Suboxone for Pain: How & When to Use Suboxone for Pain

Suboxone is a prescription medication containing two medications: buprenorphine (a partial opioid agonist) and naloxone (an opioid antagonist). The U.S. Food and Drug Administration approved Suboxone for opioid use disorder (OUD) treatment. But it’s not FDA-approved for pain management.[1]

However, many doctors also use Suboxone “off-label” for pain management. The majority of medications in the United States are used for “off label” indications, otherwise known as indications for which they have not been “FDA approved”. For example, a lot of diabetes medications have been FDA approved for Diabetes, but are used “off label” for weight loss.

Similarly, Suboxone is FDA approved as a medication for addiction treatment but can be used “off label” as a pain medication. It’s a good option for some people, but it’s not right for everyone.

Learning more about how your Suboxone medication works can help you hold an informed discussion with your doctor.

Suboxone’s Pain-Relieving Effect 

Buprenorphine is a partial opioid agonist, meaning it is an opioid medication. All opioid medications play a role in providing pain control.

Buprenorphine was actually first approved in patch form (called Butrans) for chronic pain. It was then added to Naloxone to form Suboxone, which was designed/approved as a treatment for opioid use disorder (OUD). However, many doctors recognized its potential to be a pain reliever, even a comparatively safer pain reliever as compared to full opioids like oxycodone or vicodin.

Suboxone can provide pain relief in people with the following issues:[2]

• Chronic pain: Acute pain is caused by something like surgery. Chronic pain lasts longer, and it could be caused by a difficult illness or disease.
• Addiction: OUD could make treating pain difficult, as opioids may not be effective when you’re used to them.

Someone like this needs a strong painkiller to ease discomfort. But this person has a history of misusing medications. Suboxone could offer relief while still having fewer side effects and risks than long term full opioid use.

How Does Suboxone Treat Chronic Pain?

Through its actions at the opioid receptors, buprenorphine has a pain-blocking effect that lasts between six and eight hours.

It also has a much lower risk of misuse or dependency than other opioids because it is a partial agonist (weak activator) rather than a full agonist (strong activator) at the opioid receptor.

Two forms of buprenorphine are FDA approved for chronic pain:

Belbuca

Belbuca is the brand name of a buprenorphine buccal strip.[3] The medication is absorbed through the inside of the cheek, somewhat like Suboxone.

Belbuca is prescribed for use either once per day or every 12 hours, depending on your needs for chronic pain relief. Your doctor will start you on the lowest possible dose and increase it as needed.

Butrans

Butrans, another brand name formula of buprenorphine for chronic pain, is a patch absorbed through the skin and replaced once per week. It was approved by the FDA in 2010 for chronic pain. [4]

Suboxone, in contrast, is the form of Buprenorphine combined with Naloxone for the treatment of OUD. While it is not “FDA approved” solely as a pain medication, many doctors use it “off label” for patients with chronic pain because it is generally thought to be safer than full opioid agonists like oxycodone, hydrocodone, morphine, or methadone.

When Should You Use Suboxone to Treat Pain?

Suboxone is a prescription medication, meaning you must talk to a doctor to get it. Together, you can decide if Suboxone is the right choice for you and your pain.

Experts say medications with buprenorphine should be considered in people with the following conditions:[5]

• Chronic pain (greater than one month of pain from an underlying medical condition)
• A history of drug misuse or dependency
• Responsiveness to buprenorphine

If you have chronic pain, particularly if you also have a history of addiction or opioid dependency, Suboxone could be a good choice for you. Talk to your doctor about it.

Is Suboxone Effective in Treating Pain?

The buprenorphine inside Suboxone is a partial opioid. Doctors, patients, and advocates all agree that some people get relief from chronic pain from Buprenorphine. [6]

Pain is individual, and the solutions that help one person may not help another. If you’ve tried other solutions for chronic pain without success, Suboxone could be a safe and helpful next step.

People who take Suboxone for opioid use disorder treatment, which eases withdrawal symptoms, reduces cravings, and manages compulsive addictive behaviors, may also receive partial or total pain relief with Suboxone.

Multiple studies have been conducted on this subject.

