Suboxone for Pain: How & When to Use Suboxone for Pain

Suboxone is a prescription medication containing two medications: buprenorphine (a partial opioid agonist) and naloxone (an opioid antagonist). The U.S. Food and Drug Administration approved Suboxone for opioid use disorder (OUD) treatment. But it’s not FDA-approved for pain management.[1]

However, many doctors also use Suboxone “off-label” for pain management. Many medications in the United States are used for off-label indications, otherwise known as indications for which they have not been FDA approved. For example, a lot of diabetes medications have been FDA approved for diabetes, but are used off label for weight loss.

Similarly, Suboxone is FDA approved as a medication for addiction treatment but can be used “off label” as a pain medication. It’s a good option for some people, but it’s not right for everyone.

Learning more about how your Suboxone medication works can help you hold an informed discussion with your doctor.

Suboxone’s Pain-Relieving Effect 

Buprenorphine is a partial opioid agonist, meaning it is an opioid medication. All medications that activate the mu opioid receptor play a role in providing pain control.

Buprenorphine was actually first approved in patch form (called Butrans) for chronic pain. It was then added to Naloxone to form Suboxone, which was designed/approved as a treatment for opioid use disorder (OUD). However, many doctors recognized its potential to be a pain reliever, even a comparatively safer pain reliever as compared to full opioids like oxycodone or Vicodin.

Suboxone can provide pain relief in people with the following issues:[2]

• Chronic pain: Acute pain is caused by something like surgery. Chronic pain lasts longer, and it could be caused by a difficult illness or disease.
• Addiction: OUD could make treating pain difficult, as opioids may not be effective when you’re used to them.

Someone like this needs a strong painkiller to ease discomfort. But this person has a history of misusing medications. Suboxone could offer relief while still having fewer side effects and risks than long term full opioid use.

How Does Buprenorphine Treat Chronic Pain?

Through its actions at the opioid receptors, buprenorphine has a pain-blocking effect that lasts between six and eight hours.

It also has a much lower risk of misuse or dependency than other opioids because it is a partial agonist (weak activator) rather than a full agonist (strong activator) at the mu opioid receptor.

Two forms of buprenorphine are FDA-approved for chronic pain, and they are different from Suboxone. This chart explains all three medications:[1,3,4]

	Ingredients	What Is It Used For?	Benefits	Side Effects
Belbuca	Buprenorphine	Severe pain	Two daily doses offer around-the-clock pain relief	Nausea, constipation, headache, vomiting, dizziness and sedation
Butrans	Buprenorphine	Severe pain	Skin patch format is helpful for people who dislike or can’t use oral meds	Nausea, headache, itching at the patch site, dizziness, constipation, sedation and vomiting
Suboxone	Combination of buprenorphine and naloxone	OUD treatment	Approved for at-home use	Mouth pain, headache, nausea, vomiting and constipation

Belbuca

Belbuca is the brand name of a buprenorphine buccal strip.[3] The medication is absorbed through the inside of the cheek, somewhat like Suboxone.

Belbuca is prescribed for use either once per day or every 12 hours, depending on your needs for chronic pain relief. Your doctor will start you on the lowest possible dose and increase it as needed.

Butrans

Butrans, another brand name formula of buprenorphine for chronic pain, is a patch absorbed through the skin and replaced once per week. It was approved by the FDA in 2010 for chronic pain. [4]

Suboxone

Suboxone contains buprenorphine combined with naloxone for the treatment of OUD. It is FDA-approved as a treatment for opioid use disorder.[1] However, some doctors use it off label for patients with chronic pain.[7]

When Should You Use Suboxone to Treat Pain?

Suboxone is a prescription medication, meaning you must talk to a doctor to get it. Together, you can decide if Suboxone is the right choice for you and your pain.

