Is suzetrigine effective for managing chronic pain?

Suzetrigine for Chronic Pain

Suzetrigine is NOT approved or recommended for chronic pain management—it is FDA-approved exclusively for moderate to severe acute pain in adults, with a maximum treatment duration of 14 days. 1, 2

Current FDA Approval and Limitations

• Suzetrigine (JOURNAVX™) received FDA approval on January 30,2025, specifically for moderate to severe acute pain only 1, 3
• The drug is administered as a 100 mg loading dose followed by 50 mg every 12 hours for up to 14 days or until pain resolution 1, 2
• No studies have evaluated suzetrigine's efficacy, safety, or addiction potential for chronic pain management 4
• All current clinical trials are limited to short-duration treatment of acute surgical and non-surgical pain conditions 4, 2

Mechanism and Rationale

• Suzetrigine is a highly selective NaV1.8 voltage-gated sodium channel inhibitor that blocks pain signal transmission in peripheral sensory neurons 1, 5
• Unlike opioids, it does not produce CNS effects, euphoria, or addictive potential because NaV1.8 is not expressed in the brain 5, 2
• The drug represents the first non-opioid analgesic approved in over two decades and the first in a new therapeutic class 5, 3

Evidence-Based Chronic Pain Management

For chronic pain, established guidelines recommend a structured approach:

First-Line Non-Pharmacologic Therapies

• Cognitive behavioral therapy (CBT) is strongly recommended for chronic pain management (promotes adaptive behaviors and addresses maladaptive pain-related thoughts) 6
• Physical and occupational therapy are recommended as foundational treatments 6
• Yoga is recommended specifically for chronic neck/back pain, headache, rheumatoid arthritis, and musculoskeletal pain 6
• Exercise therapy reduces pain and improves function in osteoarthritis, low back pain, and fibromyalgia 6

First-Line Pharmacologic Therapies for Chronic Pain

For neuropathic pain:

• Gabapentin is the recommended first-line oral treatment (titrate to 1800-3600 mg/day in divided doses) 6, 7
• Pregabalin is an alternative for inadequate gabapentin response or post-herpetic neuralgia 6, 7
• Capsaicin 8% topical patch provides up to 12 weeks of relief with a single 30-minute application 6, 7

For musculoskeletal pain:

• Acetaminophen is first-line for osteoarthritis and low back pain (avoid >3-4 grams/day due to hepatotoxicity risk) 6
• NSAIDs are effective but carry gastrointestinal, renal, and cardiovascular risks that increase with duration and dose 6

For refractory cases:

• SNRIs (duloxetine) or tricyclic antidepressants can be added for neuropathic pain or fibromyalgia 6
• Multimodal therapy combining pharmacologic and non-pharmacologic approaches is more effective than single modalities 6

Critical Caveats

• Suzetrigine has not been studied beyond 14 days of treatment, making its role in chronic pain completely unknown 4, 2
• The drug appears less potent than hydrocodone-acetaminophen for acute pain, raising questions about efficacy for chronic conditions 4
• Avoid suzetrigine in severe hepatic impairment (Child-Pugh Class C) and renal impairment with eGFR <15 mL/min 1
• Dose reduction is required for moderate hepatic impairment due to increased drug exposure 1

Clinical Algorithm for Chronic Pain

1. Initiate non-pharmacologic therapies first: CBT, physical therapy, and condition-specific exercise programs 6
2. Add first-line pharmacotherapy based on pain type:
   • Neuropathic: Gabapentin 1800-3600 mg/day 6, 7
   • Musculoskeletal: Acetaminophen or NSAIDs 6
3. For inadequate response after 4-8 weeks: Add pregabalin, SNRIs, or tricyclics 6, 7, 8
4. Consider topical agents: Capsaicin 8% patch for localized neuropathic pain 6, 7
5. Reassess regularly with multidisciplinary team involvement and functional goals 6

Suzetrigine has no established role in this chronic pain algorithm and should not be used off-label until long-term efficacy and safety data become available.