Taking Suboxone to treat an opioid addiction doesn’t mean that you have to suffer needlessly after surgery or injury.
Life is unpredictable. Sometimes we experience an injury, illness, or surgery that causes us acute pain. Acute pain goes away when whatever is causing it goes away—when the injury heals, or when you recover from the illness. This contrasts with chronic pain, which is long-term. People in recovery from opioid use disorder often fear facing acute pain because they don’t know if they will be able to get any relief from it. Will they just have to suffer now? This fear can be even stronger if their opioid use began with prescription medication in the first place.
You do not have to simply white-knuckle your way through pain just because you are using a medication-assisted treatment like Suboxone. Talk to your healthcare provider about your concerns, and they will suggest pain relief options. This article will discuss some of the solutions they may bring up.
Non-opioid options for pain relief while taking Suboxone
What pain medication can you take on Suboxone?
Humans have been using opioids as painkillers for thousands of years, so you may assume that when you’re in pain, opioids are the only option. But there are other alternatives. If your doctor recommends avoiding opioid painkillers while you are engaged in Suboxone treatment, that isn’t a sign that they’re being controlling or distrustful. Your Suboxone treatment may not be compatible with opioid pain medications, so your provider will make suggestions taking that into account.
Instead of opioids, many clinicians will recommend a nonsteroidal anti-inflammatory drug (NSAID) like:
- ibuprofen (popular brands include Advil, Motrin, Nuprin)
- aspirin (popular brands include Bayer, Bufferin)
- naproxen (popular brands include Aleve)
Acetaminophen (popular brands include Tylenol) does not relieve inflammation, so it is not an NSAID, but it can be effective against many kinds of pain and is safe to take while on Suboxone. There are several pain medications that combine multiple active ingredients, including brands like Excedrin and Midol. These are also compatible with buprenorphine treatment like Suboxone. Despite being common and readily available, these medications should still be taken as instructed. Your provider will tell you the best dosage and timing in order for you to get the best (and safest) relief.
Your doctor may also prescribe a medication that addresses pain differently, like gabapentin for nerve pain. Make sure your provider knows that you’re taking Suboxone so they can consider any possible drug interactions.
Non-medication pain relief
Most people in our society default to taking a medication for pain, but there are a whole range of techniques for managing pain that don’t involve drugs. Many are surprised at how effective these strategies can be. These may include:
- physical therapy
- mild electrical current from a TENS unit
If your healthcare provider suggests one or more of these strategies, try to keep an open mind. You may find unexpected relief.
Four ways of managing acute pain with opioids when on Suboxone:
Sometimes—and only sometimes—you and your doctor may decide that an opioid pain medication is the best choice, even though you’re in recovery from opioid use disorder. This is more common for treating severe, acute pain following surgical or dental procedures. If your provider suggests using an opioid pain medication, be sure all of your healthcare team, including doctors, paramedics, ER staff, anesthesiologists, and dentists, know that you are taking Suboxone. Here are four strategies that we have seen used to manage acute pain with opioids for a person on Suboxone. Remember that these should be done only under guidance of your doctor!
1). Continue Suboxone maintenance therapy and adjust the dosage of a short-acting opioid medication (e.g. morphine or oxycodone).
If your medical provider suggests continuing your regular Suboxone doses and also taking an opioid pain medication, you will need to be very careful to follow their dosing instructions precisely. You may need a higher dose of opioid than a person not taking MAT. This is because the buprenorphine in Suboxone binds to opioid receptors in the brain, so a higher dose may be needed to compensate for this. Your provider may consider putting you on a medication like hydromorphone, which binds opioid receptors strongly.
Your doctor will determine the safest dosage that will also be effective. If you and your provider decide to go this route, it is vital that you continue taking your Suboxone dose!
2). Divide Suboxone dose and take it more frequently.
In this case, the “opioid pain reliever” would be the Suboxone itself. Suboxone is not usually used as a pain reliever for acute pain, but it does have analgesic properties and is prescribed to manage chronic pain in many contexts. Like pain pills, buprenorphine binds and stimulates opioid receptors, but it only stimulates the receptors partially (whereas pain pills and methadone stimulate them fully).
Depending on your pain and situation, your provider may recommend using your Suboxone dose itself to manage your pain. When it is used in this way, your clinician may direct you to split your regular dose into smaller pieces and take them more frequently throughout the day. For example, if your usual dose is one 8mg strip, they may tell you to divide it into four pieces and take 2mg at a time, four times a day.
3). Discontinue Suboxone slowly to avoid withdrawal and start an opioid medication.
Sometimes a doctor may tell you to prepare for a medical procedure by stopping your Suboxone temporarily so that you can be given an opioid pain medication during and immediately after your operation. If this is the case, talk to your healthcare team about how and when you will restart your Suboxone once your acute pain is resolved. Having a plan in place will make this much less stressful! In most cases, you will be prescribed the opioid pain reliever for as short a time as possible.
The plan will guide you in how to best discontinue your Suboxone with the least discomfort. Dana Forman, N.P., says, “Many patients that are being treated for opioid dependence feel they need to put off having surgery because they are on Suboxone, but that is simply not the case! The surgery can be performed and acute pain can be adequately managed. At Workit, we generally ween the patient off of their Suboxone over a course of a few weeks, and then 3-4 days prior to the procedure, we take them off completely and start them on Norco or Percocet. We want the patient to restart Suboxone soon after their procedure, usually about 2-3 days post-op.”
4). Switch from Suboxone to methadone at a dose of 30-40 mg per day to avoid acute withdrawal.
Methadone is another medication that is FDA-approved to treat opioid use disorder. It is sometimes prescribed for pain, so your provider my suggest switching you from Suboxone to methadone. This change in medication has to be carefully managed to avoid acute withdrawal, so follow your doctor’s instructions exactly and talk to them if you encounter any problems. If you go this route, be sure your doctor clarifies how you will receive the methadone doses, as this medication is highly regulated in many areas.
Regardless of which method you and your provider choose—non-opioid medications, alternative treatments that don’t include drugs, or a carefully managed plan that includes opioids—know that it is possible to manage acute pain while still taking Suboxone for opioid addiction.