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Injury Care

OUD & Chronic Pain Solutions for Patients With Integrative Care

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Learn how integrative care can help treat OUD and chronic pain with personalized approaches that promote overall well-being.

Table of Contents

Abstract

In this comprehensive educational post, I, Dr. Alex Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST, present a unified, evidence-based roadmap for treating opioid use disorder (OUD) and chronic pain through medications for opioid use disorder (MOUD) — specifically buprenorphine, methadone, and naltrexone — integrated with chiropractic care, functional medicine, rehabilitation, and personal injury management. I explain the pharmacology and clinical rationale for each medication; detail standard inductions, high-dose rapid stabilization, and low-dose micro-induction strategies in the fentanyl era; and connect these protocols to a patient-centered plan that restores stability, function, and autonomy.

Our multidisciplinary practice in El Paso, Texas — Injury Medical Clinic PA (also known as Mission Plaza Injury Medical Clinic) — operates under the medical direction of Dr. Maria Guadalupe Cardenas, MD (Board Certified in Internal Medicine; NPI #1164426749; Texas MD License #J2933), an internist with 40+ years of experience. Dr. Cardenas serves as our Medical Director and Collaborative Physician, ensuring medical oversight, pharmacovigilance, and alignment with current standards. I deliver integrative chiropractic care to modulate spine-neuro-immune dynamics and biomechanics, paired with functional medicine strategies to reduce inflammation and improve sleep, stress resilience, and metabolic health.

In this post, I take you on a step-by-step journey that covers: why MOUD is lifesaving; how mu-opioid receptor pharmacodynamics inform safety and efficacy; fentanyl-specific challenges and precipitated withdrawal prevention; how Sublocade and Brixadi long-acting buprenorphine injections improve adherence; how Butrans and Belbuca fit into modern pain care; the ethical principles of harm reduction; and how I coordinate chiropractic rehabilitation with MOUD to reduce nociplastic pain and restore movement capacity. Throughout, I cite leading organizations and researchers using modern, evidence-based methods, and I include clinical observations from practice shared at sciatica. clinic and in my professional updates.

Key takeaway: medications for OUD save lives; when we pair them with integrative chiropractic and rehabilitation under medical oversight, we can reduce withdrawal and cravings, address pain drivers, restore function, and help patients reclaim their futures.

About our team-based model and me in El Paso

I am Dr. Alex Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST. Over three decades of clinical practice, I have focused on integrative, patient-centered care for musculoskeletal injury, chronic pain, and complex neuro-metabolic conditions, including opioid-related complications. Our El Paso clinic, Injury Medical Clinic PA (Mission Plaza Injury Medical Clinic), was built to address whole-person health for patients navigating pain, function, and recovery.

  • Medical direction and collaborative care
    • Maria Guadalupe Cardenas, MD (NPI #1164426749; Texas MD License #J2933), Board Certified in Internal Medicine with 40+ years of experience, serves as our Medical Director and Collaborative Physician. Dr. Cardenas oversees medical safety, MOUD protocols, laboratory and cardiometabolic assessment, and comorbidity management to ensure our care aligns with the latest evidence and standards.
  • Integrative chiropractic and functional medicine
    • I provide chiropractic care (spinal and extremity adjustments, neurodynamic interventions, soft-tissue therapies) and rehabilitation (graded exercise, motor control, progressive loading), coordinated with functional medicine to optimize nutrition, sleep, autonomic regulation, and inflammation control.
  • Scope and safety
    • Our integrated pathway leverages medical assessment (labs, ECGs when indicated, medication management), chiropractic biomechanics, rehab, and social determinants of health (SDOH) navigation — helping patients regain function while mitigating risk.

This post reflects our integrated approach and my clinical observations, including insights I share at:

Why medications for opioid use disorder save lives

When I discuss OUD treatment with patients and clinicians, I emphasize a core truth: medications for opioid use disorder are lifesaving. Both buprenorphine and methadone reduce all-cause and overdose mortality, diminish illicit opioid use, and stabilize the neurobiological circuits that drive withdrawal and craving (Substance Abuse and Mental Health Services Administration [SAMHSA], 2021; American Society of Addiction Medicine [ASAM], 2020; National Academies of Sciences, Engineering, and Medicine [NASEM], 2019).

