Suboxone and Pain Treatment

Buprenorphine in its sublingual forms, tablet or film, is only indicated and approved for the treatment of opioid addiction. So what do doctors do when their Suboxone patients have pain? This is an area of medicine that’s still evolving.

The treatment of pain depends on the type of pain and the expected duration of pain. We can organize pain into mild, moderate, or severe categories, and into acute or chronic. Most doctors define acute pain as pain expected to last less than three months, and chronic pain as expected to last more than three months.

Mild pain doesn’t always need an opioid medication. For example, many dental procedures cause pain that can be easily managed with anti-inflammatory medications like ibuprofen or Tylenol.

Mild to moderate pain can sometimes be treated with Suboxone, either by increasing the patient’s total dose, or by dividing their same dose into multiple smaller doses, spread out over the day. Because the analgesic effect of a dose of buprenorphine wears off after about six hours, patients on Suboxone who also have pain can try this last method. For example, I have a patient who was taking 16mg of Suboxone per day when she began having back pain from overwork. She called me, and I suggested to her that instead of switching to another opioid, first try taking half of a Suboxone 8mg film four times per day. Her total dose stayed the same, but we spread it into multiple doses. She had enough pain relief with this maneuver and didn’t need to switch to any other opioids.

Moderate to severe pain usually isn’t treatable with only Suboxone. Examples of moderate to severe acute pain would be a broken bone, or having surgery. Doctors use either of two methods. The first is to leave the Suboxone patient on his usual dose, and add another opioid for the treatment of pain. Doctors who chose this method say that Suboxone doesn’t completely block the analgesic effect of strong opioids, so patients will still get some pain relief. The second method, and the one I prefer, is to stop the Suboxone and switch to a stronger opioid for a short time, until the condition is resolved.

 When a patient with a history of opioid addiction needs opioids for pain, it does increase the risk of a relapse, of course. But leaving moderate to severe pain untreated isn’t an acceptable option. Plus, there are safeguards we can use to reduce the risk of relapse. For example, the doctor treating the painful condition should be aware of the patient’s higher risk of medication misuse. That doctor may wish to prescribe smaller amounts and see the patient more often. Small amounts of opioids may be less likely to trigger a patient than a big bottle with many pills.

In some cases, the patient can identify a dependable non-addict who’s willing to hold the pill bottle and dispense to the patient as prescribed. The patient should contact people in her recovery network more often than usual, and if unable to get to regular recovery meetings, ask members to bring a meeting to her home.

Besides the risk of relapse, it can be tricky to transition from full opioids back to Suboxone. For short-acting opioids like oxycodone or hydrocodone, the patient should stop these for a minimum of 24 hours before re-starting the Suboxone, or else risk the precipitation of withdrawal if taken too early. If the patient is taking an extended-release or long-acting medication, like methadone or MS Contin, she’ll have to wait up to 72 hours to be in enough opioid withdrawal to re-start Suboxone safely.

Chronic pain is a different issue. If someone has opioid addiction and chronic pain, it’s obviously best if the pain can be treated by a non-opioid. If not, Suboxone may provide enough pain relief to make the patient reasonably comfortable. Suboxone can at least keep the patient out of withdrawal.

Chronic pain and addiction is a difficult combination of medical problems to have, and sometimes there’s no good answer. Unfortunately, this blend of problems is all too common. Many people with chronic pain developed addiction as a complication of their treatment.

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4 responses to this post.

  1. Your blog is nice. What we will give is access to information and the ability connect with other suboxone patients and those who work with them.

    Reply

    • Posted by bob bobbert on November 8, 2011 at 5:20 am

      Hello, read your post and I thought I would give my 2 cents. Been on 8mg Suboxone twice a day now for73 days and its a 100% miracle drug and treats chronic pain. I wount go in to depth but was heavy oxy user for over tens. They were prescribed to me for Epic chronic pain l4 l5 s1. I got sick and tired to be a slave to the drug and had enough left in me for one last fight. So went on suboxone and in 15 minutes a swich went off and ive been better every since.For me, im a horse I would hurt and could take every pain pill till they where gone and still hurt. But with suboxone I have had ZERFO real pain. I think most of my old pain were the pain pills saying I needed more, it wasnt real pain. Even when I first got on suboxone I tried calling doctor saying i needed stronger, that was the addict. Really I could get by on just 8mg per day. I dont know who said you dont get the euphoria but you tell that to me when Im sweating my ass off cleaning the garage, shower, laundry and putting a new cieling up in basement. just like Meth. All I can say is wow what a drug and I think why people talk bad about suboxone is to try and confuse people to try and keep in our secret.

      Reply

  2. Posted by sus on June 19, 2014 at 2:20 pm

    It has been suggested I will be put on Suboxone for pain instead of Vicodin and I’m scared I have vicious back pain and fibro myalgia arthritis and flank pain . I hate doctors because they seem to always make things worse.

    Reply

    • I just started suboxone (generic Subutex to be exact) about a week ago. I am an addict and also dealing with chronic back pain, and pain that is possibly due to an underactive thyroid (still investigating the cause). I find that 4mg of Subutex daily not only gets rid of any opiate cravings but also helps with pain MORE than any of the many different opiate painkillers I have tried. It really helps with the mental aspect of pain, which was a big thing for me. As soon as a painkiller began to wear off even slightly, I would begin obsessing about the pain returning and taking another dose and on and on. I also feel it does work better physically though, even better than other opiate meds at their peak effectiveness.

      Feel free to email thejaninefowler [at] gmail if you want to talk about it! I did just start but I wouldn’t even have discovered this treatment plan if it weren’t for reading lots of blogs and forums. :)

      Reply

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