Can Suboxone Be Used for Chronic Pain?

Naloxone, the second active ingredient in Suboxone, serves as an abuse deterrent since it triggers intense opioid withdrawal symptoms if the medication is abused. These strong symptoms can be dangerous and harmful for people who are only trying to manage chronic pain.[3]

These ingredients could potentially make Suboxone a good choice for people who need chronic pain management but find they are unable to take the usual medications prescribed for that purpose due to their addictive nature. 

For people who do not struggle with opioid use disorder (OUD), Suboxone is generally not prescribed for the treatment of chronic pain. 

Is Suboxone Used to Treat Chronic Pain?

In some cases, Suboxone may be used to treat chronic pain, but most physicians reserve the prescription of this medication to very specific circumstances. That is, when someone is living with chronic pain alone, doctors are more likely to prescribe a medication like hydrocodone or oxycodone rather than a pain medication like Suboxone that includes an opioid abuse deterrent like naloxone.

How Suboxone Manages Pain

Suboxone has two main ingredients: buprenorphine and naloxone. 

Buprenorphine, a partial opioid agonist, binds to opioid receptors in the brain to reduce the perception of pain, but it has a ceiling effect, which makes it hard for people to abuse the drug or overdose.[4] For people who are trying to stop taking opioids, it can stop opioid withdrawal symptoms that can be so debilitating during detox while allowing the person to function and avoid illegal drug use.

The mechanism of buprenorphine is in contrast to full opioid agonists like morphine or oxycodone, which are usually prescribed for pain management. Those drugs have a much higher potential for abuse, addiction, and overdose.[5]

Suboxone’s Other Function

The other ingredient in Suboxone is naloxone. Naloxone is used to stop opioid overdoses. When given after opioids have been taken, naloxone essentially kicks all opioids off the receptors and stops their effects. This has the benefit of stopping the overdose, but it also can put someone into a state of full-blown opioid detox characterize by harsh withdrawal symptoms.[3]

This is a critical piece of the puzzle for people in recovery when the drug is taken regularly when not in a state of overdose. It reduces the risk of relapse because taking any full opioid agonist will trigger naloxone to activate from its otherwise dormant state, stopping the effect of all opioids in the system and causing opioid withdrawal. 

Buprenorphine vs. Suboxone 

Buprenorphine is FDA-approved for the treatment of chronic pain. For the general public, buprenorphine alone may be prescribed for this purpose due to its lower abuse potential than some full opioids.[6]

However, since Suboxone also contains naloxone in addition to buprenorphine, it is more likely that a physician will only prescribe this medication to people living with chronic pain if they also have a history of opioid abuse and addiction. 

For this population, the combination of buprenorphine’s ceiling effect with the addition of naloxone can help them avoid relapse to opioid abuse. It also serves to protect them from inadvertently overdosing if they do abuse the medication or other opioids. 

Will Doctors Prescribe Suboxone for Pain Only?

It is unlikely that a doctor will prescribe Suboxone for the management of pain only. 

Prescription pain management generally starts with medications you can find over the counter but in larger doses. For example, you may be prescribed 800 mg of ibuprofen every six hours for pain by a doctor, while the over-the-counter version of ibuprofen only has doses of 200 mg each.[7]

If high doses of over-the-counter medication are not enough, the prescribing doctor will likely move to partial opioid agonists like tramadol or buprenorphine or to a mild to moderate full agonist like hydrocodone.[8,9] Next in line are moderate to strong agonists like oxycodone.[9]

All prescriptions given for pain are given for short periods of time with regular check-ins and heavy oversight. The goal is to ensure the person is getting pain relief but never taking more than needed or abusing the medication.

The NAABT’s Stance on Suboxone for Chronic Pain

The National Alliance of Advocates for Buprenorphine Treatment (NAABT) is a nonprofit organization dedicated to increasing awareness of the benefits of using buprenorphine to manage pain and advocating for its use among treatment providers.[10] They believe that the use of buprenorphine for pain management is far safer than the prescription of medications that have a high potential for abuse that could ultimately lead to addiction or death due to overdose.

While Suboxone may be a good choice for people in recovery from addiction to painkillers (which may have developed due to living with chronic pain), the organization generally advocates for buprenorphine alone as a pathway to positive pain management.

Suboxone for Chronic Pain & Opioid Use Disorder

Suboxone is a medication-assisted treatment (MAT) option that is usually prescribed only to those who are in recovery from opioid addiction and in the process of stopping the use of all opioids entirely.

For those who are dually diagnosed with both chronic pain and opioid use disorder, Suboxone may be used on an ongoing basis to assist with the management of pain while also reducing the risk of overdose and managing OUD. This is a decision that would be made on a case-by-case basis by a supervising physician. 

If chronic pain alone is the primary reason for treatment, most doctors will prescribe buprenorphine on its own or other prescription medications as needed.