  • Key benefits of MOUD
    • Reduced mortality risk and emergency utilization
    • Reduced illicit opioid use and criminal justice involvement
    • Improved function and engagement in behavioral and rehabilitative care
    • Protection against overdose due to tolerance loss after abstinence
  • Why continuity matters
    • Continuity of MOUD is strongly associated with better outcomes; interruption increases overdose risk due to loss of tolerance (NASEM, 2019; ASAM, 2020).
    • Stabilization enables patients to participate in rehabilitation and movement-based care. In my clinic, this is foundational for successful chiropractic care and functional progress.
  • How we translate evidence to action
    • We prioritize rapid stabilization with buprenorphine or methadone, pair it with naloxone distribution for overdose prevention, and coordinate chiropractic and rehab as soon as cravings and withdrawal are sufficiently controlled to allow safe movement progression.

References:

Mu-opioid receptor pharmacodynamics and safety: translating physiology to practice

Physiology guides my induction strategies and safety planning. Understanding receptor dynamics clarifies why buprenorphine can prevent overdose but also precipitate withdrawal if mistimed.

  • Mu-opioid receptor basics
    • The mu receptor governs analgesia, reward-salience, respiratory drive, and stress response.
    • Full agonists (e.g., fentanyl, heroin, methadone) drive receptor activation to a high level, with high effectiveness for analgesia but dose-dependent respiratory depression.
    • Partial agonists (e.g., buprenorphine) exhibit high receptor affinity but a ceiling effect on respiratory depression — meaning a safer profile for overdose while still suppressing withdrawal and cravings (Dahan et al., 2006; Strang et al., 2020).
  • Why bbuprenorphine’sceiling effect matters
    • As dose increases, buprenorphine’s analgesia continues to improve while respiratory depression plateaus (Dahan et al., 2006). This underpins its outpatient safety profile and is a central reason I prefer buprenorphine for many patients with OUD and comorbid pain.
  • Antagonists and withdrawal
    • Naltrexone blocks mu receptors but offers no intrinsic analgesia; if physiological dependence is present, naltrexone can precipitate withdrawal. It’s best reserved for fully detoxified patients who prefer a non-agonist path (ASAM, 2020).

References:

Medications overview: indications, formulations, and clinical use

I individualize medication choices to align with patient goals, pain phenotype, substance history, and setting. Below is how I think through each medication, with Dr. Cardenas providing medical oversight.

Buprenorphine

  • Indications
    • First-line OUD treatment (ASAM, 2020; SAMHSA, 2021)
    • Chronic pain formulations: transdermal patch (Butrans) and buccal film (Belbuca)
  • OUD formulations
    • Sublingual monoproduct (historically Subutex)
    • Sublingual buprenorphine-naloxone combinations (e.g., Suboxone)
    • Long-acting injectables
      • Sublocade (monthly extended-release)
      • Brixadi (weekly or monthly extended-release)
  • Chronic pain formulations
    • Transdermal patch (Butrans)
    • Buccal film (Belbuca)
    • Parenteral buprenorphine (Buprenex) for acute pain in monitored settings
  • Off-label realities
    • Sublingual buprenorphine (monoproduct or combo) may be used off-label for chronic pain in carefully selected cases, particularly with central sensitization or high-risk opioid exposure (Srivastava, Kahan, & Njoroge, 2020).

References:

Methadone

  • Indications
    • OUD: must be delivered through federally certified Opioid Treatment Programs (OTPs)
    • Chronic pain: outpatient prescribable with careful monitoring
  • Pharmacology and safety
    • Full mu-agonist with NMDA antagonism — useful for hyperalgesia but with higher overdose risk due to long and variable half-life
    • QTc monitoring and careful titration are critical (ASAM, 2020)
  • Clinical interface
    • OTP coordination is essential. In our integrative setting, we align chiropractic sessions around sedation and symptom patterns to maximize safety and function.

Reference:

Naltrexone

  • Indications
    • OUD relapse prevention in fully detoxified patients (oral daily or monthly extended-release injection)
    • Alcohol use disorder: reduces heavy drinking days
  • Limitations
    • No analgesia and risk of precipitated withdrawal in dependent patients
    • Best for motivated patients who prefer antagonist therapy and can maintain abstinence

Reference:

Sublingual buprenorphine: dosing, administration, and counseling

Getting the fundamentals right improves success rates and safety.

