Updated: Dec 4, 2018
This is a question that frequently comes up since many patients initially became addicted to opioids through the legal prescription of pain medications for a legitimate medical condition. They never imagined what would ultimately ensue and would have never touched a pain pill if they had known what the future held. So as time goes on and patients eventually build a tolerance to opioids, not only is their pain no longer being adequately controlled but they are now physically dependent to these medications. While this may eventually progress to misuse and abuse of their meds and possibly even turning to illicit drug use such as heroin, many patients still suffer from whatever underlying condition caused them to become addicted in the first place. This creates a particular challenge for providers managing these patients since any treatment aimed at getting these patients off opioids will only serve to exacerbate their underlying pain.
You Didn't Answer My Question
The short answer is that yes Buprenorphine products such as Suboxone (film/tablet) do in fact help treat pain. This is due to the fact that Buprenorphine is a partial opioid agonist so you are still receiving activation of the pain receptors which in turn produce analgesia. In fact, some would argue that they have better pain control taking Suboxone than they ever did while on their former classic opioid regimen. This may be due in part to the long half-life of Suboxone meaning that it sticks around in your system for a long time after use so you don't need to frequently re-dose. Buprenorphine also has an extremely high oral morphine milligram equivalent (MME) conversion factor which is the scale used to measure the strength of all opioids. For example, Dilaudid has a conversion factor of 4 meaning that 1 mg or oral Dilaudid is equivalent to 4 mg of oral Morphine. Buprenorphine has an MME conversion factor of 30 which means that 1 mg of Buprenorphine is equivalent to 30 mg of oral Morphine! However, just because Suboxone does in fact treat pain doesn't mean that it should be used to treat pain.
So What Are My Options
Technically speaking, the use of most Buprenorphine products such as Suboxone or Subutex are not FDA-approved to treat pain, either chronic or acute. Any such use would be considered off-label and not recommended as outlined in a letter from the DEA to Dr. Heit. However, there are two forms of Buprenorphine that are FDA-approved to treat pain but are NOT indicated in the treatment of addiction. The first product is Buprenex which is an injectable form that is used to treat moderate to severe acute pain. A 0.3 mg dose of Buprenex is equivalent to receiving 10 mg of morphine sulfate. The second form of Buprenorphine approved to treat pain is known as Butrans and comes as a transdermal patch. This is used to treat chronic pain syndromes and is not meant to be used on an as-needed basis. Neither of these options are particularly good and aren't commonly used in practice. There have been some studies that have tried to look at the use of Buprenorphine in the management of chronic pain but as of now the evidence is limited and more studies are needed at this time.