Experts say medications with buprenorphine should be considered in people with the following conditions:[5]

• Chronic pain (greater than one month of pain from an underlying medical condition)
• A history of drug misuse or dependency
• Responsiveness to buprenorphine

If you have chronic pain, particularly if you also have a history of addiction or opioid dependency, Suboxone could be a good choice for you. Talk to your doctor about it.

Suboxone Risks & Side Effects

Suboxone is FDA-approved for opioid use disorder.[1] Its safety and efficacy have been tested rigorously during this process. However, the medication does come with a few risks and side effects patients should be aware of.

Common side effects associated with Suboxone include the following:[1]

• Oral reactions (like drooling or swelling) to the strips or melting tablets
• Headaches
• Nausea
• Vomiting
• Sweating
• Constipation

Like all medications in its class, Suboxone can cause life-threatening respiratory depression at high doses.[1] Everyone should follow their doctor’s instructions carefully and ensure they don’t take too much. The medication should also be stored safely, so curious kids or other family members don’t use the drug and experience an overdose.

Suboxone can also interact with other medications, including benzodiazepines and antiretrovirals.[1] Anyone using these additional drugs should talk with their doctor and ensure the combination is safe.

Is Suboxone Effective in Treating Pain?

Pain is individual, and the solutions that help one person may not help another. If you’ve tried other solutions for chronic pain without success, Suboxone could be a safe and helpful next step.

Several studies, including the following, have examined how Suboxone works in treating pain:

• A 2018 medical survey of buprenorphine formulations for chronic pain relief found that, though evidence is somewhat limited, Suboxone was an effective analgesic and had no lasting side effects.[9]
• A 2014 study found that buprenorphine alone seemed to work as an analgesic for chronic pain patients who also had addictive behaviors.[10]
• A third survey-based study from 2008 reported that 50% of participants treated for opioid use disorder who switched from buprenorphine to Suboxone experienced more adverse reactions, including fatigue, nausea and gastrointestinal pain.[11]

How Much Suboxone Is Needed for Pain Relief?

While Suboxone is not FDA approved for treating chronic pain, many doctors use it for this indication.[7] The dose and frequency people need for pain may be different than the doses needed to treat withdrawal cravings in patients with OUD. The analgesic properties of Suboxone may be shorter than their effects on reducing craving, so doctors may recommend a different dosing strategy compared to if they were only prescribing Suboxone for OUD.[7,8]

Where Can You Get Suboxone for Chronic Pain?

Suboxone is a controlled substance, and you need a prescription to get it safely. If you’re interested in using the medication for pain management, you must visit a doctor for a pain assessment and treatment plan. Some people visit their regular doctors, while others head to pain management specialists for detailed help.

As part of your assessment, your doctor will ask a series of questions to assess the following characteristics of your pain:[13]

• Character: Would you describe your pain as throbbing, aching, sharp or dull?
• Onset: When did the pain start?
• Location: Where exactly does it hurt?
• Exacerbation: What things make the pain feel more intense?
• Relief: What makes you feel less painful?
• Radiation: Does the pain seem to spread to another part of your body?
• Associations: Are there other symptoms relating to this pain?

Your doctor may run additional tests (such as imaging scans or blood panels) to understand your underlying health and any other pain triggers.

With this information, you can determine how to best treat your pain. Your doctor might suggest solutions like physical therapy or surgery for some types of pain. However, others might respond to a medication like Suboxone.

If your doctor deems it necessary, you’ll get a prescription for Suboxone that you can fill at your pharmacy. You’ll also get detailed instructions about how to use the drug, and you’ll return to your doctor regularly to discuss how you’re feeling.

Don’t buy Suboxone independently. Many street drugs contain other opioids, including fentanyl. In one study, about half of all drug users noticed fentanyl in their purchases some or most of the time.[12] This can lead to overdose or even death.

If you want Suboxone for pain control, there are safe and legal ways to get it. Talk to your doctor about whether getting Suboxone online could be right for you and your pain control needs.