  • Administration
    • Place the tablet/film under the tongue, avoid swallowing while it dissolves, and allow 10 minutes to dissolve for reliable transmucosal absorption.
    • If nausea occurs, the patient may spit pooled saliva; absorption is mucosal, not gastric.
  • Counseling
    • Physical dependence develops; avoid abrupt discontinuation.
    • Dental health: FDA warns of potential caries with buprenorphine products dissolved in the mouth — we emphasize meticulous oral hygiene, fluoride, and regular dental care (FDA, 2022).
    • Hepatic considerations: buprenorphine is hepatically metabolized; monitor LFTs, especially in hepatic impairment.
    • Avoid respiratory depressants: counsel on risks with alcohol and benzodiazepines.
  • Combination vs. monoproduct
    • Buprenorphine-naloxone combination is generally preferred; negligible sublingual naloxone bioavailability deters injection diversion.
    • Monoproduct may be considered for naloxone-related adverse effects or when clinically indicated; navigate insurance barriers with documented medical necessity.

Reference:

Long-acting injectable buprenorphine: Sublocade and Brixadi in real-world care

I increasingly rely on long-acting injectables for patients struggling with daily adherence, diversion risk, or peak-trough symptom fluctuations.

  • Why consider injectables
    • Improved adherence
    • Reduced diversion
    • More stable plasma levels
    • Fewer daily decision points, supporting behavioral focus and rehabilitation
  • Sublocade
    • Monthly depot after stabilization on transmucosal buprenorphine
    • Dosing typically 300 mg initially, then 100–300 mg monthly
    • Consider early supplemental sublingual doses if needed before steady-state
  • Brixadi
    • Weekly or monthly options; weekly flexibility facilitates fine-tuned adjustments early in care
    • Useful as a bridge before monthly transitions or in ED settings if protocols and follow-up are robust

References:

Buprenorphine initiation in the fentanyl era: preventing precipitated withdrawal and tailoring strategy

Fentanyl’s dominance in the illicit market requires precision and shared decision-making. I emphasize patient autonomy, clear options, and contingency planning.

Why precipitated withdrawal happens

  • Mechanism
    • Buprenorphine is a high-affinity partial agonist. If substantial full-agonist occupancy persists at the mu receptor, buprenorphine displaces the full agonist and provides lower net activation—triggering acute precipitated withdrawal (Varshneya et al., 2023; Volkow & Blanco, 2023).
  • Fentanyl-specific challenges
    • Fentanyl’s lipophilicity creates adipose tissue depots that slowly elute into circulation, maintaining receptor occupancy beyond expected timelines.
    • I have seen patients with severe anxiety-forward withdrawal in fentanyl exposure; GI signs may lag while restlessness, akathisia, and dysphoria dominate.

References:

Three evidence-based induction strategies

I present all three approaches with pros and cons, aligning the choice to the patient’s goals, history, and care setting, with Dr. Cardenas co-managing risk.

Traditional induction:

  • Method
    • Wait for mild to moderate withdrawal (e.g., COWS ≥ 8–12, often ≥12–13); start with 2–8 mg buprenorphine; titrate every 2–4 hours as needed to ~8–16 mg total on day 1; adjust to 12–24 mg by day 2–3.
  • Best use
    • Transitioning from short-acting prescription opioids with predictable pharmacokinetics
  • Limitations in fentanyl
    • Depot effects make timing unpredictable; increased precipitated withdrawal risk.
  • When I use it
    • Patient preference, low likelihood of fentanyl exposure, or controlled settings with close monitoring and readiness to pivot strategies

Low-dose initiation (microdosing/overlap):

  • Method
    • Start very low buprenorphine doses (e.g., 0.2–0.5 mg) while continuing full agonists; increase buprenorphine daily and taper the full agonist over 5–7+ days (Krook et al., 2020; Raheemullah et al., 2024).
  • Why it helps
    • Gradual receptor occupancy avoids abrupt displacement, reducing precipitated withdrawal risk — especially useful for fentanyl-exposed patients or those with prior precipitated episodes.
  • Adjuncts
    • Clonidine/lofexidine, hydroxyzine, trazodone, NSAIDs/acetaminophen, ondansetron, loperamide
  • Safety note
    • Overdose protection is not robust until buprenorphine approaches ~8 mg/day; harm reduction and naloxone are essential.

High-dose initiation (rapid stabilization):

  • Method
    • Confirm sufficient withdrawal (often COWS ≥ 16 with objective signs); administer 16 mg, reassess in ~30 minutes, then 8 mg increments up to 24–32 mg on day 1 as needed (CA Bridge, 2023; Herring et al., 2021).
  • Why it helps
    • Rapid receptor occupancy addresses severe withdrawal quickly and is particularly effective in ED/urgent care settings.

