Table of ContentsView AllTable of ContentsUsesHow Does Suboxone WorksAdministrationSide EffectsResearchPrescribing
Table of ContentsView All
View All
Table of Contents
Uses
How Does Suboxone Works
Administration
Side Effects
Research
Prescribing
Suboxone (buprenorphine and naloxone) is a prescription medication approved to treat opioid use disorder. It is also sometimes prescribed off-label for pain management as an alternative to opioids.
Buprenorphine, one of the active ingredients in Suboxone, acts as a partial opioid agonist. This means it provides similar analgesic effects to opioids like oxycodone without severe side effects like respiratory depression. Naloxone is added to buprenorphine in this medication to prevent intravenous abuse, since its effect against buprenorphine increases when injected.
Chronic pain is a common problem, affecting about 28% of adults in the U.S.Most people who experience it will visit a primary healthcare provider first. This is why researchers are interested in developing an effective alternative to opioids that primary care health providers would feel comfortable prescribing.
This article will discuss the off-label use of buprenorphine-naloxone for pain, including how it works, administration, and side effects.
Jose Luis Pelaez Inc / Getty Images
What Is Suboxone and What Is It Used For?
Suboxone can be prescribed “off-label” for chronic pain management. That means while it’s not officially FDA-approved for pain management, it’s been found to be helpful for that purpose, particularly for those with opioid addictions.
The combination of buprenorphine and naloxone may reverse opioid-inducedhyperalgesia, which is an increased sensitivity to pain.
Other Buprenorphine-Containing MedicationsOther brand medications contain buprenorphine and are used to treat opioid disorders. They include:Zubsolv (buprenorphine and naloxone) sublingual tabletSublocade (buprenorphine) injectionBelbuca (buprenorphine) filmBrixadi (buprenorphine) injectionButrans (buprenorphine) patch
Other Buprenorphine-Containing Medications
Other brand medications contain buprenorphine and are used to treat opioid disorders. They include:Zubsolv (buprenorphine and naloxone) sublingual tabletSublocade (buprenorphine) injectionBelbuca (buprenorphine) filmBrixadi (buprenorphine) injectionButrans (buprenorphine) patch
Other brand medications contain buprenorphine and are used to treat opioid disorders. They include:
How Does Suboxone Work for Pain?
Buprenorphine, one of the active ingredients in Suboxone, works in a way that may also make it helpful for treating chronic pain. It binds to the same receptors in the brain that opioids bind to. These receptors are responsible for pain relief. It also stays attached to those receptors for longer, which means it has a prolonged effect.
Because buprenorphine only partially activates the receptors it attaches to, it is less potent than opioids. Finally, it doesn’t create strong feelings of euphoria, as opioids do.
Advantages vs. Disadvantages of Using Suboxone or Buprenorphine for Pain
The benefits of suboxone and buprenorphine for pain include:
Disadvantages may include:
Suboxone is given as a normal tablet,sublingual(dissolved under the tongue) tablet, sublingual strip, or as abuccalfilm, which is dissolved between the gum and cheek.
Suboxone comes in several dosage strengths:
Your healthcare provider will likely start with small dosages and increase it until it’s at a safe level for you.
Other forms of buprenorphine include:
Buprenorphine and Suboxone are not as dangerous as traditional opioids. Still, they can have negative side effects including the following:
More serious side effects can occur, including:
These side effects require immediate medical attention.
Dental problems have been reported with buprenorphine formulations that are dissolved in the mouth. These include:
These problems can be serious and have been reported even in people with no history of dental issues.
Mixing buprenorphine with other drugs like benzodiazepines can be lethal.
It is important to remember that although buprenorphine is generally safer and less potent than traditional opioids, misuse can lead to dependency.
What the Research Says
Research shows that buprenorphine can reduce chronic pain without precipitating opioid withdrawal or serious adverse effects.
A 2017 review found that buprenorphine in any formulation was effective for the treatment of chronic pain. Importantly, no serious adverse effects were reported in any of the studies.
A 2014 review also found that sublingual buprenorphine is effective for the treatment of chronic pain, though most of the studies included in the review were low-quality. Additionally, the authors noted that buprenorphine could be more effective at treating certain kinds of pain and have fewer dangerous side effects. Those taking buprenorphine could also be less likely to develop tolerance.
Prescribing Buprenorphine
To a limited extent, buprenorphine is already being used totreat chronic painin the United States. Suboxone, for example, is sometimes prescribed off-label for the treatment of chronic pain.The transdermal buprenorphine patch is also available in the United States for the treatment of severe chronic pain. Still, there is no general agreement on whether buprenorphine should be used for this purpose.
Currently, the few studies examining the effect of buprenorphine on chronic pain are too dissimilar in their approaches. This makes them difficult to compare.
Before buprenorphine can become a standard treatment for chronic pain, a few issues need to be resolved. For example, past studies have rated patient pain in different ways. This makes it difficult to analyze the data.Pain rating scalesin buprenorphine studies need to be standardized. Dose and the way the drug is administered would also need to be tailored to different types of chronic pain.
