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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7 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

  3. Posted by maria gorman on November 5, 2014 at 5:10 am

    I have cervical/lumbar stenosis at 52yrs old, from a fracture in gymnastics at the age of 16. Doctors told me when I was 28 that I would be in a wheel chair by the age of 40. Then it was 50, now I am 52 and they say, anywhere from one day, to a few years and I will NOT be walking for sure. I had a son who had a tooth ache, a pretty bad one, and had no dental insurance. I gave him a piece of an oxycodone after he punched a hole in my wall from his pain. Big mistake. Every since that day, he has raided my pain medicene bottle. It got so out of hand, that I was out of medication every single month, putting me at risk of being fired by my pm doctor. I made two police reports on my own son, that were never followed up on. It got so bad, I researched online, what I could get for pain that would not give you any euphoric high, so that my son would not want it. That is when I found the suboxone. I then found a suboxone doctor, he agreed to treat me, put me on suboxone, and while I sat there in front of him, he called my pm doctor andt told him I was going to be treated by him now, on suboxone, and so my pm doctor, now when I called for an epidural, refused to treat me at all.
    The pain has gotten so bad, almost like childbirth, with stenosis, I can be completely fine with just an Excedrin, then wammo, I am in so much pain and it will last for hours to days, sometimes so bad I cannot even stand.
    Went to a new pain doctor, who when he came into the room, says this; “okay, so we are on suboxone, so no pain medicine for you” let’s see what kind of injection we can set you up with and help you with the pain. Bullcrap, I want to say bullchit. I need my medicine and I was not abusing it, my son was. I took myself off it, not my pm doctor. I did this to stop my own son from constantly stealing mine. I was lied to by this suboxone doctor and told the suboxone will help with my pain. again. bullchit. I am in tears probably at least seven days a month it is unbearable. Sometimes more. It is quite obvious there is some sort of “prescription background report” that can now be done by pm doctors, because this new doctor had never even met me, didnt even talk to me, I did NOT put down on the form that I was on suboxone, he found this out by some kind of report he has access too.
    So what am I supposed to do now. Seems NO pm doctor will touch me. I am in ridiculous pain sometimes, and I keep trying to get back into pain management, and I keep getting turned away. Not only is this happening, but the pharmacists now look at me as an opiate abuser. So here is the big question, if at all, by some miracle, a pm doctor agrees to put me back on opiates (by the way, the son is out of the home now, for good) will the pharmacy even fill it? Will my insurance even cover it? My God, it is out of hand. All because my dumb assss researched what I could go on, that you can not get any high from for pain, and I take myself out of pain management, and now look what happens. My new pm doctor, told me that suboxone is strictly for opiod abusers, and for pain. In fact if you take a pain medicine while on suboxone it will totally block the opiate from working. So what now. I am labeled an opiate abuser? I can not ever get back on my pain medicine with chronic spinal stenosis? This is insane and I am honestly so much in pain sometimes, I would rather just be dead. This is too much to bare, almost like childbirth, only the contractions are hours apart, but trust me just as painful and have that “peak” you get when bearing a child. It get’s so dam painful, I cannot walk, stand, sit, nothing without crying. Even the police have me labeled now, because I live in such a small city and everyone knows everyone. They know I am on suboxone, and now they too have me labeled. What in the hell am I supposed to do, because I am real close to even moving to another state, just to get help with my pain again.

    Reply

    • I’m not sure why your pain management doctor wouldn’t still give epidural injections.
      Your Suboxone doctor must have heard things in your history that convinced him you had not only chronic pain with physical opioid dependence, but also addiction, with the psychological obsession and complusion to use more. Otherwise, you’re right, you could be treated at a pain clinic. My only suggestion is to talk to your suboxone doctor again about your situation.
      You are right…once other doctors can see on your state’s prescription monitoring site that you’ve been prescribed suboxone, which is only suppposed to be prescribed for addiction, they will assume you have the disease of addiction.

      Reply

    • Posted by Mira on November 18, 2014 at 4:22 pm

      You can always get off of suboxone. You HAVE to discuss your options with the doctor who is the one who prescribes the suboxone to you. Suboxone is prescribed not only for opioid addiction but for pain as well.

      You CAN get back on your pain meds, your Sub Dr will need to be the one to take you off of the suboxone. Normally they do it with a slow taper over months but discuss stopping your dose, then taking an opioid for 5 days prescribed by the SUB DR, and in that time seeing your new PM Dr.

      I have been on subtext treatment since January 2014. I am having surgery this Friday on my throat. My suboxone Dr is the best, I explained to him my situation and due to anistesia (sp?) And the pain meds after I had to be off subutex. So he put me on MS Contin for 5 days before the surgery so the knock out drugs will work and so that the pain meds after will work.

      All in all your Sub Dr will have to be the one who takes you off the way he/she wants too. And then you can see a new pain mgt dr to get their unbiased help.

      Good luck to you!!!!!

      Reply

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