References:

Preventing and managing precipitated withdrawal

  • Prevention
    • Ensure adequate withdrawal for standard induction; consider microdosing for patients at high risk (notably fentanyl or methadone).
  • If it occurs
    • Do not stop buprenorphine prematurely. Increase the buprenorphine dose (often an additional 8–16 mg in divided doses) to saturate receptors and stabilize at the partial-agonist ceiling, while providing symptom support (clonidine, hydroxyzine, antiemetics, NSAIDs) and reassurance (CA Bridge, 2023).

Shared decision-making and patient-centered communication in initiation

Shared decision-making is not a courtesy — it’s the operating system for safe induction in the fentanyl era. Patients who have experienced precipitated withdrawal often carry trauma from that experience; trust and collaboration are essential (Nielsen et al., 2023).

  • What I emphasize
    • You are the expert in your own body; I am here with options.
    • We have three valid approaches (traditional, low-dose, high-dose) with clear trade-offs — we choose together.
    • We will use symptom-targeted adjuncts proactively; you will not be abandoned mid-process.
    • If you were precipitated before, we tailor to minimize risk.
  • Clinical workflow
    • Intake and risk stratification (substance history, comorbidities, SDOH)
    • Choose initiation method collaboratively
    • Provide a clear dosing map, printed instructions (including film splitting when applicable), and “when to call” rules
    • Schedule frontline follow-up contacts within 24–72 hours during critical early days

Reference:

Integrating chiropractic care with MOUD: how biomechanics and neurophysiology support recovery

In our model, once withdrawal and cravings begin to stabilize, I integrate chiropractic and rehabilitative strategies that reduce pain drivers, dampen nociplastic amplification, and build functional resilience.

  • Mechanistic synergy
    • Segmental adjustments and regional joint care provide high-fidelity mechanoreceptive input that can modulate descending inhibitory pathways (periaqueductal gray, rostral ventromedial medulla), reducing pain amplification.
    • Autonomic balance: gentle mobilization, breathing re-education, and thoracic adjustments can shift sympathetic-parasympathetic tone, reducing allostatic load and perceived threat.
    • Movement as medicine: graded exposure, neurodynamic glides, and progressive loading build capacity and confidence, decreasing reliance on pharmacologic relief.
  • Why this matters clinically
    • Pain and withdrawal amplify each other via shared autonomic and neuroimmune pathways. By reducing nociceptive input and improving movement confidence, I see less sympathetic overdrive, better sleep, and improved adherence to MOUD.
    • I share case experiences at the sciatica clinic where OUD stabilization with buprenorphine allowed patients to progress through neurodynamic and stabilization programs, reducing catastrophizing and improving gait symmetry.

References:

Functional medicine lens: reducing inflammation and supporting recovery physiology

We address systemic drivers that worsen pain and relapse risk. Dr. Cardenas and I coordinate non-sedating strategies, metabolic supports, and behavioral coaching.

  • Inflammation and pain
    • Anti-inflammatory nutrition (omega-3s, polyphenols), glycemic control, and micronutrient optimization attenuate neuroinflammatory pathways that amplify pain and craving.
  • Sleep and circadian health
    • Stabilizing sleep-wake cycles reduces hyperalgesia and limbic reactivity. Non-drug strategies (light hygiene, stimulus control, breathwork) complement non-sedating aids when indicated.
  • Stress buffering
    • HRV biofeedback, paced breathing, and mind-body practices reinforce medication effects by modulating the HPA axis and limbic activation.

Harm reduction: meeting patients where they are

Harm reduction is ethical, evidence-based, and practical. We never make abstinence a prerequisite for compassionate care. Instead, we emphasize survival, safety, and trust-building (WHO, 2014; CDC, 2024).

  • Core elements
    • Naloxone distribution with training for the patient and household (CDC, 2024)
    • Safer use counseling; wound care and infection prevention
    • Screening and vaccination for Hepatitis A/B and HIV
    • Syringe service referrals where legal and available
    • Social determinants support: transportation, housing, phones for telehealth
  • Why it works
    • Harm reduction reduces mortality, infectious spread, and stigma while increasing readiness for MOUD and rehabilitation.

References:

Buprenorphine for chronic pain: modern analgesia with a safety margin

I integrate buprenorphine into pain management when non-opioid and multimodal strategies are insufficient or when full agonists pose unacceptable risk. Its unique profile suits complex pain cases with high risk for opioid-induced hyperalgesia (OIH).