• A 2018 medical survey of buprenorphine formulations for chronic pain relief found that Suboxone was an effective analgesic and had no lasting side effects. This study has encouraged more doctors to call for a “safer” formula of buprenorphine, namely Suboxone, and other formulations that include naloxone, to be used in pain management, to reduce the risk of overdose or medication misuse.[9]
• An earlier study, from 2015, found that buprenorphine alone seemed to work better as an analgesic for chronic pain patients who also had addictive behaviors.[10]

How Much Suboxone Is Needed for Pain Relief?

While Suboxone is not FDA approved for treating chronic pain, many doctors use it for this indication. [7] The doses people need for pain may be different than the doses needed to treat withdrawal cravings in patients with OUD. The analgesic properties of Suboxone tend to be shorter, and so patients who are taking it solely or primarily for pain may need more frequent dosing; patients taking Suboxone for OUD usually only need a dose once a day. In contrast, patients taking Suboxone for pain may need to be dosed up to 3 times a day[7, 8].

Where Can You Get Suboxone for Chronic Pain?

Suboxone is a controlled substance medication, and you need a prescription to get it safely and regularly.

Don’t buy Suboxone illicitly: Many illicit substances contain other opioids, including fentanyl. In one study, about half of all drug users noticed fentanyl in their purchases some or most of the time.[12] This can lead to overdose or even death.

If you want Suboxone for pain control, there are safe and legal ways to get it. Talk to your doctor about whether getting Suboxone online could be right for you and your pain control needs.

Sources

1. Suboxone Prescribing Information. U.S. Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/020733s022lbl.pdf. February 2018. Accessed November 2022.
2. Buprenorphine/Naloxone Therapy in Pain Management. Anesthesiology. https://pubs.asahq.org/anesthesiology/article/120/5/1262/13748/Buprenorphine-Naloxone-Therapy-in-Pain-Management. May 2014. Accessed November 2022.
3. Buprenorphine Buccal (Chronic Pain). National Library of Medicine. https://medlineplus.gov/druginfo/meds/a616019.html. January 2022. Accessed November 2022.
4. Butrans (buprenorphine) Transdermal System. Food and Drug Administration. https://www.fda.gov/media/107620/download#:~:text=Butrans%C2%AE%20(buprenorphine)%20Transdermal%20System%20was%20approved%20by%20the%20FDA,alternative%20treatment%20options%20are%20inadequate. September 2017. Accessed February 2022.
5. Understanding Buprenorphine for Use in Chronic Pain: Expert Opinion. Pain Medicine. https://academic.oup.com/painmedicine/article/21/4/714/5699282. January 2020. Accessed November 2022.
6. Pathways to Prevention Workshop: The Role of Opioids in the Treatment of Chronic Pain. National Institutes of Health. https://prevention.nih.gov/sites/default/files/documents/programs/p2p/ODPPainPanelStatementFinal_10-02-14.pdf. September 2014. Accessed November 2022.
7. 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 November 2022.
8. Safe and Responsible Use of Opioids for Chronic Pain. U.S. Department of Veterans Affairs. https://www.va.gov/PAINMANAGEMENT/Opioid_Safety/OSI_docs/10-791-Safe_and_Responsible_Use_508.pdf. October 2018. Accessed November 2022.
9. Treatment of Chronic Pain with Various Buprenorphine Formulations: A Systematic Review of Clinical Studies. Chronic Pain Medicine. https://journals.lww.com/anesthesia-analgesia/fulltext/2018/08000/treatment_of_chronic_pain_with_various.36.aspx. August 2018. Accessed November 2022.
10. Buprenorphine-Naloxone Therapy in Pain Management. Anesthesiology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3999180/. May 2015. Accessed November 2022.
11. A Retrospective Evaluation of Patients Switched From Buprenorphine (Subutex) to the Buprenorphine/Naloxone (Suboxone) Combination. Substance Abuse Treatment, Prevention, and Policy. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2453114/. June 2008. Accessed November 2022.
12. Fentanyl-Contaminated Drugs and Nonfatal Overdose Among People who Inject Drugs in Baltimore, MD. Harm Reduction Journal. https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-018-0240-z. July 2018. Accessed November 2022.