Does Suboxone help with pain?

Official answer

by Drugs.com

Suboxone is sometimes used “off-label” by doctors to help with acute or chronic pain in certain patients. “Off-label" use of a drug refers to when a doctor prescribes a medicine for a different purpose than those formally approved by the FDA and found in the package labeling.

Suboxone (buprenorphine and naloxone) sublingual film is NOT approved by the FDA for use as a pain relief medication. Suboxone is only approved to treat narcotic (opiate) addiction (opioid use disorder). Only single agent buprenorphine (without naloxone) is approved to treat pain.

Follow your doctor’s instructions for Suboxone use exactly.

Do NOT use Suboxone for pain unless your doctor has specifically prescribed it for this use. Do not adjust doses yourself.

There have been reports of deaths in people who are not using opioids (opioid-naive patients) who used a 2 mg sublingual buprenorphine dose for pain relief.

Never give anyone else your Suboxone for any reason. They could die from taking it. Keep it out of reach of children. If you are using Suboxone for any purpose, discuss with your doctor having naloxone (Narcan) available for the emergency treatment of an opioid overdose. In the U.S., pharmacists can usually provide naloxone from the pharmacy without the need for a prescription.

How does Suboxone come?

The Suboxone sublingual film comes in the following strengths:

buprenorphine 2 mg / naloxone 0.5 mg

buprenorphine 4 mg / naloxone 1 mg

buprenorphine 8 mg / naloxone 2 mg

buprenorphine 12 mg / naloxone 3 mg

Suboxone contains a combination of buprenorphine (a partial mu opioid receptor agonist, kappa opioid receptor antagonist, and ORL-1-receptor agonist) and naloxone (a pure opioid antagonist). Suboxone works in the brain to help with opioid addiction.

Suboxone is administered as a film that dissolves under the tongue (sublingually) or in the cheek area (buccal use) and is given as a single daily dose for opioid dependence. It is used as part of a complete treatment program that also includes counseling and behavioral therapy.

Related: Suboxone Dosage (detailed information on FDA-approved dosage and administration).

Because Suboxone contains the opioid buprenorphine, some people may try to abuse it by injecting it. Buprenorphine is well absorbed sublingually, but naloxone, the opioid antagonist, is poorly absorbed when given by mouth. Naloxone is included in Suboxone to reduce its abuse by injection. When injected, naloxone can cause sudden and severe withdrawal symptoms. Due to this effect, the patient has less temptation to misuse their medication.

Do not switch from Suboxone sublingual film to other medicines that contain buprenorphine without talking with your doctor. The amount of buprenorphine in a dose of Suboxone sublingual film is not the same as the amount of buprenorphine in other medicines that contain buprenorphine.

Do not stop taking Suboxone without speaking to your doctor. You could become sick and have withdrawal symptoms. Follow your doctor’s direction on how to discontinue Suboxone.

Other products that contain buprenorphine and are used for the treatment of opioid use disorder include:

Zubsolv: a brand name combination product of buprenorphine and naloxone, available as an orally disintegrating sublingual tablet, used to treat opioid use disorder.

Sublocade: an extended-release buprenorphine injection (depot formulation) given once a month for the treatment of opioid use disorder. This product does not contain naloxone.

Does buprenorphine treat pain?

Buprenorphine has pain-relieving effects and is approved by the FDA as a single agent in several forms for pain.

An extended-release, transdermal (skin patch) formulation of buprenorphine (brand name: Butrans) is approved by the FDA for the treatment of moderate-to-severe chronic (long-lasting) pain. Butrans is NOT to be used to treat acute pain on an as-needed basis. Belbuca (buprenorphine buccal film) is also used to treat chronic pain not controlled by other medicines.

These buprenorphine agents are for the daily management of pain severe enough to require around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate. They are NOT used to relieve acute pain quickly or on an as-needed basis.

Buprenex (buprenorphine injection) is also available for pain severe enough to require an opioid analgesic and for which alternate treatments are inadequate. It can be given by intravenous or intramuscular injection.

See Buprenorphine Dosage for detailed information on buprenorphine dosage and administration.

Off-label use of Suboxone for the treatment of pain

The FDA has NOT approved the use of Suboxone for the treatment of pain. Some doctor’s may still use this medicine “off-label” for pain in certain patients already using Suboxone to treat opioid use disorder. Research studies have been published that address the "off-label" use of Suboxone for treatment of both acute and chronic pain.

Acute pain, which is usually short-term, can occur after surgery, a medical or dental procedure, or trauma (sprain, broken bone) from an accident.