  • Mechanisms relevant to pain
    • Partial mu-agonism with kappa antagonism and ORL-1 activity may mitigate hyperalgesia and reduce dysphoria.
    • Stable receptor occupancy supports analgesia with a lower respiratory risk than full agonists (Dahan et al., 2006).
  • Formulations for pain
    • Transdermal (Butrans) and buccal (Belbuca) provide steady analgesia at lower total opioid exposure.
    • In select cases, off-label sublingual buprenorphine (mono or combo) can be used for severe pain or high opioid tolerance when indicated.
  • Clinical pearls
    • Consider dose splitting (e.g., 4 mg TID vs 12 mg QD) for analgesic effect if using sublingual formulations off-label.
    • Always pair with nonpharmacologic interventions: chiropractic adjustments, graded exercise, cognitive-behavioral coping, sleep optimization, and anti-inflammatory nutrition.

References:

Methadone for OUD and comorbid pain: when and why

Methadone is highly effective, particularly when buprenorphine trials have failed, in severe OUD, or when full agonist analgesia is clinically needed within an OTP framework.

  • Indications
    • Severe OUD or repeated failed buprenorphine trials
    • Significant comorbid pain where NMDA antagonism may benefit hyperalgesia
    • Pregnancy when methadone is preferred or already established
  • Safety and logistics
    • QTc monitoring and careful titration due to long/variable half-life
    • Coordinated care through OTPs is required by law
    • Chiropractic and rehab sessions timed to avoid sedation peaks and optimize safety

Reference:

Naltrexone for OUD: where it fits

Naltrexone is best for motivated, fully detoxified patients who prefer an antagonist approach and do not need opioid analgesia. It plays a more prominent role in alcohol use disorder.

  • Clinical considerations
    • Requires 7–10+ days opioid-free before initiation
    • Blunts opioid analgesia — perioperative planning is essential
    • Chiropractic and non-opioid pain strategies become even more important

Reference:

Special populations: pregnancy, perioperative care, and adolescents

  • Pregnancy
    • Continue or initiate buprenorphine for OUD during pregnancy; sublingual formulations are preferred. Long-acting injectables are not FDA-approved for pregnancy.
    • Physiological changes may necessitate higher or split dosing.
    • Coordinate with obstetrics; use gentle chiropractic techniques for pregnancy-related pelvic and low-back strain (ASAM, 2020).
  • Perioperative patients
    • Maintain buprenorphine through the perioperative period in coordination with anesthesia and surgery; apply multimodal analgesia and regional blocks.
    • Chiropractic-informed positioning and post-operative progressive mobilization support recovery.
  • Adolescents (≥16 years)
    • Buprenorphine is FDA-approved for OUD in adolescents ≥16 years.
    • Emphasize clarity, family engagement, and school coordination; chiropractic care supports sports-related pain and posture concerns.

Reference:

Safety considerations: polypharmacy, sedation, and respiratory risk

We address respiratory depressant combinations non-punitively to keep patients engaged and safe.

  • Benzodiazepines and alcohol
    • Co-use with buprenorphine heightens respiratory risk. We counsel clearly, coordinate benzodiazepine tapers when appropriate, and avoid abrupt cutoffs that drive disengagement.
  • Sedatives and CNS depressants
    • PDMP checks, staged changes, and emphasis on sleep hygiene and non-sedating anxiety strategies (breathwork, HRV biofeedback).
  • Liver disease
    • Baseline and periodic LFTs, adjusting monitoring to clinical status.

Reference:

Personal injury and OUD: special considerations in my practice

Acute injury often initiates an opioid exposure cascade. We minimize risk while restoring function.

  • Injury cascade
    • Early multimodal analgesia, clear opioid exit strategies, and rapid MOUD access when indicated prevent chronic opioid exposure.
    • For whiplash, lumbar strain, and radiculopathy: gentle cervicothoracic work, vestibular drills as needed, direction-specific spinal-sparing strategies, and neurodynamic techniques once irritability decreases.
  • Documentation and communication
    • We carefully document function, impairment, and return-to-work capacity. Under Dr. Cardenas’ medical direction, we align medical therapy and chiropractic progress with legal and occupational requirements.

