Suboxone for opioid use disorder treatment can help people manage withdrawal symptoms and avoid relapse. Since it contains the opioid buprenorphine, it has some pain-relieving effects. While Suboxone may help chronic pain patients with an opioid use disorder manage their pain as well as their withdrawal symptoms, it is not the best medication for individuals without an opioid use disorder.
[maxbutton id=”2″]
Chronic Pain and Substance Use Disorder
Chronic pain is pain that lasts longer than three to six months, and it can affect anyone. People have used opioids to manage pain for centuries, and pharmaceutical companies have developed a variety of opioid medications to meet the wide demand for pain management solutions. This led to an increase in opioid misuse and opioid use disorder. Research estimates that over 10% of individuals with chronic pain misuse prescription opioids.
Chronic pain and the accompanying emotional discomfort can increase a person’s risk of developing opioid use disorder because it dysregulates the brain’s reward and stress centers. Some chronic pain patients are more prone to opioid use disorder than others. When individuals have chronic pain along with cooccurring mental health conditions or substance use disorders, they have a higher risk of misusing prescription opioids.
What Are Buprenorphine and Suboxone?
Buprenorphine medication relieves the withdrawal symptoms caused by opioid use disorder. It activates the opioid receptors in your brain to reduce your withdrawal symptoms and help you focus on recovery. As a compound medication, Suboxone contains buprenorphine and naloxone, a medicine that reverses opioid overdose. The naloxone in Suboxone protects patients by discouraging misuse through injection.
How Does Suboxone Work for Opioid Use Disorder?
When you have opioid use disorder, your brain uses opioids to manage mood, pain and other sensations instead of the hormones naturally produced by your body. As a result, you become reliant on opioids to function normally, and if opioids are not present you can experience significant withdrawal symptoms. Suboxone activates your opioid receptors so that your brain feels satisfied enough to stop causing withdrawal symptoms.
Like other buprenorphine medicines, Suboxone has a “ceiling effect,” meaning its ability to cause euphoria becomes limited at a certain amount, and increasing the dose won’t increase its effects. This effect helps patients stay safe as they work toward recovery.
What Can Suboxone Do to Relieve Pain?
Since your opioid receptors manage your pain sensations, activating them with Suboxone could relieve pain in some patients. The research that scientists have so far on Suboxone’s painkilling effects shows promise. Compared to other opioid painkillers, Suboxone could involve:
- Less immune system suppression
- Easier usage among seniors and patients with renal issues
- Lower tolerance development
- Better effectiveness with neuropathic pain
- A lower ceiling effect for respiratory depression
Suboxone’s ceiling effect could also make it safer to take. The naloxone included in the medicine causes it to create unpleasant withdrawal effects when someone tries to inject it and blocks the effectiveness of other opioids. As a result, the patient has less temptation to misuse their medication. When someone needs to relieve pain with an opioid and has a history of addiction, this feature could protect them.
Why Suboxone for Pain May Not Be a Good Idea
When people are in pain, they will do anything to not experience the pain. And that may mean mixing medications, even though it’s a dangerous idea. If you mix Suboxone with alcohol or benzodiazepines such as Xanax, the combination could be fatal. Additionally, the National Alliance of Advocates for Buprenorphine Treatment (NAABT) doesn’t support the use of Suboxone for pain.
The NAABT website includes a letter from the Drug Enforcement Administration to a Dr. Heit, who asked about prescribing Subutex or Suboxone for pain. The letter states that the use of sublingual buprenorphine “is not prohibited under DEA requirements.” However, there may be a problem with scheduling and dispensing the various buprenorphine formulations.
Suboxone is FDA-approved to treat opioid use disorder but not chronic pain. Physicians sometimes prescribe it “off-label” to treat pain, but this is not its intended use. Even though it can effectively treat opioid use disorder and prevent individuals from craving opioids, Suboxone still contains an opioid that can cause physical dependence.
Buprenorphine works as an opioid antagonist that limits its pain-relieving effect, which means that it’s unlikely to effectively relieve patients’ pain when they don’t have an opioid use disorder. Because the liver metabolizes buprenorphine (the primary ingredient in Suboxone) so slowly, it is less efficient than other pain medications. The slow processing may lead people to take more buprenorphine which can lead to an overdose.