Chronic or long-lasting pain might involve various forms of ongoing joint or back pain, cancer pain or nerve (neuropathic) pain.

Acute Pain in Patients with Opioid Use Disorder

Although buprenorphine / naloxone (Suboxone) is given only once per day for treatment in opioid use disorder (OUD), the pain-relieving effect from buprenorphine may only last 6 to 8 hours.

For acute pain or for surgery, your doctor may decide to continue your buprenorphine / naloxone (Suboxone) treatment. To help to minimize any pain, non-drug therapies like cold, heat, or physical or behavioral therapy might also be started. Non-opioid medicines (for example: NSAIDs, acetaminophen, topical treatments, corticosteroids) may also be ordered by your doctor. NSAIDs include medicines like ibuprofen, naproxen, or ketorolac (Toradol). Regional and local (numbing) anesthesia may also be used.

In some patients, the daily dose of buprenorphine / naloxone (Suboxone) may be increased and given in 3 or 4 divided doses per day (every 6 to 8 hours) to help control mild-to-moderate pain. Your doctor will adjust your dose if needed.

If needed, your doctor may temporarily add other opioid treatments to control your pain. Staying on your buprenorphine / naloxone (Suboxone) treatment will help you maintain your treatment goals with less risk for a relapse, but may not always be possible. The use of buprenorphine might make it more difficult to treat your pain with other types of opioids. The decision to continue buprenorphine / naloxone (Suboxone) treatment will be made on a case-by-case basis.

Consensus is growing that patients can continue their Suboxone treatment when being treated for certain levels of acute pain. If you are having surgery, ask your medical team if you will need to temporarily stop your Suboxone treatment and for how long.

The level of pain expected and the type of procedure may help to determine if you can continue buprenorphine / naloxone (Suboxone) around the time of surgery. Your doctor can also help manage any withdrawal symptoms, if needed. A pain consulting service from the hospital may be utilized, as well.

Chronic pain in opioid-dependent patients

Studies have shown that buprenorphine / naloxone (Suboxone) has been increasingly prescribed off-label to treat chronic (longer-term) pain in opioid-dependent patients. There is a risk of overdose and death in opioid-naïve patients (not currently using opioids) who use Suboxone.

Chronic pain is common among people with opioid use disorder. In addition, opioid use may worsen pain (called opioid-induced hyperalgesia or OIH). OIH can occur when a patient receiving opioids for pain actually becomes more sensitive to pain.

As with acute pain treatment, chronic pain in opioid-dependent patients should be addressed with nonopioid analgesics like NSAIDs (ibuprofen, naproxen) or acetaminophen (Tylenol), and non-drug treatments such as physical therapy or behavioral therapy. Treatment for opioid use disorder is often continued, and your doctor will discuss this option with you.

If Suboxone is used for opioid use disorder and chronic pain management, treatment is always individualized and your doctor may adjust your dose. Follow your doctor’s dosing instructions exactly and do not increase your dose without speaking to your doctor first.

In one study, chronic pain patients who switched from using a full opioid agonist drug to buprenorphine / naloxone (Suboxone) therapy had a 2.3 point pain reduction on a 0 to 10 pain scale within 60 days of the switch.

A review of patients with opioid dependence and chronic pain who stayed on their treatment required lower doses of buprenorphine / naloxone (Suboxone) over time or were able to stop opioids all together.

Several randomized controlled studies showed that chronic pain patients with opioid dependence experienced over a 12% reduction of pain with buprenorphine / naloxone therapy and were able to reduce oxycodone abuse.

Advantages to Buprenorphine

As an opiate, buprenorphine still has the potential for abuse and is a controlled substance. However, it is a Schedule III narcotic, which may ease prescribing and patient access over Schedule II opioids used for chronic pain.

Suboxone also has a longer duration of action than many opioids, but a 30 to 60 minute onset of action. It may produce fewer withdrawal symptoms upon discontinuation.

Buprenorphine may be safer than some full opioid agonists when used for chronic pain. It may cause less physical dependence and euphoria (feeling of “high”), less respiratory depression, and less opioid-induced hyperalgesia.

It also has a ceiling effect for respiratory depression, but respiratory depression can still occur, especially when used with benzodiazepines (like Xanax or Valium), alcohol, or other respiratory depressants (including street drugs). When combined with any of these products, it can cause severe drowsiness, decreased awareness, breathing problems, coma, and death.

This is not all the information you need to know about Suboxone (buprenorphine and naloxone) for safe and effective use and does not take the place of your doctor's directions. Review the full Suboxone information here, and discuss this information and any questions you have with your doctor or other health care provider.

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