Step-by-step clinic pathway: from intake to stabilization

  • Comprehensive assessment
    • OUD diagnosis and risk profile (overdose history, polysubstance use, SDOH)
    • Pain phenotype (nociceptive, neuropathic, nociplastic)
    • Function metrics, vitals, and labs as indicated
  • Shared decision-making
    • Present induction options (traditional, low-dose overlap, high-dose)
    • Align plan with patient goals, prior experiences, and logistics
  • Induction and early stabilization
    • Execute the chosen protocol
    • Provide naloxone, clear written guidance, and proactive adjuncts
    • Ensure follow-up within 24–72 hours
  • Chiropractic and rehab onboarding
    • Initiate low-threat mobilization, breath mechanics, and isometrics as cravings settle.
    • Progress mobility → motor control → strength → meaningful task capacity
  • Functional medicine adjuncts
    • Anti-inflammatory nutrition, hydration, and electrolytes
    • Sleep strategies and stress tools (breathing, HRV biofeedback)
  • Ongoing optimization
    • Titrate MOUD; consider Sublocade/Brixadi
    • Taper sedatives cautiously when safe
    • Regularly measure outcomes; iterate as needed

Patient education checklist for buprenorphine

  • How to take it
    • Place under tongue; let dissolve fully; okay to spit saliva if nauseated.
  • What to expect
    • Decreased withdrawal and cravings; improved function over days to weeks.
  • Safety
    • Avoid mixing with alcohol or benzodiazepines; keep naloxone available for household and community safety.
  • Dental care
    • Brush after dosing when feasible; use fluoride; schedule regular dental visits.
  • Liver health
    • Report jaundice, RUQ pain, or dark urine; keep lab appointments.

Reference:

Insurance navigation and access

  • Monoproduct buprenorphine
    • Provide documentation of medical necessity in naloxone-intolerant cases.
  • Long-acting injectables
    • Prior authorizations and patient assistance programs preserve continuity; our team coordinates with specialty pharmacies.
  • Dose coverage in fentanyl era
    • Many patients initially need >24 mg/day buprenorphine; document clinical necessity and align with evolving policies that accept doses up to 32 mg/day for selected cases (ASAM, 2023).

References:

Measuring outcomes that matter

  • Functional metrics
    • Return-to-work readiness, lifting tolerance, sit-stand endurance, gait quality, sleep quality
  • Pain and function scales
    • PEG, Oswestry Disability Index (ODI)/Neck Disability Index (NDI), Patient-Specific Functional Scale
  • OUD stability
    • Cravings trends, urine toxicology, days of nonmedical opioid use, retention in care

Clinical observations from my practice: sciatica, fentanyl-era inductions, injectables, and dental prevention

From my work in El Paso and insights I share publicly, including at sciatic a.clinic and on my professional updates, several patterns stand out:

  • Sciatica and neuropathic pain
    • Stabilizing OUD with buprenorphine allows meaningful participation in neurodynamic flossing, segmental stabilization, and graded loading, reducing catastrophizing and improving gait symmetry.
  • Fentanyl-era inductions
    • Micro-induction has been particularly valuable for patients with heavy fentanyl exposure who previously failed standard inductions due to severe precipitated withdrawal.
  • Long-acting injectables
    • Weekly Brixadi serves as a useful bridge for patients reluctant to commit to monthly dosing or needing fine-tuned early adjustments.
    • Transitioning stabilized patients to Sublocade simplifies logistics and supports adherence; some require early supplemental sublingual doses.
  • Dental prevention
    • Proactive oral hygiene guidance at buprenorphine initiation reduces reports of dental sensitivity and caries.

Resources:

Putting it all together: a case-inspired journey

  • Week 0–1
    • A patient with lumbar radicular pain and daily fentanyl exposure presents. We choose micro-induction, start low-dose buprenorphine while continuing a full agonist, layer in gentle neurodynamic drills and diaphragmatic breathing, and provide robust adjuncts and naloxone.
  • Week 2–4
    • Stabilized at ~16 mg/day, cravings diminish. I add targeted spinal adjustments, hip hinge drills, and sleep regularization; anti-inflammatory nutrition begins; close check-ins maintain momentum.
  • Month 2
    • Transition to monthly Sublocade for adherence; progress to posterior chain strength and graded aerobic conditioning; monitor for end-of-interval symptom drift and supplement sublingual doses if needed.
  • Month 3–6
    • Functional goals achieved (full shift tolerance, fewer flares). Behavioral coping skills solidify; relapse-prevention continues with naloxone access and scheduled follow-up.

Conclusion: our multidisciplinary ethos in El Paso

  • Medical safety and MOUD excellence
    • Maria Guadalupe Cardenas, MD (NPI #1164426749; Texas MD License #J2933), anchors our medical supervision, risk mitigation, and clinical governance.
  • Chiropractic, rehab, and functional medicine integration
    • My team and I guide biomechanical correction, movement retraining, and physiological resilience. We address nociplastic pain, autonomic dysregulation, and inflammatory drivers while MOUD stabilizes the reward/withdrawal circuitry.
  • Humane, precise, sustainable care
    • Our model pairs lifesaving medications with integrative chiropractic care and rehabilitation — a coordinated plan to reduce risk, improve function, and support long-term recovery.

