(who the f*** has thought out that screen name?)
Firstly be welcome on Drugs
I am no pain patient, just a substituted ex-heroin
user, all my knowledge about the substances in question comes from maintenance therapy.
I suppose I know why you can't get sufficient answers. I believe no one has ever thought about combining a buprenorphine
patch with methadone
And even I have no real clue about which patch 10 or 20mcg/h gets how much buprenorphine on your receptors.
Which is the problem as you will see when you follow me to the next paragraph.
When used as a substitute for opiates
(maintenance therapy), buprenorphine ( I write bup from now on) is given in doses of 2mg up to 16mg, in some rare cases even more.
This is way beyond the doses that are used in pain management.
Bupe, unlike methadone, which is a full opiate
agonist, is a partial agonist/antagonist, means it has different properties on the receptor site.
Methadone acts like any normal opioid
does, it simply bonds to the receptors and that is that.
Bupe is able to throw other opiates off the receptors, to bond there itself after having done so. And it bonds! Near to not removable, that stuff,- due to its long half life time.
This means when your receptors are filled with bupe, other opiates have no chance to get through to the receptors, this is the so-called "blocking effect" of bupe.
When your receptors are filled with methadone, bupe is able to throw methadone off the receptors, thus causing the so-called "precipated withdrawal
syndrome" which no one wants to experience.
(I have been there, done that - by accident- and I reassure you that you don't want to experience this. It is multiplied withdrawal with raging diarrhoia, vomiting, cramping intestinies, headache, RLS,- what is normally experienced over a time of several days then is compressed in five hours.
So the answer to your question depends on how much of the bupe is actually on your receptors. And now we are back where we began.
I only could give you information on part of your issue, now you know how bupe and methadone work.
I hope some of the more knowledgeable members have a satisfying answer for you, this might take a while, we have very many posts per day, but you got a good chance..
One thing is sure: should you be dosed high enough on bupe to have all your receptors filled, taking methadone won't have an additional effect on the pain.
If your receptors are only partly filled with bupe, methadone on top should work.
What I never heard anything about is whether the bupe-patches you mentioned really DO fill up your receptors. So,- lets hope for someone wiser than me.