Can you prescribe Suboxone for chronic pain?

October 10, 2025 •

4 min read

According to the National Institutes of Health, chronic pain is a major public health problem affecting over 30% of the U.S. population. The question of whether you can prescribe Suboxone for chronic pain is complex, as the medication is not FDA-approved for this specific purpose, though it is sometimes used off-label, particularly in patients with opioid dependence.

Quick Summary

Suboxone is not FDA-approved for treating chronic pain, but it may be prescribed off-label for certain patients, especially those with co-occurring opioid use disorder or a history of opioid misuse. Its buprenorphine component has analgesic effects, providing a safer, longer-acting alternative to full opioids for select individuals. Milder side effects can occur.

Key Points

FDA Approval: Suboxone is FDA-approved only for treating opioid use disorder, not chronic pain.
Off-Label Use: Physicians may prescribe Suboxone off-label for chronic pain, especially for patients with a history of opioid misuse or dependence.
Buprenorphine's Role: The buprenorphine in Suboxone is a partial opioid agonist with analgesic properties, providing pain relief with a lower potential for abuse and respiratory depression.
Precipitated Withdrawal: Using Suboxone in a patient physically dependent on full opioids can cause sudden, severe withdrawal due to the naloxone component.
Safer Profile: For high-risk patients, Suboxone may offer a safer, longer-acting alternative to full opioids for long-term pain management.
Not for All Pain: Due to its lower analgesic potency, Suboxone may not be suitable for severe pain and is not a first-line treatment for most patients without co-occurring OUD.

Understanding Suboxone's Primary Indication

Suboxone is a combination medication containing buprenorphine and naloxone. Its primary and only FDA-approved indication is for the treatment of opioid use disorder (OUD), a condition formerly known as opioid addiction. In this context, it is used as part of a medication-assisted treatment (MAT) program alongside counseling and behavioral therapy. Buprenorphine is a partial opioid agonist that binds to and partially activates opioid receptors, reducing cravings and withdrawal symptoms without producing the strong euphoria of full opioids. Naloxone is an opioid antagonist that blocks opioid receptors, serving as a deterrent to misuse via injection.

Off-Label Prescribing for Chronic Pain

While not officially approved for this use, healthcare providers sometimes prescribe Suboxone off-label for chronic pain management, a practice that is legal and common for many medications. This practice is typically reserved for specific patient populations, such as those with co-occurring chronic pain and OUD or those with a high risk of opioid misuse and dependence. The rationale behind this lies in buprenorphine's analgesic (pain-relieving) properties and safer profile compared to full opioid agonists like oxycodone or morphine.

Potential Benefits of Using Suboxone for Chronic Pain

For the right candidate, using Suboxone for chronic pain can offer several advantages:

Lower risk of dependence: As a partial agonist, buprenorphine has a lower potential for abuse and physical dependence than full opioid agonists.
Ceiling effect: Suboxone exhibits a ceiling effect on respiratory depression, meaning that increasing the dose beyond a certain point does not increase the risk of respiratory failure, making it safer from overdose.
Lower tolerance development: Studies suggest that buprenorphine may be less prone to tolerance development, meaning its effectiveness may be maintained over a longer period.
Effective for certain types of pain: Evidence suggests that buprenorphine can be effective for neuropathic pain and may help alleviate opioid-induced hyperalgesia, a condition where long-term opioid use increases pain sensitivity.
Long-acting relief: Buprenorphine has a long half-life, providing sustained pain relief and stability for patients.

Risks and Considerations for Off-Label Use

Off-label prescribing is not without risks and requires careful consideration from both the patient and the provider. Key points include:

Lower analgesic potency: For patients with severe pain, the partial agonist action of buprenorphine may not provide sufficient relief compared to full opioids.
Risk of precipitated withdrawal: If a patient is physically dependent on full opioids and switches to Suboxone without a proper induction protocol, the naloxone can trigger sudden and severe withdrawal symptoms.
Potential side effects: Patients may experience side effects similar to other opioids, including nausea, constipation, headache, and drowsiness.
Drug interactions: Suboxone can interact with other medications and central nervous system depressants like benzodiazepines, increasing the risk of respiratory depression and sedation.
Requires specialized medical oversight: Given its complex pharmacology and the potential for misuse, Suboxone prescribing is limited to eligible providers and often requires significant patient monitoring.