Key takeaways:

  • MOUD is lifesaving; buprenorphine’s respiratory depression ceiling underpins its safety advantage (Dahan et al., 2006; NASEM, 2019).
  • Individualized induction — standard, high-dose, or micro-induction — is essential in the fentanyl era to prevent precipitated withdrawal (ASAM, 2023; CA Bridge, 2023).
  • Integrative chiropractic care complements MOUD by reducing pain drivers, restoring movement, and enhancing function (Chou et al., 2016).
  • Medical oversight by an experienced internist like Dr. Cardenas ensures safety, quality, and continuity.
  • Harm reduction, patient education, and functional metrics keep recovery grounded in outcomes that matter.

References

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General Disclaimer *

Professional Scope of Practice *

The information herein on "OUD & Chronic Pain Solutions for Patients With Integrative Care" is not intended to replace a one-on-one relationship with a qualified health care professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional.

Blog Information & Scope Discussions

Welcome to El Paso's Premier Wellness and Injury Care Clinic & Wellness Blog, where Dr. Alex Jimenez, DC, FNP-C, a Multi-State board-certified Family Practice Nurse Practitioner (FNP-BC) and Chiropractor (DC), presents insights on how our multidisciplinary team is dedicated to holistic healing and personalized care. Our practice aligns with evidence-based treatment protocols inspired by integrative medicine principles, similar to those found on this site and our family practice-based chiromed.com site, focusing on restoring health naturally for patients of all ages.

Our areas of multidisciplinary practice include  Wellness & Nutrition, Chronic Pain, Personal Injury, Auto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Headaches, Sports Injuries, Severe Sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Complex Injuries, Stress Management, Functional Medicine Treatments, and in-scope care protocols.

Our information scope is multidisciplinary, focusing on musculoskeletal and physical medicine, wellness, contributing etiological viscerosomatic disturbances within clinical presentations, associated somato-visceral reflex clinical dynamics, subluxation complexes, sensitive health issues, and functional medicine articles, topics, and discussions.

We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for musculoskeletal injuries or disorders.

Our videos, posts, topics, and insights address clinical matters and issues that are directly or indirectly related to our clinical scope of practice.

Our office has made a reasonable effort to provide supportive citations and has identified relevant research studies that support our posts. We provide copies of supporting research studies upon request to regulatory boards and the public.

We understand that we cover matters that require an additional explanation of how they may assist in a particular care plan or treatment protocol; therefore, to discuss the subject matter above further, please feel free to ask Dr. Alex Jimenez, DC, APRN, FNP-BC, or contact us at 915-850-0900.

We are here to help you and your family.

Blessings

Dr. Alex Jimenez DC, MSACP, APRN, FNP-BC*, CCST, IFMCP, CFMP, ATN

email: coach@elpasofunctionalmedicine.com

Multidisciplinary Licensing & Board Certifications:

Licensed as a Doctor of Chiropractic (DC) in
Texas & New Mexico*
Texas DC License #: TX5807, Verified: TX5807
New Mexico DC License #: NM-DC2182, Verified: NM-DC2182

Multi-State Advanced Practice Registered Nurse (APRN*) in Texas & Multi-States 
Multi-state Compact APRN License by Endorsement (42 States)
Texas APRN License #: 1191402, Verified: 1191402 *
Florida APRN License #: 11043890, Verified:  APRN11043890 *
Colorado License #: C-APN.0105610-C-NP, Verified: C-APN.0105610-C-NP
New York License #: N25929, Verified N25929

License Verification Link: Nursys License Verifier
* Prescriptive Authority Authorized

ANCC FNP-BC: Board Certified Nurse Practitioner*
Compact Status: Multi-State License: Authorized to Practice in 40 States*

Graduate with Honors: ICHS: MSN-FNP (Family Nurse Practitioner Program)
Degree Granted. Master's in Family Practice MSN Diploma (Cum Laude)

Dr. Alex Jimenez, DC, APRN, FNP-BC*, CFMP, IFMCP, ATN, CCST
(Board Certified: Family Practice Nurse Practitioner—Multistate)*
(Licensed Nurse Practitioner & Chiropractor - Multistate)*
Clinical Director
Digital Business Card

Dr. Maria Cardenas, MD
(Board Certified: Internal Medicine)
(Licensed Medical Doctor)
Medical Director, Clinical Director & Collaborative Physician
NPI # 1164426749
MD License #: J2933