Primary care health providers can become eligible to prescribe buprenorphine after completing eight hours of training.Still, this isn’t something many primary care providers have done.
The CDC has guidelines in place for the treatment of chronic pain in the primary care setting. The guidelines recommendopioidsonly when non-opioid treatments haven’t worked. They also recommend prescribing opioids at the lowest possible dose. In this context, buprenorphine could essentially be considered an opioid alternative.
Summary
Opioids are often used to treat chronic pain, but there is a risk of overdose and dependency. Some studies have found that Suboxone, a combination of buprenorphine and naloxone, may be an effective opioid alternative.
Suboxone is not as dangerous as the opioids that are often prescribed for chronic pain. It is currently used to treat opioid addiction. Although it is not yet an FDA-approved treatment for chronic pain, some healthcare providers prescribe it off-label.
Buprenorphine and Suboxone can have side effects, including sleep problems, headache, and stomach pain. Serious side effects can also occur.
14 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Chen KY, Chen L, Mao J.Buprenorphine-naloxone therapy in pain management.Anesthesiology.2014;120(5):1262-74. doi:10.1097/ALN.0000000000000170Centers for Disease Control and Prevention.Chronic Pain Among Adults—United States 2019-2021.Indivior Inc.Suboxone [package insert].Velander JR.Suboxone: rationale, science, misconceptions.Ochsner J. 2018;18(1):23-29.Sansone RA, Sansone LA.Buprenorphine treatment for narcotic addiction: not without risks.Innov Clin Neurosci. 2015;12(3-4):32-36.U.S. National Library of Medicine.Buprenorphine sublingual and buccal (opioid dependence).Food and Drug Administration.Buprenorphine: drug safety communication - FDA warns about dental problems with buprenorphine medicines dissolved in the mouth to treat opioid use disorder and pain.Crane EH.Emergency department visits involving buprenorphine. In: The CBHSQ Report. Rockville, MD: Substance Abuse and Mental Health Services Administration (US); 2013.Powell VD, Rosenberg JM, Yaganti A, et al.Evaluation of buprenorphine rotation in patients receiving long-term opioids for chronic pain: a systematic review.JAMA Netw Open. 2021;4(9):e2124152. doi:10.1001/jamanetworkopen.2021.24152Aiyer R, Gulati A, Gungor S, Bhatia A, Mehta N.Treatment of chronic pain with various buprenorphine formulations: a systematic review of clinical studies.Anesth Analg.2018;127(2):529-538. doi:10.1213/ANE.0000000000002718Cote J, Montgomery L.Sublingual buprenorphine as an analgesic in chronic pain: a systematic review: sublingual buprenorphine for chronic pain.Pain Med. 2014;15(7):1171-1178. doi:10.1111/pme.12386Lee M, Silverman SM, Hansen H, Patel VB, Manchikanti L.A comprehensive review of opioid-induced hyperalgesia.Pain Physician. 2011;14(2):145-161.Substance Abuse and Mental Health Services Administration.Training requirements (MATE Act) resources.Dowell D, Haegerich TM, Chou R.CDC guideline for prescribing opioids for chronic pain - United States, 2016.MMWR Recomm Rep. 2016;65(1):1-49. doi:10.15585/mmwr.rr6501e1
14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Chen KY, Chen L, Mao J.Buprenorphine-naloxone therapy in pain management.Anesthesiology.2014;120(5):1262-74. doi:10.1097/ALN.0000000000000170Centers for Disease Control and Prevention.Chronic Pain Among Adults—United States 2019-2021.Indivior Inc.Suboxone [package insert].Velander JR.Suboxone: rationale, science, misconceptions.Ochsner J. 2018;18(1):23-29.Sansone RA, Sansone LA.Buprenorphine treatment for narcotic addiction: not without risks.Innov Clin Neurosci. 2015;12(3-4):32-36.U.S. National Library of Medicine.Buprenorphine sublingual and buccal (opioid dependence).Food and Drug Administration.Buprenorphine: drug safety communication - FDA warns about dental problems with buprenorphine medicines dissolved in the mouth to treat opioid use disorder and pain.Crane EH.Emergency department visits involving buprenorphine. In: The CBHSQ Report. Rockville, MD: Substance Abuse and Mental Health Services Administration (US); 2013.Powell VD, Rosenberg JM, Yaganti A, et al.Evaluation of buprenorphine rotation in patients receiving long-term opioids for chronic pain: a systematic review.JAMA Netw Open. 2021;4(9):e2124152. doi:10.1001/jamanetworkopen.2021.24152Aiyer R, Gulati A, Gungor S, Bhatia A, Mehta N.Treatment of chronic pain with various buprenorphine formulations: a systematic review of clinical studies.Anesth Analg.2018;127(2):529-538. doi:10.1213/ANE.0000000000002718Cote J, Montgomery L.Sublingual buprenorphine as an analgesic in chronic pain: a systematic review: sublingual buprenorphine for chronic pain.Pain Med. 2014;15(7):1171-1178. doi:10.1111/pme.12386Lee M, Silverman SM, Hansen H, Patel VB, Manchikanti L.A comprehensive review of opioid-induced hyperalgesia.Pain Physician. 2011;14(2):145-161.Substance Abuse and Mental Health Services Administration.Training requirements (MATE Act) resources.Dowell D, Haegerich TM, Chou R.CDC guideline for prescribing opioids for chronic pain - United States, 2016.MMWR Recomm Rep. 2016;65(1):1-49. doi:10.15585/mmwr.rr6501e1
