Managing Acute Pain For Suboxone Patients

The question of how to manage acute pain in patients taking Suboxone is one that comes up quite often.
The list of Suboxone provider grows daily, but the knowledge of how to treat pain in patients taking Suboxone does not grow along with that list.
And because of that it has become up to the patient to educate themselves as much as possible so that in return they can educate their provider when necessary.
Read the following information, memorize it, copy it.


Behaviors associated with drug abuse frequently result in the development of acute and chronic pain conditions. These conditions may be caused by the toxic effects of the drug itself, as well as by trauma and infection.
Patients receiving addiction treatment also may experience pain due to illness or injury unrelated to drug use. Physicians must manage this pain efficiently and appropriately.
Opioids are among the most effective available options for managing pain, but they are often not prescribed to patients receiving treatment for addiction out of fear of “feeding the addiction” or of triggering relapse in currently abstinent patients.

State laws governing the prescription of opioids to known substance abusers may place prescribing physicians at risk for prosecution unless the medical record clearly distinguishes between treatment of the addiction and treatment of the pain condition.

Treatment Approach
Little clinical experience is documented regarding the treatment of pain in patients receiving buprenorphine. Pain in patients receiving buprenorphine treatment initially should be treated with non opioid analgesics when appropriate. Although buprenorphine itself has powerful analgesic properties, the once daily administration of buprenorphine, as used for the treatment of opioid addiction, often does not provide sufficiently sustained relief of pain.

Additionally, the onset of action of analgesia with buprenorphine may not be adequate for the treatment of acute pain. In a study of the use of buprenorphine for acute analgesia (Nikoda et al. 1998), the high analgesic activity of buprenorphine was comparably to that of morphine, but the onset of action was found to be inadequate for urgent care.

Patients managed on buprenorphine whose acute pain is not relieved by non opioid medications should receive the usual aggressive pain management, which may include the use of short acting opioid pain medications, the administration of buprenorphine generally should be discontinued.

Note that, until buprenorphine clears the body, higher doses of short-acting opioids may be required. As it may be difficult to achieve analgesia with short-acting opioids in patients who have been maintained on buprenorphine.
Analgesic dose requirements should be expected to decrease as buprenorphine clears the body.

When re-starting buprenorphine administration, physicians should refer to induction procedures, to prevent the precipitation of withdrawal.

There is much more information available on treating patients with pain while taking Suboxone. Please refer to out Suboxone Assisted Treatment website for more information.
http://www.suboxoneassistedtreatment.org/50.html





Posted by: Dee
08/30/2009

I'm a healthcare provider and would like to clarify why we are cautious about prescribing additional pain relieving meds to people who take Suboxone. It is not so much that we are concerned about "feeding the addiction" as you suggest, but rather because we don't want the patient to overdose and have respiratory depression.