 

Licenses and Board Certifications:

MD: Medical Doctor
DC: Doctor of Chiropractic
APRNP: Advanced Practice Registered Nurse 
FNP-BC: Family Practice Specialization (Multi-State Board Certified)
RN: Registered Nurse (Multi-State Compact License)
CFMP: Certified Functional Medicine Provider
MSN-FNP: Master of Science in Family Practice Medicine
MSACP: Master of Science in Advanced Clinical Practice
IFMCP: Institute of Functional Medicine
CCST: Certified Chiropractic Spinal Trauma
ATN: Advanced Translational Neutrogenomics

Memberships & Associations:

TCA: Texas Chiropractic Association: Member ID: 104311
AANP: American Association of Nurse Practitioners: Member  ID: 2198960
ANA: American Nurse Association: Member ID: 06458222 (District TX01)
TNA: Texas Nurse Association: Member ID: 06458222

NPI: 1205907805

National Provider Identifier

Primary Taxonomy Selected Taxonomy State License Number
No 111N00000X - Chiropractor NM DC2182
Yes 111N00000X - Chiropractor TX DC5807
Yes 363LF0000X - Nurse Practitioner - Family TX 1191402
Yes 363LF0000X - Nurse Practitioner - Family FL 11043890
Yes 363LF0000X - Nurse Practitioner - Family CO C-APN.0105610-C-NP
Yes 363LF0000X - Nurse Practitioner - Family NY N25929

 

Dr. Alex Jimenez, DC, APRN, FNP-BC*, CFMP, IFMCP, ATN, CCST
(Board Certified: Family Practice Nurse Practitioner—Multistate)*
(Licensed Nurse Practitioner & Chiropractor - Multistate)*
Clinical Director
Digital Business Card

Dr. Maria Cardenas, MD
(Board Certified: Internal Medicine)*
(Licensed Medical Doctor)*
Medical Director, Clinical Director & Collaborative Physician
NPI # 1164426749
MD License #: J2933

Dr Alexander D Jimenez DC, APRN, FNP-BC, CFMP, IFMCP

Specialties: Stopping the PAIN! We Specialize in Treating Severe Sciatica, Neck-Back Pain, Whiplash, Headaches, Knee Injuries, Sports Injuries, Dizziness, Poor Sleep, Arthritis. We use advanced proven therapies focused on optimal Mobility, Posture Control, Deep Health Instruction, Integrative & Functional Medicine, Functional Fitness, Chronic Degenerative Disorder Treatment Protocols, and Structural Conditioning. We also integrate Wellness Nutrition, Wellness Detoxification Protocols and Functional Medicine for chronic musculoskeletal disorders. We use effective "Patient Focused Diet Plans", Specialized Chiropractic Techniques, Mobility-Agility Training, Cross-Fit Protocols, and the Premier "PUSH Functional Fitness System" to treat patients suffering from various injuries and health problems. Ultimately, I am here to serve my patients and community as a Chiropractor passionately restoring functional life and facilitating living through increased mobility. Purpose & Passions: I am a Doctor of Chiropractic specializing in progressive cutting-edge therapies and functional rehabilitation procedures focused on clinical physiology, total health, functional strength training, functional medicine, and complete conditioning. We focus on restoring normal body functions after neck, back, spinal and soft tissue injuries. We use Specialized Chiropractic Protocols, Wellness Programs, Functional & Integrative Nutrition, Agility & Mobility Fitness Training and Cross-Fit Rehabilitation Systems for all ages. As an extension to dynamic rehabilitation, we too offer our patients, disabled veterans, athletes, young and elder a diverse portfolio of strength equipment, high-performance exercises and advanced agility treatment options. We have teamed up with the cities' premier doctors, therapist and trainers in order to provide high-level competitive athletes the options to push themselves to their highest abilities within our facilities. We've been blessed to use our methods with thousands of El Pasoans over the last 3 decades allowing us to restore our patients' health and fitness while implementing researched non-surgical methods and functional wellness programs. Our programs are natural and use the body's ability to achieve specific measured goals, rather than introducing harmful chemicals, controversial hormone replacement, un-wanted surgeries, or addictive drugs. We want you to live a functional life that is fulfilled with more energy, a positive attitude, better sleep, and less pain. Our goal is to ultimately empower our patients to maintain the healthiest way of living. With a bit of work, we can achieve optimal health together, no matter the age, ability or disability.

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Diagnose • Treatment • Recovery • Prevention • Freedom

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