New Suboxone clinic in central Pennsylvania

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PSimpson MD
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New Suboxone clinic in central Pennsylvania

Post by PSimpson MD » Mon Jan 27, 2020 1:23 pm

I have opened a new Suboxone clinic in Bellefonte, Pennsylvania to treat chronic pain and/or opiate dependence with comprehensive buprenorphine-based programs. I have been developing these programs over five years of practice in these fields after 35 years of primary care Internal Medicine practice. We are taking new patients at:

Pain Recovery Medical Centre
218 W. High St.
Bellefonte, PA 16823
814-883-0215
www.painrecoverymedical@gmail.com

Paul K. Simpson, MD

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Brenn55
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Re: New Suboxone clinic in central Pennsylvania

Post by Brenn55 » Mon Jan 27, 2020 2:07 pm

Hi was wondering what your thoughts are on treating chronic pain with Bup. VS Methadone. I had a really bad time while on Suboxone and very little success in treating my pain. So I ended up switching to methadone and it was like night and day when it came to treating my pain/cravings.
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Re: New Suboxone clinic in central Pennsylvania

Post by PSimpson MD » Mon Jan 27, 2020 7:12 pm

Methadone is a strong pain reliever and has been in use in the US for decades for that purpose. It’s problem stems from the fact that it is a full opiate receptor agonist. Rising tolerance necessitates periodic dose increases to maintain effective pain relief. People usually experience some sedation for a matter of days or weeks after dose increases. Some patients experience sedation the entire time they are on methadone.
Buprenorphine is a much stronger pain reliever milligram for milligram. Because buprenorphine is a partial receptor agonist, users equilibrate at the buprenorphine ceiling, causing tolerance to remain at the same level as long as the patient continues regular dosing. The result is that buprenorphine continues to provide the same amount of pain relief at the same dose in perpetuity. Poor pain relief with buprenorphine is, in my experience, almost always the result of failure to achieve adequate systemic buprenorphine levels because of the difficulty with dosing through the oral lining. A somewhat complicated and meticulous dosing technique is required to achieve optimal blood levels. Dr. Junig has been an invaluable resource in this area. I have found that pain control which is adequate at first but begins to drop is usually the result of the patient gradually drifting away from optimal technique. Inadequate pain control at the beginning is usually the result of an impediment to proper dosing at the outset. This can be caused by many factors, and troubleshooting low levels at the onset of treatment is one of the most challenging parts of my job. I have had patients whose buprenorphine urine levels rose as much as twentyfold after they started taking their full plate dentures out for dosing. Much of my clinic time is spent monitoring and fine-tuning dosing technique with my patients. During this process, regular assessment of urine buprenorphine levels is very helpful. Optimal dosing is a hassle, but my patients find it well worth the effort.

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Brenn55
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Re: New Suboxone clinic in central Pennsylvania

Post by Brenn55 » Wed Jan 29, 2020 12:11 pm

Thank you so much for taking the time to explain that. So how do you find administering Bup. so the patient gets as much out of each dose? During my time on Suboxone I definitely felt some days I would feel my dose more than others. But the main reason I stopped taking it was because I would get terrible side effects from it to the point I ended up in the ER a couple times. It also really messed up my mental health issues I never had my entire life.
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Re: New Suboxone clinic in central Pennsylvania

Post by PSimpson MD » Sat Feb 01, 2020 4:06 pm

Brenn55 wrote:
Wed Jan 29, 2020 12:11 pm
Thank you so much for taking the time to explain that. So how do you find administering Bup. so the patient gets as much out of each dose? During my time on Suboxone I definitely felt some days I would feel my dose more than others. But the main reason I stopped taking it was because I would get terrible side effects from it to the point I ended up in the ER a couple times. It also really messed up my mental health issues I never had my entire life.
In my experience, most side effects are caused by naloxone, not buprenorphine. Side effects can usually be avoided by meticulous dosing technique which avoids swallowing any of the Suboxone-containing saliva. Very little naloxone is absorbed through the mouth, but more can be absorbed through the rest of the G.I. tract. If dosing technique to minimize swallowing Suboxone is carefully followed, and side effects persist, switching to Subutex is the final test to determine if reactions are the result of buprenorphine itself. Intolerable reactions to buprenorphine are rare, but do occur. in these patients, alternative treatment is necessary.

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