Does Suboxone Help With Pain?

The U.S. Food and Drug Administration (FDA) does not currently give approval for Suboxone purely as a pain medication (with the exception of the Butrans patch, which is FDA approved for chronic pain).

However, many other countries do use Buprenorphine as a pain medication because it does have analgesic properties in the same way that other opioids do. In the US, many doctors use Suboxone as an off-label treatment for chronic pain, particularly in patients who have previously been on opioids and do not want to continue to use opioids long term due to the risks of addiction and dependence.

Should Suboxone Be Used as a Pain Reliever?

Bicycle Health does not treat chronic pain, and we do not prescribe buprenorphine (Suboxone) for the treatment of pain.

The FDA currently has not approved buprenorphine as a pain medication alone, with the exception of Butrans which is a subdermal patch form of Buprenorphine that is in fact FDA approved to treat chronic pain.[1]

However, the majority of medications in the US are used by doctors “off label”, aka for indications other than strictly what the FDA has approved them for. For example, Hydroxyzine is approved as an antihistamine drug to treat allergies, but because of its sedating properties, it is often used “off label” as a drug to treat anxiety and poor sleep. In this same way, Suboxone can be safely and effectively used “off label” to treat chronic pain, particularly when the alternative is subjecting an individual to chronic opioid use which may prolong or put them at risk of developing an OUD.

Researchers say buprenorphine is a safe and effective pain medication.[5] In one overview study of 25 trials, researchers found 14 proving buprenorphine’s efficacy.[6] And in another study, researchers found no evidence of respiratory depression (a hallmark of overdose) in people using this medication for pain control.[7]

How Commonly Is Suboxone Used for Pain Relief?

Some doctors may use Suboxone for pain relief, although it’s not common. Many more clinicians are starting to use Suboxone as a pain medication as we become more familiar with it over time.

Several roadblocks keep doctors from using this medication to ease discomfort. 

FDA Oversight 

Although many medications are used off label, because of the stigma around opioid use disorder and the barriers to this treatment, some doctors have been more hesitant to use Suboxone “off label” to treat chronic pain in their patients with or without concurrent OUD.

Waiver Requirements 

Doctors must go through significant training and registration processes to prescribe buprenorphine, a process called obtaining an X-waiver. This creates additional barriers to prescribing this medication.

Insurance Coverage 

When a doctor writes a prescription for Suboxone, the doctor must offer a diagnosis code.[4] Doctors who use any code other than OUD can be rejected by insurance companies. 

Availability of Other Medications 

Suboxone isn’t the only medication that can ease discomfort. Other choices are available, and most doctors prefer to start with non-opioid medications for pain control due to their better safety profiles and lower likelihood of dependency.

What About Pain Relief for People Already Using Suboxone?

Sometimes patients with OUD on Suboxone have chronic pain, or like anyone else have an acute episode of pain after an accident or after requiring surgery. Patients on Suboxone or with a history of OUD may be even more sensitive to pain than their counterparts. In this case, they may require alterations in their dose or even the addition of other pain medications temporarily. If you are a patient on Suboxone and anticipate having a worsening of your pain (an upcoming surgery, for example), talk to your doctor well ahead of time to help plan for how you will manage your pain while on Suboxone. There are a number of options available.

Sources

1. Prescribing Information: Suboxone. U.S. Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/020733s022lbl.pdf. February 2018. Accessed July 2022.
2. Buprenorphine-Naloxone Therapy in Pain Management. Anesthesiology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3999180/. May 2015. Accessed July 2022.
3. Treating the Opioid-Addicted Chronic Pain Patient: The Role of Suboxone. Practical Pain Management. https://www.practicalpainmanagement.com/treatments/addiction-medicine/opioid-use-disorder/treating-opioid-addicted-chronic-pain-patient-role. March 2019. Accessed July 2022.
4. Suboxone for Pain Makes Sense. Why Don’t More Doctors Prescribe it? MedPage. https://www.kevinmd.com/2018/11/suboxone-for-pain-makes-sense-why-dont-more-doctors-prescribe-it.html. November 2018. Accessed July 2022.
5. Buprenorphine: An Attractive Opioid With Underutilized Potential in Treatment of Chronic Pain. Journal of Pain Research. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4675640/. 2015. Accessed July 2022.
6. Treatment of Chronic Pain with Various Buprenorphine Formulations: A Systematic Review of Clinical Studies. Anesthesia and Analgesia. https://journals.lww.com/anesthesia-analgesia/fulltext/2018/08000/treatment_of_chronic_pain_with_various.36.aspx. August 2018. Accessed July 2022. 
7. Benefit-Risk Analysis of Buprenorphine for Pain Management. Journal of Pain Research. https://www.dovepress.com/benefit-risk-analysis-of-buprenorphine-for-pain-management-peer-reviewed-fulltext-article-JPR. April 2021. Accessed July 2022.