From the Guidelines
Pain medication can be given to patients on Suboxone (buprenorphine/naloxone), but with careful consideration and management by specialists. The most recent and highest quality study 1 suggests that non-opioid pain medications like acetaminophen, NSAIDs, and adjuvant medications are preferred first-line options and can be used without special precautions. For more severe pain, the study recommends individualizing the treatment to the patient and clinical circumstances, considering the prescribed daily dose of buprenorphine, indication for buprenorphine treatment, risk of relapse, and expected level of postsurgical pain. Some key points to consider when managing pain in patients on Suboxone include:
- Using non-opioid pain medications as first-line options
- Temporarily increasing the Suboxone dose for more severe pain
- Avoiding traditional full opioid agonists like oxycodone or morphine due to buprenorphine's high binding affinity for opioid receptors
- Considering high-potency opioids like fentanyl or hydromorphone for severe acute pain, under specialist management
- Informing all healthcare providers about the patient's Suboxone treatment and not adjusting medications without specialist guidance. The study 1 also notes that buprenorphine has a high binding affinity for the μ-opioid receptor, which can block the effects of other full opioid agonists, and that higher doses of buprenorphine may be used to provide additional analgesia. However, the most recent study 1 provides the most up-to-date guidance on managing pain in patients on Suboxone, and its recommendations should be prioritized.
From the Research
Pain Management for Patients on Suboxone
- Patients on Suboxone (buprenorphine/naloxone) may require pain management due to various medical conditions or procedures 2.
- The use of full opioid agonists in patients on Suboxone can be challenging due to the potential for precipitated withdrawal 3.
- However, some studies suggest that pain medication can be given to patients on Suboxone, with careful consideration of the patient's individual needs and medical history 2.
Types of Pain Management Strategies
- Non-opioid adjuncts, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can be used to manage pain in patients on Suboxone 2.
- Conversion to sublingual buprenorphine or performing surgery at trough serum buprenorphine concentration may also be considered 2.
- A multimodal analgesic approach, combining opioids, non-opioid analgesics, and regional anesthesia, may be effective in managing pain in patients on Suboxone 2.
Safety and Efficacy
- The safety and efficacy of pain management strategies for patients on Suboxone are not well established, and further research is needed to identify optimal adjunctive medications and define overall strategies 2.
- However, some studies suggest that pain management can be achieved without significant adverse events, such as respiratory depression or toxicity 2.
- The use of buprenorphine/naloxone (Suboxone) has been shown to be effective in reducing opioid withdrawal symptoms and improving treatment outcomes for patients with opioid use disorder 4, 5, 6.