Suboxone is the brand name of a combination of two drugs—buprenorphine and naloxone.
Many people wonder if it can be used for treating chronic pain since it provides some pain relief to patients using it for opioid use disorder (OUD).
Suboxone can be prescribed as a form of pain relief for patients dealing with chronic severe pain that’s not responsive to, or indicated for, opioid therapy.
Here’s how it works and whether your doctor can prescribe Suboxone for chronic pain.
How Does Suboxone Work?
Buprenorphine is an opioid. This means that it can bind to opioid receptors, which are molecules that coat the surface of neurons (cells that make up the brain).
This binding alters brain pathways, such as those for pain. Opioids block pain signals that are traveling to the brain from the body and are therefore used as pain medicines.
Unlike stronger opioids, like morphine, buprenorphine is a partial agonist, meaning it activates opioid receptors only partially, lowering the risk of opioid dependence that leads to addiction.
The other drug in Suboxone is naloxone, which is an opioid antagonist, meaning it blocks opioid effects.
It causes opioid withdrawal symptoms such as a runny nose, watery eyes, agitation, nausea, and vomiting.
Naloxone is added to Suboxone so that patients do not misuse Suboxone by injecting it into a vein.
What Is Chronic Pain?
Chronic pain is defined as pain that lasts longer than three months. There are multiple reasons for this type of pain, including:
- Musculoskeletal : Musculoskeletal pain is due to diseases of the muscles or bones. An example is lower back pain due to muscle spasms (abnormal, unwanted contractions).
- Neuropathic : Neuropathic pain is due to nerve dysfunction. It most commonly occurs due to diabetes (diabetic neuropathy), where it involves the hands and feet.
- Inflammatory : Inflammatory pain is due to long-running diseases such as rheumatoid arthritis.
- Mechanical : Mechanical pain occurs due to the physical compression of tissues. For example, tumors can grow large and compress surrounding tissues to cause chronic.
Can Suboxone Treat Chronic Pain?
Although Suboxone can treat chronic pain, it is not FDA-approved for this purpose. It is FDA-approved only for treating opioid addiction.
But buprenorphine alone is FDA-approved for treating pain, which is why doctors use Suboxone as an off-label drug to provide pain relief.
Multiple studies have evaluated the effectiveness of buprenorphine in the treatment of chronic pain.
A meta-analysis by Harvard researchers that looked at 11 studies concluded that buprenorphine is indeed effective for pain.
Its pain-relieving effect is greater in people who do not suffer from opioid use disorder than in those who do.
In addition, when compared to other opioid drugs, buprenorphine is equally effective for pain.
According to multiple comparative studies where 0.3-0.4 grams of buprenorphine was given to one set of patients and ten grams of morphine to another, the relief from pain was similar for both groups.
Note that buprenorphine alone has been evaluated as a pain medicine in various conditions such as post-operative pain, musculoskeletal pain, and pain due to diabetic neuropathy.
But the combination of buprenorphine and naloxone has been evaluated as a pain medicine only in people with opioid use disorder.
This means more research is needed before we can determine how well Suboxone treats chronic pain in the general population.
How Is Suboxone Used for Chronic Pain?
Suboxone is available as a film/strip or a tablet, which can be taken either sublingually or buccally.
Sublingual buprenorphine administration means that it is placed under the tongue, from where it is absorbed directly into the bloodstream.
Buccal administration means that it is placed against the cheek.
Suboxone works sublingually because only buprenorphine (not naloxone) is absorbed from this route.
This ensures that only buprenorphine enters the body and helps combat pain without the opposing effects of naloxone.
If someone decides to inject Suboxone into the bloodstream, naloxone will take over and cancel out buprenorphine’s pain-relieving effect.
Suboxone is available in four doses, which are:
- 2 mg buprenorphine/0.5 mg naloxone
- 4 mg buprenorphine/1 mg naloxone
- 8 mg buprenorphine/2 mg naloxone
- 12 mg buprenorphine/3 mg naloxone
The exact dose will be determined by your doctor according to the severity of the pain you’re experiencing and overall health condition.
What Are the Benefits of Using Suboxone for Chronic Pain?
Benefits of using Suboxone for chronic pain management include:
- Better efficacy : Opioids are strong painkillers and are often reserved for when non-opioid painkillers do not work. Suboxone contains a weak opioid making it better than regular painkillers.
- Low addiction risk : The downside to opioids is the risk of dependence. But because Suboxone contains a weak opioid, it helps treat pain with a lower chance of causing dependence, unlike strong opioids, which cause physical tolerance and addiction.
- Cannot be misused : If someone tries to inject Suboxone, they will experience withdrawal effects instead of euphoria, which makes it less likely that patients will abuse this drug.
What Are the Disadvantages of Using Suboxone for Chronic Pain?
Despite Suboxone’s benefits as a pain medicine, it has a range of side effects that you should know about before using it. They include:
1. Constipation
Opioids like buprenorphine slow gut movement.
Decreased gut motility can manifest as constipation, which means you should eat a healthy diet with plenty of fruits and vegetables and enough hydration if you’re on Suboxone.
In some cases, your doctor might prescribe additional drugs, like laxatives, to regulate your bowel movements.
2. Allergy
Some people may be allergic to buprenorphine. The allergic reaction can vary in severity from mild to severe.
In mild cases, it may manifest as a rash, redness of skin, or water eyes.
In severe cases, it could cause swelling of the hands, feet, or face, as well as trouble breathing. A severe reaction, like anaphylaxis, requires emergency medical treatment.
3. Respiratory depression
Opioids slow down signaling in parts of the brain that control breathing.
In high doses—or when taken alongside other depressants like alcohol, benzodiazepines, or barbiturates—buprenorphine can slow down breathing or cause it to stop.
This is the cause of most opioid overdose deaths.
Should I Take Suboxone for Chronic Pain?
Although it is not FDA-approved for chronic pain relief, many doctors use Suboxone for this purpose because of its effectiveness.
Off-label use for drugs is acceptable only if it’s under the supervision of a doctor.
Suboxone is generally safe but can cause serious side effects when taken in excess or alongside other medicines that slow the nervous system.
This is why it’s important to have a thorough discussion with your doctor on how to use it properly before starting it.
Frequently Asked Questions
How Long Does Suboxone Take to Work for Pain?
Suboxone can relieve pain within 30 minutes. In chronic pain patients with a faster metabolism or those who are addicted to a stronger opioid, this time may be longer.
What Not to Take With Suboxone?
If you’re taking other nervous system depressants—such as seizure medications—it’s best to avoid Suboxone.
What Happens When You Mix Suboxone and Gabapentin?
Gabapentin is used to treat seizures. When taken with Suboxone, it can cause dangerous effects such as trouble breathing, coma, or even death.
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