When Suboxone for Chronic Pain Is Appropriate
Suboxone can benefit individuals who have chronic pain in combination with opioid use disorder. Suboxone can help patients simultaneously manage chronic pain and the uncomfortable symptoms during withdrawal from opioids. Individuals with opioid use disorder and chronic pain have a higher risk of overdose when they take certain pain medications, but Suboxone can reduce their pain while helping them avoid relapse.
When you’re in a medication-assisted treatment program, doctors monitor your use of Suboxone. Talk with your buprenorphine doctor about using buprenorphine or Suboxone for pain. For example, the doctor for a woman anticipating a C-section delivery may increase the dose of Suboxone a small amount for the days immediately after the procedure. However small the amount, it is absolutely something that must be done in communication with your doctor, regardless of the reason for anticipating pain. Dose adjustments should never be made by a patient without speaking with your medical provider.
Can My Doctor Prescribe Suboxone for Pain?
Some doctors write off-label prescriptions for buprenorphine or Suboxone. However, since we have only preliminary research on buprenorphine’s painkilling effects, the medical field has more studies to complete. Once we have enough evidence showing its benefits for chronic pain, we can better understand its uses. In the meantime, you can speak with a trusted doctor or the medical provider at opioid use disorder clinic if you have more questions on the topic.
National Alliance of Advocates for Buprenorphine Treatment (NAABT) Recommendations
The National Alliance of Advocates for Buprenorphine Treatment (NAABT) makes the following recommendations for handling pain during surgery:
- Your doctor can continue your regular Suboxone treatment and gradually introduce an increasing dose of a pain medication if needed. You may need a higher-than-normal dose in order to break through the effects of the naloxone, but need to be carefully monitored.
- Your doctor can order your Suboxone dose to be taken as a divided dose. Instead of one 8mg film daily, you would take half the amount twice per day. This may well help with your pain—but it’s not a guarantee.
- Your doctor can halt your Suboxone therapy 72 hours ahead of your procedure. Once the procedure has passed and the analgesics you took are out of your system, you can resume Suboxone therapy. You will need to undergo the induction period once again.
- Your doctor can switch you from buprenorphine to methadone at a small dose—30 or 40 mg—so that your pain is managed and you also do not experience withdrawal symptoms. This process will need to be closely monitored by your medical provider.
Remember to follow your doctor’s direction when taking Suboxone and another painkiller. You can also coordinate care among your providers to ensure they know about every medication you take.
Possible Options for Treating Pain as a MAT Patient
You may simply have an elective surgery or dental surgery and you’re in a maintenance program with Suboxone. Again, before you take any type of medication, you must talk with your doctor. Acetaminophen and ibuprofen are two different categories of over-the-counter analgesics. However, aspirin, ibuprofen, and naproxen are all categorized as non-steroidal anti-inflammatory medications, and so they cannot be taken together. Ask your doctor if you can take one of them along with acetaminophen to help you deal with pain.
Other methods for managing pain without medication include massage therapy, gel packs, acupuncture, relaxation techniques, or physical therapy. Many people also work with a hypnotherapist to learn techniques that help them relax or put themselves into a different state of mind. The American Psychological Association is an advocate for hypnosis for the relief and control of pain.
Keeping open communication with your buprenorphine doctor is the best way to get the pain relief you need without putting yourself in danger.
Begin a MAT Program at BAART Programs
We have over 40 years of experience providing treatment for opioid use disorder. Our accredited recovery services are patient-focused and individualized to meet your needs. BAART staff members understand the challenges of pursuing recovery and are passionate about helping individuals overcome these challenges. We provide comprehensive treatment with mental health services and quality health care to help people overcome opioid use disorder and reclaim their lives.
Ready to start the path to recovery? Our team of compassionate medical professionals can help you manage your withdrawal symptoms with a comprehensive MAT program. We have over 30 locations across the United States ready to support you. You can contact our team by completing our online contact form or calling 844-341-4040.
