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What Pain Medications Work with Suboxone?

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated Dec 13, 2023 • 3 cited sources

Before taking any additional medications with your Suboxone, you should always consult your medication for addiction treatment (MAT) provider. Certain medicines can interact with your Suboxone and cause serious harm if taken together with your Suboxone. Generally, though, you are safe to take over-the-counter pain relievers like Advil and Tylenol. You may also want to try topical pain medications like lidocaine.

Does Suboxone Relieve Pain?

Quick Answer

The mechanism is complicated. Because Suboxone contains buprenorphine, a partial opioid agonist, it does have some pain-relieving properties for those with opioid use disorder (OUD). However, if you don’t have opioid use disorder, Suboxone may not adequately relieve your pain. Either way, you may still need to supplement your buprenorphine/naloxone with another pain medication.

What Painkillers Can I Take with Suboxone?

Always check with your doctor or provider before taking a painkiller or pain medication while on Suboxone. However, these medications are safe to take with Suboxone: [1]

  • Acetaminophen (Tylenol)
  • Ibuprofen (Advil, Motrin)
  • Aspirin (Bayer)
  • Naproxen (Aleve)

You can also use topical pain medications you can purchase over the counter, such as:

  • Lidocaine patches or creams
  • Menthol creams or gels 
  • Salicylate creams
  • Capsaicin gels or creams

Your doctor may prescribe other medications, such as gabapentin, especially if you have nerve pain. Just always make sure to disclose that you are taking Suboxone to your provider. 

Can I Take Opioid Painkillers with Suboxone?

In some situations of moderate or severe pain, your doctor may prescribe an opioid medication, such as oxycodone or hydromorphone, but that is very situational and only after other options have been exhausted.

Is Suboxone Effective in Treating Pain?

Suboxone is not FDA-approved to treat pain—this medication is only approved to treat opioid use disorder. However, some doctors may prescribe buprenorphine or Suboxone to manage chronic pain.

Evidence suggests that Suboxone may provide pain relief in patients with opioid dependence or opioid use disorder. However, it may not relieve pain in opioid-naive patients—those without an opioid dependence. [3]

Evidence suggests that Suboxone may provide pain relief in patients with opioid dependence or opioid use disorder.[3]

One study of chronic pain patients with OUD who transitioned from a full agonist opioid medication like methadone to Suboxone experienced a 2.3-point reduction in pain (on a 10-point scale) within 2 months of the switch. Another study showed a nearly 13% reduction in pain.[3]

Suboxone’s Unique Opioid Effects

Buprenorphine works differently in the brain than full opioid agonist painkillers like oxycodone and hydrocodone and is considered a weak analgesic. One possible reason Suboxone can relieve pain in opioid-dependent people but not opioid-naive is that it may reverse opioid-induced pain hypersensitivity they developed from chronic misuse. [3]

That said, Suboxone may not provide sustained pain relief for those with chronic pain. This is because buprenorphine’s duration of action for pain relief is only about 4-8 hours. And most patients tend to take Suboxone once a day so the period of analgesia is likely too short.[1]

How is Pain Managed for Surgical Procedures while on Suboxone?

The American Society of Addiction Medicine (ASAM) 2020 guidelines no longer recommend discontinuation of Suboxone prior to surgery since higher-potency pain medications can be used during surgery to control pain adequately. 

However, since the use of Suboxone can decrease how effective opioid medications are, possibly causing inadequate pain control, not all providers agree on whether or not Suboxone should be stopped for elective procedures. 

Therefore, when possible, individuals who require elective surgical procedures taking Suboxone should work with their surgeon and MAT provider before their surgery to discuss expectations and develop a pain management plan. 

Depending on the type of procedure required, your doctor may administer anesthesia or another pain medication to control your pain. Whichever drug is chosen should be individualized to your particular needs and situation by your healthcare team.  

Managing Non-Surgical Short and Long-Term Pain while on Suboxone

Maximizing non-opioid pain medications (i.e., non-steroidal anti-inflammatory drugs – NSAIDs – and acetaminophen) whenever possible and not contraindicated is the preferred first-line treatment. 

Additionally, before trying opioids, other adjunct medications should be used, such as:

  • Gabapentinoids
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Selective serotonin and norepinephrine reuptake inhibitors (SNRIs)
  • Tricyclic antidepressants (TCAs)
  • Muscle relaxers
  • Ketamine
  • Nerve blocks

Managing Pain with Suboxone and Opioid Painkillers

If opioid pain medications are necessary for short-term pain treatment, they should be temporary and limited to a maximum of three or seven days. 

If opioid pain medications are necessary for long-term chronic pain treatment, expert pain specialists should be included with your MAT provider to ensure they are used appropriately and safely with your Suboxone. 

Regardless of the type of pain (short or long term), if opioids are essential to your pain management plan, it is crucial that you discuss the risks of supplemental opioid use while taking Suboxone with your healthcare team. 

Combining Suboxone with other opioids for any length of time increases the risk of overdose. 

It is strongly recommended that any person requiring supplemental opioids have access to naloxone (Narcan) for emergency treatment of an opioid overdose. Oftentimes, providers will prescribe this opioid overdose medication alongside opioid painkillers.

Non-Medication Pain Relief

You may find that the best way to manage your pain is some combination of interventions, such as OTC medications, topical pain relievers, and holistic or alternative options, such as:

  • Massage therapy
  • Chiropractic care
  • Transcutaneous electrical nerve stimulations (TENS)
  • Physical therapy
  • Meditation
  • Counseling
  • Acupuncture

Reviewed By Peter Manza, PhD

Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role ... Read More

Sources
  1. Alford DP, Compton P, Samet JH. Acute pain management for patients receiving maintenance methadone or buprenorphine therapy [published correction appears in Ann Intern Med. 2006 Mar 21;144(6):460]. Ann Intern Med. 2006;144(2):127-134. doi:10.7326/0003-4819-144-2-200601170-00010
  2. The ASAM National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use. American Society of Addiction Medicine. (2015). 
  3. Chen KY, Chen L, Mao J. Buprenorphine-naloxone therapy in pain management. Anesthesiology. 2014;120(5):1262-1274. doi:10.1097/ALN.0000000000000170

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