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Chen KY, Chen L, Mao J.Buprenorphine-naloxone therapy in pain management.Anesthesiology.2014;120(5):1262-74. doi:10.1097/ALN.0000000000000170Centers for Disease Control and Prevention.Chronic Pain Among Adults—United States 2019-2021.Indivior Inc.Suboxone [package insert].Velander JR.Suboxone: rationale, science, misconceptions.Ochsner J. 2018;18(1):23-29.Sansone RA, Sansone LA.Buprenorphine treatment for narcotic addiction: not without risks.Innov Clin Neurosci. 2015;12(3-4):32-36.U.S. National Library of Medicine.Buprenorphine sublingual and buccal (opioid dependence).Food and Drug Administration.Buprenorphine: drug safety communication - FDA warns about dental problems with buprenorphine medicines dissolved in the mouth to treat opioid use disorder and pain.Crane EH.Emergency department visits involving buprenorphine. In: The CBHSQ Report. Rockville, MD: Substance Abuse and Mental Health Services Administration (US); 2013.Powell VD, Rosenberg JM, Yaganti A, et al.Evaluation of buprenorphine rotation in patients receiving long-term opioids for chronic pain: a systematic review.JAMA Netw Open. 2021;4(9):e2124152. doi:10.1001/jamanetworkopen.2021.24152Aiyer R, Gulati A, Gungor S, Bhatia A, Mehta N.Treatment of chronic pain with various buprenorphine formulations: a systematic review of clinical studies.Anesth Analg.2018;127(2):529-538. doi:10.1213/ANE.0000000000002718Cote J, Montgomery L.Sublingual buprenorphine as an analgesic in chronic pain: a systematic review: sublingual buprenorphine for chronic pain.Pain Med. 2014;15(7):1171-1178. doi:10.1111/pme.12386Lee M, Silverman SM, Hansen H, Patel VB, Manchikanti L.A comprehensive review of opioid-induced hyperalgesia.Pain Physician. 2011;14(2):145-161.Substance Abuse and Mental Health Services Administration.Training requirements (MATE Act) resources.Dowell D, Haegerich TM, Chou R.CDC guideline for prescribing opioids for chronic pain - United States, 2016.MMWR Recomm Rep. 2016;65(1):1-49. doi:10.15585/mmwr.rr6501e1
Chen KY, Chen L, Mao J.Buprenorphine-naloxone therapy in pain management.Anesthesiology.2014;120(5):1262-74. doi:10.1097/ALN.0000000000000170
Centers for Disease Control and Prevention.Chronic Pain Among Adults—United States 2019-2021.
Indivior Inc.Suboxone [package insert].
Velander JR.Suboxone: rationale, science, misconceptions.Ochsner J. 2018;18(1):23-29.
Sansone RA, Sansone LA.Buprenorphine treatment for narcotic addiction: not without risks.Innov Clin Neurosci. 2015;12(3-4):32-36.
U.S. National Library of Medicine.Buprenorphine sublingual and buccal (opioid dependence).
Food and Drug Administration.Buprenorphine: drug safety communication - FDA warns about dental problems with buprenorphine medicines dissolved in the mouth to treat opioid use disorder and pain.
Crane EH.Emergency department visits involving buprenorphine. In: The CBHSQ Report. Rockville, MD: Substance Abuse and Mental Health Services Administration (US); 2013.
Powell VD, Rosenberg JM, Yaganti A, et al.Evaluation of buprenorphine rotation in patients receiving long-term opioids for chronic pain: a systematic review.JAMA Netw Open. 2021;4(9):e2124152. doi:10.1001/jamanetworkopen.2021.24152
Aiyer R, Gulati A, Gungor S, Bhatia A, Mehta N.Treatment of chronic pain with various buprenorphine formulations: a systematic review of clinical studies.Anesth Analg.2018;127(2):529-538. doi:10.1213/ANE.0000000000002718
Cote J, Montgomery L.Sublingual buprenorphine as an analgesic in chronic pain: a systematic review: sublingual buprenorphine for chronic pain.Pain Med. 2014;15(7):1171-1178. doi:10.1111/pme.12386
Lee M, Silverman SM, Hansen H, Patel VB, Manchikanti L.A comprehensive review of opioid-induced hyperalgesia.Pain Physician. 2011;14(2):145-161.
Substance Abuse and Mental Health Services Administration.Training requirements (MATE Act) resources.
Dowell D, Haegerich TM, Chou R.CDC guideline for prescribing opioids for chronic pain - United States, 2016.MMWR Recomm Rep. 2016;65(1):1-49. doi:10.15585/mmwr.rr6501e1
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