When it comes to chronic pain, relief can be hard to find. Many patients, frustrated by their unresponsive pain levels, turn to opioids as their only choice. But research is finding that the risks of opioids far outweigh the potential pain relief (and that long-term pain relief is actually minimal). If this sounds like you, keep reading. Long used in medication-assisted treatment of substance use disorders, Suboxone for pain is an option that can safely moderate pain levels with less chance of dependence or addiction.
What Is Suboxone For Pain?
Suboxone treatment is a combination of two medications (buprenorphine and naloxone). It works to block opioid receptors in the brain and is primarily used to combat opioid addiction.
The buprenorphine reduces opioid cravings and withdrawal symptoms. The naloxone blocks the “high” that people with substance use disorder need. For these reasons, Suboxone is often used in medication-assisted treatment programs for substance use disorders.
When it comes to Suboxone for pain, the action is similar in that it works on the opioid receptors that manage pain. The major difference? Suboxone is less likely to cause dependence in at-risk patients. It has a ceiling at which it works to manage pain, which decreases the chances of dependence. In addition:
- It is better for the immune system than opioids
- It’s easier for older patients and people with kidney dysfunction to take
- People with a history of drug abuse are less likely to become addicted
And where opioids are largely ineffective against neuropathic pain, Suboxone for nerve pain is showing some promise. While it is not a long-term solution, Suboxone treatment has fewer side effects and may provide relief while other treatment options are explored.
Is Suboxone FDA-approved for pain?
Although Suboxone is approved by the U.S. Food and Drug Administration in medication-assisted treatment programs for substance use disorders, the rules for directly managing chronic pain are different.
Buprenorphine is FDA-approved for pain relief as a single medication in different forms. A transdermal patch of buprenorphine is approved for moderate to severe chronic pain. Film dissolved in the cheek (buccal) or under the tongue (sublingual) is also approved by the FDA for unresponsive chronic pain. In extreme cases, a buprenorphine injection is approved for managing pain that has required opioids in the past. It is important to note that injected buprenorphine is arguably as potentially addictive as opioids themselves.
All forms of buprenorphine should not be used to manage acute pain or pain that is resolved within three months.
As a compound medication, Suboxone is not approved by the FDA for treating chronic pain, but many doctors use this medication off-label. Patients who are either at risk of opioid dependence or in recovery from it are key beneficiaries in the treatment of both acute and chronic pain. Suboxone takes effect in under an hour, but the pain-relieving effects last longer than opioids. Pain relief peaks within two to three hours and lasts for 24. This kind of sustained action discourages misuse.
Additionally, Suboxone does not suppress the respiratory system in the way that opioids do. There is a ceiling at which this side effect (and others) occurs, making it safer for those with respiratory illness.
It is important to remember that rules and regulation are in a constant state of change as new products and new research enters the market. Always talk to your doctor for the most up-to-date approvals and restrictions on Suboxone for chronic pain.
How Does Suboxone For Pain Work?
Before unpacking the action of Suboxone, it is important to first understand how pure opioids work in the brain and the body. Opioids are agonists, binding to receptors in your brain and spinal cord (among other areas of the body). They block pain signals and provide profound, temporary relief.
Unfortunately, they also trigger a chemical release that causes euphoric feelings — the “high” is brief and intense. Taking opioids for chronic pain or for “recreational” purposes actually causes your brain to change. In addition to requiring more opioids to find that euphoric release, the effects of the high wear off faster over time.
Suboxone has two medications that work together on the opioid receptors. The first, buprenorphine, is a partial agonist. It also binds to opioid receptors in a quest to relieve pain and trigger a release of good-feeling chemicals, but it is not as fast acting or as intense. This means that there is no high, and the pain relief does not wear off quickly.
The second medication, naloxone, is an opioid antagonist. Its sole purpose is to counteract the effect of opioids on opioid receptors. This is why it is used as a life-saving treatment in the case of opioid overdose. In Suboxone, naloxone prevents withdrawal symptoms as the buprenorphine wears off. With the euphoric rush blocked, there is simply no point in taking more of the medication.
Suboxone is a safer alternative
As part of a medication-assisted treatment program for patients in pain, Suboxone is safer and offers less chance of addiction or relapse while patients are in recovery. One study found that without this type of treatment, the relapse rate for patients in recovery was 100%. In contrast, 25% of patients taking Suboxone experienced a relapse.
Because many people initially started taking opioids for chronic pain, it’s very promising to note that one medication can help treat issues of both pain and dependence at the same time.
