Nucynta

Hey guys.
So I'm preparing myself for another lumbar steroid injection, which I hope wil help with pain, since according to the neurosurgeon, I have nothing surgical to repair. I'm just kind of supposed to live like this because my herniation was so bad that they think it might take years to recover, if ever. It was repaired May 2011.
Anyway, I have a Rx for Lortab, which I take pretty sparingly, neurontin, which I also take sparingly because it makes me dizzy. Lots of Ibu 800mg.
I do all the usual things to help: ice, tens, PT, Chiro, stretching.
To make a long story short: I recently started a trial of Nucynta 100mg which seems to help the most.
I know it's chemical similar to tramadol, which I really don't like. Plus, because I take Cymbalta 90mg, and I worry about seratonin syndrome.
I see mt first pm doctor next week, and I know we'll do the injection.
My question is, how do you guys bring up the idea of taking meds in addition to the injection? In TX, it's gotten ridiculous about docs Rx pain medication. I mean, it sounds counterintuitive to me that pain docs don't want to Rx meds and just do procedures. I know it's all about the $$$, but I think there needs to be a reality check. I'm willing to do whatever it takes to get better, whatever procedure they want me to do.

Ok so the two questions: how do you approach pm about meds in addition to doing procedures?
Second, what has been y'all experience with Nucynta? I know they have an ER version. Any difference?

Thanks for being so supportive and I hope everyone is having a relatively pain free day!

As for approaching the PM about meds vs. injections, I'm not sure what advice to give. It depends quite a bit about your medical history and the nature of the practice. But you can discuss what you would like to be able to do (work, sit, go for walks, etc.) and what the PM can offer to help you restore more quality of life. You can also find a PM that specializes in or exclusively deals with meds. In my case, I have one who does, and I see a different PM for injections.

Regarding Nucynta, though it is suppose to be similar to Tramadol, I find them very different in effects. Tramadol tends to activate me and when I first started using it, kept me up. Nucynta, on the other hand, makes me groggy. For pain, I haven't found either as effective as Hydrococone or Oxycodone.

As for the new ER option, it surely will be pricey, but so is Nucynta.

You definitely have room to tirate up on the Nucynta if needed. Is it just 100mg for the day? or per dose?

And how many of the Lortab are you adding in per day for BT pain?

I would think it might be a bit easier for you to talk with the Dr. as you are in the medical field yourself...So you know their ways of asking the right questions..

For my Dr. I've known him so long that he can tell just by looking at me if it's been a good week/day or not.

So hopefully you all can discuss the follow up for the Nucynta and let him know how it's working and if it needs going up more...

Have you tried Lyrica before since you say the Neurontin makes you dizzy? I had that side effect for the first few weeks but it went away....I would think being on a good nerve pain medication should help some as well.

What about any type of muscle relaxer? Have they offered or talked about this?

I hope the injection offers some relief too....As you know...it's really about adding all these things together to keep the pain at a 5-6 level....that it's never going to be just a magic pill...(We all wish for this! LOL)...

And maybe they can suggest some more therapies like aqua therapy, massage, acupuncture, stretching bands, yoga....

I wish you luck!

Post Edited (Snowbunny21) : 3/25/2012 9:08:13 PM (GMT-6)

Baileysmom….I do have a question for you. I see you are on neurontin! …and see that you are using it sparingly? If you don't mind…what dose are you on. and how often do you take it? My PCD started me on it a couple of weeks ago at 300mg x4…..does this sound like too much…..and should I be using it sparingly as well? I hate taking med's…..but am hoping that it will help with any nerve damage that I have.

I figure as a PA you might have some insight about this med…..and I would be grateful for your thoughts on it.

Thanks!

SE

Thought I would post my experiences on Nucynta. When I first started pain management in Oct of 2010, I had been on 30mg oxycodone every 6hrs, and had very little (if any) pain relief. The first thing my pain management doc tried me on was Nucynta IR, 100mg 4x a day.....It worked unbelievably well! Last fall, when Nucynta ER came out, I switched over to that. I am on the max dose (250mg every 12 hour), and it still works great. It took me about 1 month on Nucynta before some of the side effects went away (they weren't really horrible to begin with anyway), and it has really helped me to keep working. Hope that Nucynta keeps working for you!

