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Does Suboxone help with pain?

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The U.S. Food and Drug Administration (FDA) doesn't allow doctors to prescribe Suboxone for pain control. 

If you're using Suboxone to address an opioid use disorder (OUD), your prescription could help with pain too. But if you have just pain and no OUD, your doctor will likely reach for a different medication than Suboxone to ease your discomfort.

Suboxone contains two active ingredients. Naloxone is an agonist substance, keeping you from overdosing if you take too many opioids. Buprenorphine is a mild opioid that can ease your withdrawal symptoms and cravings.

Buprenorphine alone is FDA approved for pain relief. Many doctors believe this substance could revolutionize the way we address discomfort.

Should Suboxone Be Used as a Pain Reliever?

The FDA is clear: Suboxone is a prescription medication designed to address OUDs.[1] No other condition can be treated with Suboxone.

The buprenorphine within Suboxone is a controlled substance. Take too much, and you could face an overdose. 

Officials work hard to keep those overdose numbers down by tightly restricting who has access to Suboxone products. And they ensure that the medications are sold in dosages that work for people with opioid use disorders. 

Researchers say the amount of buprenorphine in a Suboxone dose is likely unhelpful for people without OUDs who have pain.[2] Naloxone's blocking power might keep the full power of buprenorphine from hitting your body. 

Products made just for pain have a smaller amount of buprenorphine and no naloxone at all.[3] A medication like this can likely deliver relief to people who don't have an opioid issue and who have never taken buprenorphine at all. 

How Commonly Is Suboxone Used for Pain Relief?

While some doctors may use Suboxone for pain relief, it's not common. Two main roadblocks keep doctors from using this medication to ease discomfort. 

FDA Oversight 

Suboxone seems like an ideal medication for pain relief. It contains an opioid to ease discomfort, and naloxone should block overdoses. But the FDA does not agree. 

Doctors must go through significant training and registration processes to prescribe buprenorphine. When they're done, they have added documentation to put on each prescription they write. 

When a doctor writes a prescription for Suboxone, the doctor must offer a diagnosis code.[4] Doctors who use any code other than OUD could face serious problems and put their licenses at risk. 

Other Choices

Suboxone isn't the only medication that can ease discomfort. Other choices are available, and most of them don't involve breaking the law or working against the FDA. 

Can Buprenorphine Be Used as a Pain Reliever?

Researchers say buprenorphine is a safe and effective pain medication.[5] It works quickly. While buprenorphine includes a ceiling effect that can limit overdose risks, that benefit doesn't seem to keep the medication from easing discomfort. 

In one overview study of 25 trials, researchers found 14 proving buprenorphine's efficacy.[6] And in another study, researchers found no evidence of respiratory depression (a hallmark of overdose) in people using this medication for pain control.[7]

Your doctor can choose from three formulations made for pain:[7]

  • Buprenex injections for acute pain
  • Belbuca buccal strips for chronic pain
  • Butrans transdermal patches for chronic pain. 

Your doctor may limit your prescription and encourage you to stop taking the medication as soon as you feel better. 

What About Pain Relief for People Already Using Suboxone?

If you're treating an opioid use disorder with Suboxone and you feel uncomfortable, it's tempting to take a bigger dose to feel better.

OUDs can be subtle, and sometimes, a relapse comes from an unexpected direction. One day, you're taking slightly more of your medication to feel better. The next day, you've returned to heroin as the Suboxone wasn't strong enough.

If you feel physical or mental discomfort as you treat your OUD, talk to your doctor. Never adjust your Suboxone dose without having this important conversation.

SOURCES

  1. Prescribing Information: Suboxone. U.S. Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/020733s022lbl.pdf. February 2018. Accessed July 2022. 
  2. Buprenorphine-Naloxone Therapy in Pain Management. Anesthesiology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3999180/. May 2015. Accessed July 2022. 
  3. Treating the Opioid-Addicted Chronic Pain Patient: The Role of Suboxone. Practical Pain Management. https://www.practicalpainmanagement.com/treatments/addiction-medicine/opioid-use-disorder/treating-opioid-addicted-chronic-pain-patient-role. March 2019. Accessed July 2022. 
  4. Suboxone for Pain Makes Sense. Why Don't More Doctors Prescribe it? MedPage. https://www.kevinmd.com/2018/11/suboxone-for-pain-makes-sense-why-dont-more-doctors-prescribe-it.html. November 2018. Accessed July 2022.
  5. Buprenorphine: An Attractive Opioid With Underutilized Potential in Treatment of Chronic Pain. Journal of Pain Research. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4675640/. 2015. Accessed July 2022. 
  6. Treatment of Chronic Pain with Various Buprenorphine Formulations: A Systematic Review of Clinical Studies. Anesthesia and Analgesia. https://journals.lww.com/anesthesia-analgesia/fulltext/2018/08000/treatment_of_chronic_pain_with_various.36.aspx. August 2018. Accessed July 2022. 
  7. Benefit-Risk Analysis of Buprenorphine for Pain Management. Journal of Pain Research. https://www.dovepress.com/benefit-risk-analysis-of-buprenorphine-for-pain-management-peer-reviewed-fulltext-article-JPR. April 2021. Accessed July 2022.

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