Chronic pain is one of the most important public health issues we face in this country, with direct and indirect consequences that trickle down to permeate society. At least 10% of the general population suffers with chronic pain at a level that significantly worsens their quality of life. The US Department of Health and Human Services established a Pain Management Best Practices Task Force to promote better practices for pain management. The Task Force reported that Suboxone (buprenorphine/naloxone)® was approved and effective for treatment of chronic pain and should be used as a primary treatment rather than only after failure of opioids such as oxycodone ³.
Alternatives to Opioid Therapy
At Connecticut Addiction Medicine, we provide optimal non-interventional management of chronic pain from many origins, especially musculoskeletal. Many patients will seek treatment in the setting of inadequate pain control on chronic opioid therapy. Some patients will have a history of substance abuse, others will not. Treatment with traditional opioids is effective for moderate-severe acute pain, but those medications have been shown to be of decreasing effectiveness beyond three months. Furthermore, chronic opioid therapy may heighten pain sensitivity and thereby aggravate the pre-existing pain (secondary hyperalgesia).
Suboxone is Effective for Treating Chronic Pain
Studies have consistently shown strong efficacy for Suboxone® treatment of chronic pain. Representative results include:
- pain score improvement from 7.2 to 3.5 (visual acuity scale where 10 is excruciating pain and 0 is no pain) ¹, and
- pain score improvement from 62 to 16 (100 point visual acuity scale) ².
Observational analysis of chronic pain patients in our own practice has shown similar results, with the majority of patients receiving greater the 50% improvement in pain within one month. For optimal results Suboxone® is commonly used in conjunction with ancillary medications from other classes e.g., SNRIs, tricyclics, anticonvulsants such as gabapentin and muscle relaxants.
Suboxone is Safe to Use to Treat Chronic Pain
Regarding safety, Suboxone® has an excellent profile, especially when compared to other opioids. Specifically, there is no development of tolerance, minimal risk of respiratory depression, less potential for misuse and no risk of overdose. Additionally, there is less sedation, nausea, cognitive dysfunction, constipation and hypogonadism. New patients undergo Suboxone® induction in the office after being off all opioids for at least 24 hours. Comfort medications are prescribed as needed prior to induction. Pain management dosing is achieved by two weeks. Patients are followed by the prescribing physician initially weekly and eventually monthly. Ancillary medications are considered after observing the patient’s response to full pain management dosing of Suboxone®.
Patients with co-morbid psychiatric illness will be managed by our psychiatry team. Those with co-morbid substance abuse will be provided individual and group therapy; urine toxicology testing will be performed frequently; and participation in 12-step recovery will be facilitated. Occasionally, patients will be referred to hospital-based pain management services for interventional therapies.
1. Daitch D. et al. Conversion from High-Dose Full-Opioid Agonists to Sublingual Buprenorphine Reduces Pain Scores and Improves Quality of Life. Pain Medicine. 2014. 2087-2094.
2. Kanna I. Buprenorphine — An Attractive Opioid With Underutilized Potential In Treatment of Chronic Pain.
Pain Research. 2015. 859-870.
3. Gudin J. A Narrative Pharmacological Review of Buprenorphine: A Unique Opioid for Treatment of Chronic Pain. Pain Ther. January 2020.
4. Fishman M and Kim P. Buprenorphine for Chronic Pain: A Systemic Review. Current Pain and Headache Reports. 2018. 22-83.
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