Chronic Pain and Buprenorphine

Buprenorphine (the active ingredient in Suboxone) is used for the treatment of chronic pain in those who have become physically dependent on painkillers. Buprenorphine provides an alternative to pain medicines that no longer work.Opiates are the treatment of choice for acute, immediate pain. They are also frequently prescribed for chronic pain, or pain that is long standing and not getting better with treatment. However, over time, opiates lose their pain relieving effect, resulting in a very well-known pattern of gradually increasing the dose and switching to more and more potent painkillers. This process is known as “tolerance.” Eventually, the patient is taking medicine that no longer works but causes withdrawal if they try to stop it. The patient is now “stuck” with taking this medicine.

Buprenorphine (trade name Subutex), which is the active ingredient in Suboxone, is a new alternative to those with never-ending pain that is not responsive to current treatment. An appropriate pain patient for buprenorphine treatment is one who has been in pain nearly every day for over 6 months; has had surgery, but the pain is the same or worse; has been seen by a pain management doctor who has applied nonsurgical treatments to the patient without sufficient pain relief; and/or is physically dependent on the medicine (which means they have withdrawal on discontinuing the medicine).

About 50% of the patients who come to Dr. Rao’s office because of physical dependence on opiates were started on opiates because of a car accident or a sports accident which resulted in chronic pain; or a chronic medical condition (such as rheumatoid arthritis or migraine headaches) that causes ongoing pain unrelieved by surgical and/or medical treatment.