Regarding treatment, NSAID's are sometimes effective for neuropathic pain secondary to an inflammatory process, but most often they are not effective. Opioids are effective some of the time. Adjuvant medications such as tricyclic anti-depressants and anti-convulsants can be very effective for neuropathic pain, but sometimes no medications help adequately.

The important point of understanding how pain is perceived is that there are many different steps where pain pathways may be blocked or affected in order to decrease perceived pain. This is the theory for using multi-drug therapy for the treatment of pain, as different medications interrupt pain pathways at different steps. Often, pain can be treated more effectively by a combination of medications than by using any single medication.

The first step to treating chronic pain is to diagnose the pain, and its etiology. This is accomplished in a similar fashion as with all new medical problems. A detailed pain history is obtained as to the onset, location, quality (what the pain feels like), exacerbating, and relieving factors of the pain. A pertinent physical exam is performed looking for anatomical and neurological abnormalities. Sometimes, reproduction of the pain during the physical exam can be very informative. A presumptive pain diagnosis(s) can be made and various studies can be ordered if indicated. Pain treatment can be instituted at this time, before a final diagnosis is reached.

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