Well-known for its ability to reduce cravings for opioids and withdrawal symptoms, Suboxone (buprenorphine/naloxone) has helped many Americans achieve long-term recovery. At a time when there are over 200 opioid overdoses a day, Suboxone—which is FDA-approved to treat opioid use disorder—saves lives. Less well known, however, is Suboxone’s off-label use for pain management. This blog explores the challenges of managing pain, how Suboxone works, and how Suboxone is being used as an alternative to opioids to provide pain relief.
I want to be clear that Workit Health clinicians prescribe Suboxone to treat opioid use disorder when appropriate, but do not prescribe it to treat pain. This post is for informational purposes only.
What is Suboxone?
Suboxone is the brand name for a medication that combines buprenorphine and naloxone. It is one of three FDA-approved medications to treat opioid use disorder (or opioid addiction). You may have heard of the use of this drug as medication-assisted recovery (MAR) or medication-assisted treatment (MAT).
What you need to know is that MAT is an evidence-based treatment endorsed by the National Institute on Drug Abuse as an effective treatment and by the World Health Organization as an essential medicine.
The reasons that Suboxone is so effective is because it:
- Relieves withdrawal symptoms
- Reduces cravings
- Blocks the effects of other opioids
- Has a lowered potential for misuse and overdose
Suboxone helps people to get off opioids with minimal disruption. It may even return the brain to its pre-dependent state, giving people their lives back! If you want to read more about Suboxone for medication-assisted recovery, you can read our blog on The Science of Suboxone.
Challenges managing pain
Chronic pain impacts 30 percent of Americans for three to six months. It is one of the most frequent reasons to seek medical care. While doctors use a multidisciplinary approach, usually combining physical therapy and medication management, opioids have been regarded as a powerful treatment to manage pain, especially in cases of severe pain. However, the use of opioids also presents a number of challenges and adverse health risks, including:
- Risk of overdose
- Varied rates of effectiveness
- Side effects: 50 to 80 percent of patients experience side effects, like constipation, dizziness, nausea, itching, decreased and erratic respiration
- Potential risk of misuse
- Risk of dependence and addiction
- Medication interactions, like the use of benzodiazepines, which increase the risk of overdose
According to the Journal of Anesthesiology, the increase in use of opioids medications is correlated with the increase in opioid misuse and unintentional opioid overdoses. Currently, 11 million Americans misuse opioids and over 200 people die of an opioid overdose each day. This leaves physicians with the challenge of finding effective alternatives to opioids for managing pain. Some look to Suboxone for this purpose.
Do people take Suboxone for pain?
Even though Suboxone was initially developed as a pain reliever, it is only approved by the FDA to treat opioid use disorder. However, it is used off-label (which means it is prescribed for a purpose for which it has not been FDA-approved), to treat chronic pain. While Suboxone has not been approved to treat pain, other buprenorphine medications (like Belbuca) are FDA-approved to treat chronic pain. Several studies support the use of buprenorphine for pain relief. Buprenorphine formulations that are approved to treat pain usually come in much lower dosages than Suboxone does.
Like any other medication, Suboxone is not for everyone, but it may provide pain relief for some people. Providers who prescribe it off-label usually are more likely to prescribe it for people with chronic pain looking for an alternative to opioid pain management or those with substance use disorder who need an effective pain reliever.
You may wonder how Suboxone works to treat pain. It is the buprenorphine component of Suboxone that helps to manage pain by binding to and partially activating opioid receptors (called mu opioid receptors) in the brain and blocking pain messengers for between six to eight hours. As it does not fully activate the receptors, it has a less intense effect than other opioids which activate them fully.
The naloxone ingredient in Suboxone works as an opioid antagonist, meaning it blocks the effects of opioids. Naloxone is included in Suboxone to reduce the risk of misuse and overdose.
The main benefits of using Suboxone for pain management include:
- It is a safer alternative to traditional opioids
- Lowered risk of overdose compared to other opioids
- Provides long-acting pain relief
- Reduced risk of respiratory depression
- Is a safe alternative for people with opioid use disorder
- Reduces opioid withdrawal symptoms
- Its use is not affected by age, meaning it is great for pain relief in elderly patients
- It can be used in people with renal conditions
There have been various studies conducted to evaluate the effectiveness of Suboxone for pain relief and the sublingual use was found to be an effective analgesic. In fact, 23 out of 24 studies found that buprenorphine was just as effective as morphine, fentanyl, sufentanil, and oxycodone for pain treatment.
While it is not considered as risky as other opioids, there are some potential side effects from Suboxone, including:
- Nausea
- Vomiting
- Constipation
- Heart arrythmia
- Headache
- Stomach pain
- Difficulty sleeping
- Mouth numbness
- Back pain
- Blurred vision
- Dental problems, like tooth decay and cavities
More serious side effects include difficulty breathing and swelling of the mouth of the tongue. If you, or a loved one, experiences these side effects, please seek immediate medical attention by dialing 911 or going to the nearest emergency room.
Bottom line: Suboxone is not approved to treat chronic pain, but some doctors prescribe it for that purpose. It has been suggested as a safer alternative to other opioids for the management of pain, carrying fewer risks and side effects. However, Suboxone does have side effects of its own, and those must be balanced with the benefits in consultation with a medical provider. And again, Workit Health providers do not prescribe Suboxone off-label for pain management.