Suboxone for pain conditions
For patients in long-term opioid therapy, Suboxone is effective in reducing chronic pain of different types. It was especially effective for patients who were not finding relief with increasing levels of opioid therapy or who are in recovery and at risk of relapse. Another benefits-risk analysis from 2021 found that Suboxone for chronic pain is a good alternative to opioids to consider, with fewer side effects or chance of dependence.
Research on specific chronic pain conditions is limited, but there is evidence that Suboxone for back pain is an effective alternative to opioids. As an FDA-approved treatment for moderate to severe chronic pain, some studies have indicated that a buccal film of buprenorphine reduced back pain significantly over placebo.
Suboxone works differently
Because Suboxone — and buprenorphine in particular — work on opioid receptors in ways that differ from how opioids work, there is some evidence that it can be effective in the treatment of nerve pain. Another interesting finding is that although there is a ceiling for respiratory depression (it will slow respiration only to a point and no further) buprenorphine has unlimited analgesic effects.
Nerve pain was also relieved with the transdermal application of buprenorphine in patients with diabetic peripheral neuropathy. In a small, randomized and controlled study, just over 86% of patients in the buprenorphine group reported a 30% reduction in pain. However, side effects including nausea, vomiting, and constipation (also frequent side effects with prescription opioids) dampened these results.
How does Suboxone feel?
For many people, the highlight of Suboxone is the lack of extreme reactions. Although there is a period of acclimation, once you are on your prescribed dose, you may feel nothing other than relief from pain and slight drowsiness.
Of course, due to body chemistry, everyone experiences the medication differently. Your doctor can help you better understand what to expect and how Suboxone for pain might affect you.
Would Suboxone Help Me?
For chronic pain patients who are struggling with substance use disorders, Suboxone can offer a treatment approach that addresses both opioid dependence and pain. Suboxone is most commonly prescribed for this specialized group of patients. People who are opioid-tolerant or are experiencing opioid-induced hyperalgesia may also benefit from switching to Suboxone.
Additionally, Suboxone is a good option for acute pain relief in patients with a history of substance abuse or with family risk factors. A 2020 panel convened to discuss the benefits of buprenorphine for this population. They concluded that:
- Buprenorphine offered desirable outcomes with less risk
- There was no need to have a weaning period for treatment
- It may be helpful for acute pain (e.g., pre- and post-operative pain) when substance abuse is a risk
Suboxone side effects
All medications come with side effects, and Suboxone for pain is no different. Side effects may include:
- Back pain
- Opioid withdrawal symptoms
- Blurred vision
- Mouth numbness or burning
- Stomach pain
- Tongue pain
More serious side effects are also possible. These require immediate medical attention, as they can lead to death if not addressed.
- Difficulty breathing
- Swelling of the mouth or tongue
Patients may also experience dental issues if they take Suboxone that is dissolved in the mouth (buccal film in the cheek or tablets), including tooth decay, cavities, oral infections, and tooth loss.
Suboxone safety precautions
Do not take Subuxone with other depressant medications. When combined, they can have dangerous respiratory side effects. Other safety precautions to keep in mind include:
- Only take Subuxone as prescribed by your doctor
- Do not share your prescription
- Do not take more than is prescribed
- Do not inject Suboxone
- Do not stop taking Suboxone suddenly
- Do not take Suboxone and opioids at the same time
- You should not drive or drink alcohol when taking Suboxone
If you seek treatment in an emergency room (or from a healthcare provider who is not your regular doctor), inform them that you are taking Suboxone for pain.
Who should not use Suboxone for pain
There are some groups who should not take Suboxone for chronic pain. These include people with:
- Respiratory issues
- Any structural issues that restrict breathing (e.g., scoliosis)
- Addison’s disease
- An enlarged prostate
- Difficulty urinating
- Issues in or disease of liver, kidney, or gallbladder
- Head injury or neurological disorder
- Adrenal gland or thyroid gland problems
Because mental health challenges can be intensified by depressant medications, it’s critical that you work with your doctor closely, especially if you have a history of or are in treatment for a mood disorder or other mental health condition.
Our Chronic Pain Management Approach
For many people, chronic pain is just one of the challenges they face. In Arizona, patients struggling with the related conditions of chronic pain, mental health issues, and substance use disorder can receive life-changing care at Arizona Pain’s Mercy Care Center of Excellence program. Our holistic approach addresses all three issues at once, with support every step of the way.
And, if you’re not covered by Mercy Care, Arizona Pain helps with treatment options to reduce your opioid use and better manage chronic pain. Get in touch today. We can help you get back to better.