Is it possible that Suboxone might help to make fibromyalgia symptoms more tolerable?
Suboxone treatment uses the prescription opioid, buprenorphine, to treat opioid dependence and addiction. The Suboxone Film is a strip containing sublingual buprenorphine and naloxone, to be placed carefully under the tongue for absorption.
It is an effective addiction treatment for people who are addicted to pain medication or street opioids. The buprenorphine in Suboxone has a unique mixed effect on the opioid receptor that reduces opioid withdrawal and cravings.
Buprenorphine, the main ingredient in Suboxone, is also approved for pain on its own, as the Butrans patch and the Belbuca buccal film, and Suboxone itself is sometimes used for pain off label. Could it help a chronic pain patient with fibromyalgia, even one who has never had an opioid problem?
Fibromyalgia pain occurs with very light touch at one or more of various tender points on the person’s body. This chronic pain condition that causes widespread pain throughout the body reduces a person’s ability to function in daily life.
A person with fibromyalgia must always be on guard for accidental skin pressure that can elicit excruciating pain. For example, a simple hug can be intolerably painful.
Why do doctors choose to use other pain meds besides opioid medication to treat conditions such as fibromyalgia and neuropathic pain?
Doctors try to avoid opioid use in treating this condition because they are concerned about opioid addiction. They may also be worried about medication tolerance and opioid-induced hyperalgesia, a condition where opioids can intensify the pain.
Is it possible that a person with fibromyalgia who goes to a pain management doctor for opioid therapy can develop opioid use disorder? While most pain patients do not become addicted, there is a significant risk of drug abuse, addiction, and opioid dependency.
There was a period, not long ago, when doctors prescribed opioid drugs more freely for pain relief. Then, with the opioid epidemic and the Centers for Disease Control writing a report on responsible opioid prescribing in 2016, most doctors quickly reduced or stopped opioid prescribing.
Suboxone is approved by the FDA for treating opioid dependence, and any use for pain is off label. The main ingredient, buprenorphine, is approved for pain in its own right as Butrans and Belbuca, and it is an effective pain reliever that carries less risk of respiratory depression than full agonist opioids.
Additionally, buprenorphine is less likely to cause opioid tolerance, addiction, or respiratory depression. While it is not perfect in every respect, its properties would have been preferable to most other opioids.
Why would Suboxone not be a good choice for treating fibromyalgia?
While Suboxone is less likely to cause many of the problems of other opioids, it does cause significant physical dependence within a short time. People who take Suboxone long-term find it difficult to stop taking it, due to the discomfort of opioid withdrawal.
Stopping Suboxone abruptly can cause uncomfortable opioid withdrawal symptoms. Some people claim that Suboxone withdrawal is worse than heroin withdrawal, but in Dr. Leeds’ experience that is more of a myth than a reliable description, and he has seen multiple patients taper off buprenorphine and complete treatment without it being a major issue.
Still, it is possible to taper off of Suboxone gradually. It may also help to use Lucemyra, a drug approved by the FDA to reduce withdrawal symptoms.
In addition to developing opioid dependence from Suboxone use, patients who take the drug may experience side effects. Some Suboxone side effects include constipation, headache, insomnia, difficulty urinating, and excessive sweating. The label also warns that combining buprenorphine with benzodiazepines, alcohol, or other sedatives can cause dangerous breathing problems, overdose, and death.
It is important that, if a doctor chooses to prescribe Suboxone to their patient to treat fibromyalgia flare-ups, that they explain the risks of Suboxone side effects clearly. Patients must be provided with informed consent.
What does the naloxone in Suboxone do?
When a doctor prescribes Suboxone, they are prescribing both buprenorphine and naloxone together.
Buprenorphine helps the patient to feel better and to function better. Naloxone, taken under the tongue as intended, is barely absorbed.
The naloxone in Suboxone is there as an abuse deterrent, to discourage injecting the films or tablets.
If a person who is dependent on heroin or fentanyl injects Suboxone, the naloxone reaches the bloodstream and pushes those opioids off the opioid receptors, so precipitated withdrawal comes on quickly and is very unpleasant. Naloxone holds the receptors less tightly than buprenorphine does, so at the amount in Suboxone it does little to the buprenorphine itself.
How is naloxone related to low dose naltrexone?
Naloxone, as an opioid receptor blocker, is in an interesting family of drugs. It is related to another opioid antagonist, naltrexone.
Both of these drugs block opioid receptors. Naloxone is shorter-acting, and it is only minimally absorbed when taken orally.
Naltrexone, on the other hand, works very well orally, and it lasts for many hours. While the standard dose of naltrexone tablets for treating alcoholism is 50 mg, there is another use of naltrexone in the range of about 1 mg to 6 mg.
Using naltrexone at very low dosages is known as low dose naltrexone, or LDN. LDN is thought to work differently than full dose naltrexone, and it has been proposed to calm neuroinflammation and influence the body’s endorphin system, though the evidence is limited.
There is also a protocol, known as ultra low dose naltrexone, that uses dosages lower than 1 mg. Its proposed benefits rest on the mild, short-acting effect of naltrexone in that dosage range.
Low dose naltrexone is still an opioid blocker, and naltrexone holds the opioid receptors about as tightly as buprenorphine does. For someone taking buprenorphine, even an LDN dose can push buprenorphine off the receptors and bring on precipitated withdrawal, and the risk is greatest when the buprenorphine dose is low and the naltrexone is started at the top of the LDN range. Anyone taking buprenorphine or Suboxone should not start LDN unless the prescriber who manages their buprenorphine has planned it.
Does naloxone get absorbed when a person takes Suboxone the right way?
Very little. A small amount of naloxone is absorbed when Suboxone is taken properly, under the tongue, and at that amount it does little to the buprenorphine.
Naloxone shows up on sensitive, quantitative lab tests that measure the amounts of drugs in the patient’s system. It is absorbed orally in small amounts.
Is Suboxone better than Subutex for treating fibromyalgia?
Buprenorphine, a drug that partially acts as an opioid agonist, may help with the painful symptoms of fibromyalgia, as it does with other kinds of pain. Buprenorphine is the main ingredient of both Suboxone and Subutex, both of which are sublingual medications.
The difference between Suboxone and Subutex is that Suboxone contains both buprenorphine and naloxone, while Subutex only contains buprenorphine. For pain, buprenorphine is the ingredient doing the work in either one.
Dr. Leeds can advise on buprenorphine for pain in a consultation. Contact the office today.