Comparison of Buprenorphine Formulations

It is critical to distinguish between Suboxone and other buprenorphine-containing medications, some of which are specifically FDA-approved for pain. The following table highlights the differences:


Feature	Suboxone (Buprenorphine/Naloxone)	Butrans (Buprenorphine Transdermal Patch)	Belbuca (Buprenorphine Buccal Film)
FDA-Approved Indication	Opioid Use Disorder (OUD)	Moderate-to-severe chronic pain	Moderate-to-severe chronic pain
Route of Administration	Sublingual film	Transdermal patch (once weekly)	Buccal film (absorbed via cheek)
Primary Purpose in Use	Treats OUD, with secondary pain relief	Around-the-clock chronic pain management	Around-the-clock chronic pain management
Contains Naloxone?	Yes, to deter misuse via injection	No	No
Best For...	Patients with co-occurring OUD and pain	Patients who need consistent, long-term pain control	Patients who need consistent, long-term pain control

Medical Guidelines and Expert Opinions

Medical guidelines and expert opinions on prescribing Suboxone for chronic pain are evolving. While its use is becoming more common, especially in high-risk patients, it is not a first-line treatment for pain alone. Organizations like the National Alliance of Advocates for Buprenorphine Treatment (NAABT) acknowledge its off-label use but prioritize its role in OUD treatment, suggesting that buprenorphine-only products are generally more appropriate for pain alone. Comprehensive pain management often involves a multimodal approach that includes non-opioid therapies, physical therapy, and psychological support alongside any medication. For providers, this means engaging in shared decision-making with patients, carefully assessing risk factors, and monitoring treatment progress closely.

Conclusion

In summary, while the answer to “can you prescribe Suboxone for chronic pain?” is technically yes, it is an off-label use and not the medication's intended purpose. Suboxone is primarily for treating opioid use disorder, but its buprenorphine component provides analgesic effects that make it a viable, safer alternative to full opioid agonists for select patients. This includes individuals with co-occurring OUD and chronic pain or those at high risk of opioid misuse. However, a prescription for Suboxone for chronic pain requires careful patient evaluation, balancing potential benefits against risks like lower analgesic potency and precipitated withdrawal. Other buprenorphine formulations, specifically approved by the FDA for pain, may be more appropriate for patients without a history of opioid dependence. Consulting with a healthcare provider and adhering to a personalized, comprehensive pain management plan is crucial.

Visit the VA's guide to Buprenorphine for Management of Chronic Pain for further information on its role in high-risk patients

Further Resources

For those interested in exploring the use of Suboxone and buprenorphine for pain, it is important to seek information from reliable medical sources and engage in an open dialogue with your healthcare provider. Organizations dedicated to pain management and addiction treatment provide valuable resources to help patients and clinicians make informed decisions.

Frequently Asked Questions

No. Suboxone contains both buprenorphine and naloxone, and is approved for opioid use disorder. Other formulations, like Butrans patches and Belbuca buccal films, contain buprenorphine only and are FDA-approved specifically for chronic pain.

Suboxone is a partial opioid agonist, meaning it has a 'ceiling effect' that limits its potential for respiratory depression and euphoria. This makes it a safer option for patients with chronic pain who are at risk of opioid misuse or dependence, particularly when compared to full opioid agonists.

Off-label prescribing is when a doctor uses an FDA-approved drug for a different purpose than what it was approved for, based on their medical judgment and available evidence. For chronic pain, this typically occurs after a careful assessment of the patient's history and risk factors, particularly concerning substance use disorder.

Suboxone is most often considered for patients with chronic pain who also have opioid use disorder, or those who are at high risk of developing it. It can provide pain relief while also addressing dependence issues.

While not a standard treatment, some research suggests buprenorphine may be effective for neuropathic (nerve) pain. This is part of the off-label use consideration for certain patients, but its effectiveness can vary.

Common side effects can include nausea, constipation, headache, dizziness, and drowsiness. As with any opioid, there are also risks of more serious side effects, especially when combined with other depressants like alcohol or benzodiazepines.

This is a decision made in consultation with your prescribing physician. Suboxone is primarily for OUD, but many patients in treatment also experience pain relief. Your doctor may adjust your dose or discuss other non-opioid pain management strategies as part of your comprehensive care plan.