In looking at some information completely unrelated to this topic, I came across something called "Fast Facts and Concepts" from the Medical College of Wisconsin. They have several hundred different topics there that deal with a large variety of items. They are intended for use by healthcare providers. In any event, Fast Fact and Concept #221 actually deals with the â€œTreatment of Pain in Patients Taking Buprenorphine for Opioid Addiction.â€ It looks like it was released in November 2009. It seems to have some additional suggestions for treating patients like us, who find themselves in need of pain relief in spite of the fact that we are also taking Bup on a daily basis. Although they start out by saying "While there are no clinical studies addressing how to treat pain in patients taking buprenorphine,..." they do have some good suggestions and also list nine sources for references. Although I have not looked up any of the references, they too may have some additional information.
I did find one portion very interesting: "Opioids that have a higher intrinsic activity at the mu-opioid receptor, including morphine, fentanyl, or hydromorphone, are all options, while opioids with less efficacy such as hydrocodone or codeine should be avoided." In other words, Vicodin is not suggested as a good pain medication for Bup patients, while morphine, fentanyl and Dilaudid is. My Bup doc has said to me in the past they he believes that fentanyl does the best job of competing with Bup. Unfortunately, none of this has been clinically studied so we really don't know for sure. It really would be nice if someone conducted a clinical trial so we could get some science to help determine what works the best.
I don't know if anyone has posted this web page here in the past or not, but here is it in the event that it might help others. I am also pretty certain that Dr. J. is a faculty member at the Medical College of Wisconsin. It's a huge place. Here is the paper: