Buprenorphine for Chronic Pain Management
There is now an effective medication for both opiate addiction treatment and/or maintenance pain management that is FDA (Food and Drug Administration) approved. The medication is buprenorphine, which is an opiate agonist/antagonist and a very effective pain medication for appropriate patients. It has been used in pain management for many years—mostly in its injectable form. Buprenorphine is now available in the United States as sublingual (dissolved under the tongue) medication and is many times more potent than injected morphine. Buprenorphine is different from other opiates in that the patient usually feels more “clear headed” when taking it.
Being the first oral medication that has been approved in the U.S., physicians can now prescribe buprenorphine in their offices for people who are dependent or addicted to opiates such as opiate pain medication, heroin, or methadone. Buprenorphine is an effective medication for opiate addiction which does not require daily or weekly visits to a clinic. Buprenorphine blocks the effects of other opiates; it eliminates cravings and prevents withdrawal symptoms such as pain and nausea. Patients can be maintained on buprenorphine or go through detoxification.
Subutex and Suboxone are the brand names under which buprenorphine is being marketed for the treatment of opiate dependence. Both medications contain the active ingredient, buprenorphine hydrochloride, which works to reduce the symptoms of opiate dependence. Subutex contains only buprenorphine hydrochloride which was developed as the initial product. The second medication, Suboxone contains an additional ingredient called Naloxone to guard against misuse or abuse. Subutex is usually given during the first few days of treatment, while Suboxone is used during the maintenance phase of treatment. Both medications come in 2 mg and 8 mg strengths as sublingual (placed under the tongue to dissolve) tablets.
However, this medication is also being used very effectively by some pain management physicians for people living with chronic pain. It is important to remember that medication is only one modality for effective chronic pain management. It is also crucial to develop non-medication based treatment interventions as well as learning to treat the psychological/emotional components of chronic pain. A multidisciplinary team approach always gives the best treatment outcomes. For someone with chronic pain who has developed an addictive disorder this medication may be the best intervention possible along with concurrent addiction treatment modalities. In addition, it is important to help people differentiate between the physiological and psychological/emotional components of their pain. Once that is done then cognitive behavioral approaches can help people manage the psychological components more effectively.
To learn more about chronic pain management please check out our website at www.addiction-free.com and go to our Publications page and check out my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. If you want to learn more about non-medication intervnetions for chronic pain management you can find my article Managing Pain Without Pills that you can download for free on our Ariticles page.
To check out our July Chronic Pain Solutions Newsletter please click here.
May 12th, 2009 at 3:32 pm
I just started suboxone today and it is great !!!
October 26th, 2009 at 9:50 pm
I started suboxone treatment in April 09. The dr. I went to at that time wasn’t very knowledgable about the use of this medicine for chronic pain. That is the MAIN reason i started back using lortab’s because he told me it wouldn’t help patients with chronic pain. This was the worst mistake in my life. I went today after i’ve been clean for 36 days. Hardest thing in my life was dealing with the withdraw symptoms with NO help. I went to my pain management dr. told him my sister O.D. on morphin a year ago and i feel like the pain was just getting worst the more i told of the narcotic. He suggest me going to a suboxone dr. I’m soooo looking forward to taking it and getting my life BACK!!! I am sooooo tired of the constant struggle and worry about not having anything for my pain. I’m soooo happy i found this article to again reassure me i’m taking the right step. I have alot of medical problems which causes me pain. Neuropathy, fibro. arthritis, herniated disk, degenerate bone disk disease and depression!!!! I sure hope that i’m finally on the right path. I’m soooo happy i found this article to ease my mine!! Good luck everyone…….. this is the right path!!!
January 14th, 2010 at 8:15 pm
Suboxone is a great pain reliever for someone like me who survived herpes encephalitis/meningitis and is left in horrible head pain from front to back of my brain. Thank God for my doctor, he saved my life!
January 24th, 2010 at 9:45 am
While this and many other medications can be used in order to limit chronic pain I think that it is important that it has the potential to become addictive. This medication can be wonderful but like many other pain medications it can be abused. Suboxone abuse is on the rise. So while it has many great features it is important to self monitor for addiction. Thank you so much for this article. I am sure that it is helping many people.
February 27th, 2010 at 3:48 pm
After a terrible car accident, I was diagnosed with Chronic pain.. no end in sight. I was on both Oxycontin and Vicodin ES. The Oxycontin was 20mg x 3 daily. The Vicodin ES 7.5mg was 4 x daily for breakthrough pain. I was literally a walking zombie. Sick if I didn’t take my meds on time. Half out of my mind when I took them enough to control the pain. After walking out of a local supermarket with my basket full of groceries and being arrested for theft, I knew I could not live on these heavy narcotics. I’d taken a Xanax (also prescribed since the accident for PTSD and anxiety) before leaving the house. I felt fine. But later when I tried to remember the incident, i was unable to. Several times I began treatment programs, only to have so much pain it was unbearable long after withdrawal. Then I went to a treatment center where they used Subutex. I couldn’t believe that not only did I not suffer withdrawal, I also minimized my pain considerably. It wasn’t a walk in the park to switch to Subutex. I had tried many methods that I continue to use in combination with the Subutex. Physical therapy, acupuncture, and even meditation. But Subutex has given me back my life. My children are forever grateful to have their mother back. I’d never been a drug user and didn’t even drink alcohol. For them to see me so strung out with seemingly no hope for the future, they were getting depressed and many times embarrased by my behavior. I’m so, so, thankful for Subutex. It is hard for me to believe stories that I hear about it being abused. I don’t see how it could be as I have now been on it since 2004 and never been tempted to take a higher dose or double dose. I don’t feel “high” off of it. No one at work even knows that I take a medication. I am able to take it when I wake up and then I take another one on the way home and one before bed. It’s so great. The cost was a huge burden. I was so thankful when they came out with a generic that actually worked! I think we all know that generics work differently and some are not very effective. But I actually find the generic Subutex better than the brand name. Now in California, we are having trouble getting it at the pharmacy. At first it was available every time, and now that people have switched from Suboxone to the Generic Subutex for cost reasons, they are suffering shortages. I know that the makers of Subutex held back the generic patent for an extra 2 years so they could make more money. I’ve heard they are fighting to hold other companies back from releasing generics. It’s sad that our medical community is so focused on greed rather than what is best for their patients. Hopefully, things will change if a universal healthcare program is adopted by our government. Bless all of you and I’m so glad you found Subutex. It’s the greatest! FYI.. I did find after a few years that it was hard on my teeth. I suggest that you brush your teeth well after the pill has disolved and then use a rinse that has flouride. If not, you may find yourself getting cavities near the gumline especially. All the best to you!
April 1st, 2010 at 10:27 am
as for me Subutex is the best medicine for chronic pain u can have all that other crap and burn it,i have taken methadone,morphine,oxycontin,etc.subutex it is a real smooth medicine,nice to wake and feel normal,I’m 56 had 2 back surgerys 1knee surgery,been through w/d many times but no more Subutex is the best and it don’t take a truck load of it to help u,and the D.E.A. is concerned about deversion and they should be hell, most pain centers load u slap up with multiple drugs insane,u will never stop deversion unless u get people to get serious about their health and well being,they r pathetic all u hear is bs in a pain center i hated them still do no different than a methadone clinic,anyway who can write subutex other than dr,s that have taken a corse can anyone now,since it is a dual medicine,let me know ty steve
May 25th, 2010 at 8:51 am
Great info. Thanks for the publish.
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September 27th, 2010 at 9:34 pm
I am 35 years old and have had chronic pain for almost 15 years. I was diagnosed with mild-severity scoliosis at age 10, but had back problems my entire teenage years. It was so bad I cried at times, and my parents learned from doctors and chiropractors how to help me with my pain in between visits. My Dad would sometimes walk on my back, it sounds weird, but it made my back crack in all the right places and felt great. But I still suffered pain pretty often. I started having SEVERE back pain two years ago, to the point the misery was a daily thing. I was finally put on Norco 10/325, and within 6 months I was taking 20-25 per day. It sounds like a whole lot to me but I’ve heard of people who take even more than that, I couldn’t imagine. I got off Norco, only to have my dr. replace Norco with, of all things, OXYCONTIN, 20 mg x 1/day. I kid you not, within a month, she had increased my dose to 40mg x 6/day (240 mg/day!) The end of two more months I was so addicted it was sickening. I craved it constantly, I had never experienced anything like that. I decided I needed and wanted to get myself off it, yet my Dr. stated she “had no expertise” in that area (getting me off Oxy) so I tried to do it myself. Over the next 3 1/2 months I gradually cut down to 120 mg/day, which was hell as crazy as it sounds. I had horrible withdrawals. Finally, one day 1 week after having ACL surgery on my left knee, I was so sick of the pain (I still was weaning off after my surgery) I took 20 Oxy at once. They were 40 mg pills. I was unconscious within hours. I was rushed to the hospital and unconscious for over 24 hours. When I got out of the hospital, my husband insisted I go to rehab. I was in rehab 9 days (not very many but that’s all we could do), got out April 15th, and have touched Oxy since. It has been extremely difficult and at times I’ve wanted to die. I have had to take Norco 5/325’s a few times because of my knee, my chronic pain, and because I was in two car accidents within a month. My Dr. became concerned I was abusing the Norcos (which I found laughable considering the amount of Oxycontin she put me on) but–she completely cut me off from my pain meds altogether, refusing anything but ibuprofen or tramadol (neither of which work for me).
The issue here is there are so many people like me, who were unfortunate enough to have been born with an addictive gene, and also to have chronic pain. It wasn’t until I took narcotics for pain that I had ever been addicted to anything, and I found it ironic that the very thing that helped my pain was also taken away from me because I was supposedly abusing it. I realize that there are many people who abuse these drugs and don’t have pain, but what about the people like me who-though may become addicted to their pain meds unintentionally- really need them?
October 19th, 2010 at 6:03 pm
Has not worked for me at all, have been addicited to pain pills for 14 years now, and will continue to be. This wasn’t the miracle drug for me that everyone says it is
January 11th, 2011 at 12:57 pm
I have been experiencing chronic pain since 2003. So, for the last eight years I have been on pain meds. The doctors started me on “crap meds” that did NOTHING!! Well sorry, they made me tired, too tired to function as a mother. So I started taking oxycodone 5mg five times a day, until I got to 10-15 a day. I then began Morphine. 100mg once a day and worked my way up to 200-250 mg a day. Then off the morphine and put on oxycodone 30mg 8 times a day. After a year they quit working well. And even when they worked at their peak I would be in extreme pain especially in the Am till my meds kicked in. So I was couched, curled up in a ball and unable to function for about one hour or so. Even then I was not at full function mode until my third dose or so. Some life! I have now found Subutex. I wake up at a functional level BEFORE my first dose!! I am so grateful! My life is no longer dependent on having my dose ready at all times to function and be the MOTHER I crave to be. I do still have pain, but it is controlled at a constant level rather that the roller coaster ride that I lived with for so long. Why isn’t this medicine offered first?
February 24th, 2011 at 6:49 am
i have been on oxycodone and oxycotin for years , i died in Dec of a buildup of meds i did not over take them, only as my Dr told me, i have copd bad lungs.. now a different Dr wants to put me on suboxone, is it suboxin? the pain Drs took me off every thing.. i still had oxycodone so have been useing them, i have an app with this new Dr the 28th of feb, as that is when he is going to but me on suboxone, i have to take some thing for my pain it is bone pain, the blood leaves the bones and they die it is very painful i can not move when the pain comes is it going to hurt me to take the oxycodone till monday the 28, when i go on suboxone.. thank you jessi
March 9th, 2011 at 2:45 pm
I was introduced to temgesic by a caring physician in Mexico. With 35 different broken bones and 4 implants to hold bones together the pain is not only cronic but also depressing. Thank God for the friend that took me to Mexico. Unfrotunately with the violence etc. in Mexico I searched for an alternative. Opinor was found in Pakistan. My first order made it through customs with an opening and reseal of pakage. My life was back. My wife even noticed and commented whatever you are doing, it is working and I am all for it. My second order has been sent from customs to FDA and now they are detaining it for whatever reason. What do I do now. I have Medicare through Humana and would like to continue with injections. They seem to work better for me. How do I get them here in the good old US? Please help I am desperate. I have an appointment with a pain center next week but how do I make sure that he can prescribe the Buprenorphine hydrochloride? Please help.
July 26th, 2011 at 9:49 am
Like many of the other stories here, I too have been a chronic pain patient for over 15 years. Multiple shoulder, knee and back surgeries. I started on Oxycontin 20mg 3Xday and at the end in January of this year was up to 80mg 5Xday along with 30mg oxycodone for breakthru and Fentanyl Patch 100mg every 48hours. I was on enough medication to kill a horse yet I only weighed 115 pounds. It was the tolerance to the medication that the “doctor” explained was causing my constant need for increases. I was in a constant fog. In January my Pain Management Doctor had his license suspended for questionable over prescribing of prescription drugs. DUH!!! I was petrified! I knew I would not survive an old fashioned detox. Locked in a room and bouncing off the walls for a week. I was lucky enough to have a friend suggest the Subutex and found a Doctor quickly. I am now maintained on 32mg daily of Subutex and I am a new person. To anyone that has doubts….just give it a try. It changed my life 100% and it can do the same for you.