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Intro, plus New Meds, how long do I let this go before I call?

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Chronic Pain
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Posted 3/9/2015 10:05 PM (GMT 0)
Hello I am new to this forum, but not chronic pain. Spent 3 yrs in "interventional" pain management practice getting cortisone shot everywhere with only negative effects, hello type 2 diabetes, 5 yrs treatment from my PCP with MS Contin and Oxycodone after that with Lexapro and Gabapentin thrown in. Recently referred to PM. Saw that Dr. Feb 25 and was prescribed Nucynta both ER and IR as well as zonisamide to replace everything. I started taking zonisamide right away, but it took a week to get thru the prior auth with the ins and then have the pharm order the Nucynta so it will be one week tomorrow for that. Is there some point where I should start feeling somewhat normal again? I see the Dr's NP on Mar 24, and no clue how that will go. At this point I dont know if I should call them or just tough it out until I go back. Right now I feel like I've got a real bad case of the flu.
Posted 3/10/2015 12:39 AM (GMT 0)
Hello tigger and welcome to the CP forum at HW. I'm somewhat confused about the zonegren because you don't mention a seizure disorder and I have not seen any one else using it off label for sciatica or neuropathy,is that what they gave it to you for? Replacing the neurontin?

As for the flu like symptoms they're likely withdrawal and we see this often with folks coming from oxy and other various opiates onto nucynta. I think its just the nature of the drug personally since its almost always a complaint in opiate tolerant people. Drink plenty,try to eat healthy and get rest and you should see that start to get better though it may take another week or so.
Posted 3/10/2015 12:47 AM (GMT 0)
Yes, it's a replacement for the gabapentin. I get swelling in the feet and hands with higher doses of gabapentin and could not tolerate lyrica at all. Right now I'm only able to eat a little without being sick, and sleeping is a challenge, made it two hours or so last night, which probably accounts for not making sense.
Posted 3/10/2015 1:04 AM (GMT 0)
Wow, I'm not very impressed with your PM so far. He should have made this transition for you a lot easier. Did he at least give you clonodine? And did he prescribe correctly (eg do your doses match), because a lot of docs don't quite understand how nucynta translates to opiates and vice versa.

Also, don't ever ever ever miss a nucynta dose or you will pretty much sweat your weight. No fun. (Gee can you tell I'm not a fan?)

Welcome! :)
Posted 3/10/2015 3:27 AM (GMT 0)
Sounds exactly like you're going through opiate withdrawals, with the flu-like symptoms. I just went through it, and had acute symptoms for about three days, and then gradually tapering symptoms for about three or four weeks. No fun at all. I was on morphine and neurontin, but had to quit the morphine fast due to side effects.

It's a shame your doctor didn't describe the symptoms you'd be having after he removed the two opiates, but try googling opiate withdrawal timeline, or something like that, and see if it sounds like what you're feeling and you can find various timelines for how long the symptoms last. And no, you don't have to abuse it, as some sites say, in order to have withdrawals. I took only the minimum to control pain, no feeling of a drug high at all, and had the same withdrawal symptoms as a street addict according to what's on the internet.

I'm not familiar with nucynta, but as AnnaBananna said, I believe there are ways to treat the symptoms of opiate withdrawal with short-term drugs. (I just used Immodium for the diarrhea, but was ready to call my doctor if I couldn't handle any of the other symptoms.)
Posted 3/11/2015 4:33 PM (GMT 0)
Putting aside the issues from the flu-like feeling for a sec... are you getting any relief at all from the new meds yet in terms of what they were prescribed for?

At this point, there really isn't much the PM can do for the flu feeling. In general, not much can be done anyway, but usually, if the dr is going to ease the transition they will offer something in the beginning.

So my advice would be to just try and get through it. Every day from here on out you should feel a little better.

But definitely keep track of your pain, symptoms, and side effects. By the time your appointment comes around...the meds will have been in your system long enough that you *should* be noticing a difference either way.
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