Chronic Pain Management and Buprenorphine

Written By: Dr. Stephen F. Grinstead, LMFT, ACRPS, CADC-II Date: April 6th, 2009. Topic: Member Blogs.

There is an effective medication for both opiate addiction treatment and/or transitional pain management that is FDA (Food and Drug Administration) approved for treating patients with opiate addiction. 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 about the synergistic phenomenon that occurs when chronic pain management and addiction meet and how it impacted one of my chronic pain management patients—Mary—please check out my article Understanding the Addiction-Pain Syndrome™ that you can download for free on our Ariticles page.

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you or a loved one is undergoing chronic pain management, especially if you’re in recovery or believe you may have a medication or other mental health problem and you want to learn more effective chronic pain management tools, please go to our Publications page and check out my book the Addiction-Free Pain Management® Recovery Guide: Managing Pain and Medication in Recovery. To purchase this book please Click Here.

To learn about two skill trainings coming up in Sacramento California designed to teach treatment strategies for people undergoing chronic pain management who also experience coexisting disorders including addiction please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

To listen to a radio interview I did conducted by Mary Woods for her program One Hour at a Time please Click Here to go to this interview.