Baileysmom,

I hope you can find something that works for you.... I don't know about medication making you feel "stoned" - I wish I even felt my pain meds work.....

--Tina

BaileysMom,

I am glad to hear you are getting relief from the Nucynta (tapentadol). I've been on it since 2010 (occasionally switched out with Vicodin for 1 month) and its worked better than hydrocodone and tramadol and with similiar efficiency to roughly 10mgs of oxycodone with a longer duration (at the 75mg level) and less side effects. Also, it builds tolerance MUCH slower than Oxycodone. RADAR actually put out a report in Feb 2012 that used an 18 month study and found misuse and abuse of tapentadol has actually decreased since it came out. I personally feel this is partially due to its slow building tolerance and the fact that it doesn't cause as much sedation. It causes LESS mental fogginess than oxycodone too. Of the C-IIs, it seems (in my opinion) to have the least abuse potential and least opioid related side effects.

As for Nucynta concerning seratonin syndrome seems to be less of a risk than with tramadol. Tramadol has stronger SSRI properties than Nucynta. However, Nucynta does have mild seratonin effects but unlike tramadol, the increase in Seratonin isn't considered clinically significant to its pain relief properties. Nucynta CAN still cause Seratonin syndrome. This is partially because Nucynta has moderately potent Norephedrine Reuptake Inhibitation (NRI) properties. The NRI properties have an indirect effect on Seratonin levels. However, as I understand, the risk is still less than tramadol as well as anti depressants.

The fairly potent NRI properties of Nuncynta is also key to its comparable pain relief to moderate doses of other C-IIs, as its Mu opioid receptor binding affinity is 18x weaker than morphine, yet its about 1/3rd the stregnth of oral morphine in terms of pain relief. It is important to note that Nucynta IS more potent than tramadol in its Mu opioid receptor agonism and while similiar to tramadol has some differences. Older studies showed that 200mgs of Nucynta was superior in pain relief to 60mgs of oral morphine.

Sorry that this is practically a repeat discussion on my part as I've posted to answer Nucynta questions a few times now. It's still a relatively new medication so I'm happy to provide my personal insight on both the benefits and risks of the medication.

Be sure you drink plenty of water with it as it WILL dehydrate you. Also, at doses of 75 mgs, it had mild but noticable and tolerable mental effects. It seems to have a mild anti like depressant effect on mood. However, because the medication is mildly stimulating, you might find you need to take your last dose of the day about 2 hours before bedtime instead of right at bedtime. Also, if your doctor allows for a breakthrough dosing for flare ups (mine allows me to use 150 instead of 75 for flare-ups), the side effects increase substantially. For this reason, I'll try to get by with just an extra half one if I have a flare-up, which does cause some increase in side effects, but its tolerable. At 150mgs, it will literally drop my pain from an 8 to 0 but while shorted lives (about 90 minutes to 2 hours) the breakthrough dose causes a feeling of losing touch with reality as far as body effects go, as well as anxiety and naseua. Mentally (only at the 150 dose) it causes mild auditory hallucinations and closed eye visuals and "corner of eye" peripheral effects. These can be unpleasant but if they do happen, they usually improve within 2 hours.

Also, it seems that the effectiveness of the medication increases a little with repeated dosings (by this I mean if you take a second one 6 hours after the first dose, it seems to have better pain killing effects than if you didn't take it till the next day.

All in all its a great medication, ESPECIALLY for nueropathic pain! Again, at the 50-100mg dosings, low level of side effects compared to most narcotics. With less stomach related effects, its also easier to take asprin. Its effects on cognition are noticable but less than oxycodone or morphine so it has little impact on my "living life" and being outgoing. Please only take my advice with a grain of salt as I'm not a medical professional, just someone who has kept himself well informed concerning the medication since its a daily regiment.

I hope this helps and best of wishes. Remember to stay well hydrated :)

BaileysMom is the appt on April 19th for an eppie or is it your first consult with this dr? If its for a consult, rather than not knowing until the appt, I would call and just ask if this PM dr writes scripts for meds if he feels they are warranted. Just say you know some do procedures only with no meds.

Just a thought.