New Here, question about Butrans/Nucynta

Hi,

I'm new here, so thanks for reading. Currently working on getting appropriate treatment for cervical spinal stenosis/spondylosis or "degenerative disc disease" as it was described to me. Will be seeing "Back and Spine Program" tomorrow to start a treatment plan. I saw Pain Management for first time 2 weeks ago. My primary doc refused to treat my pain, which is how I wound up at PM. Anyway, the Doctor at PM is awesome, he really listened and was the first to actually go over my MRI with me and explain what I am dealing with. He rx'd butrans patch for me at 10mcg/hour. (Prior to this I had been taking norco 7.5 strength 1-2 times a day for about 3 weeks). I adapted fine to the patch, but after about 4 days, pain broke through and wasn't responding to advil or etc. Pain Doc increased to 15mcg/hour. Soonafter I ended up in ER with an interaction between that and my tizandine for muscles. Also, the patch at 15 was not doing enough for pain and making me very "dingy" in head.

I had a cervical epidural steroid injection yesterday. So far it has cut down the referral to my arm a bit, but it's early to tell the outcome. Because the Butrans was not really doing what we needed and was interacting with other med, PM doc RX'd Nucynta (not the XR, just the regular) at 50mg up to three times a day as needed. He told me to take the patch off 6 hours before starting the Nycynta. I haven't received it yet, it will be in tomorrow, but I am concerned. I've read quite a few things online about it being very hard to just stop these patches. Now I've only been on a total of two weeks, so I don't know if maybe this just doesn't apply to me, but I'm wondering about withdrawal. In preparation, I did take the 15mcg off today and applied the 10mcg I still had remaning. Should I do more, such as reducing size of the 10 I'm wearing, or will I really be OK to just take it off tomorrow and start the Nycynta? I don't want to put myself in a bad spot, however, since I haven't been on any narcotics that long, I realize I might be overthinking the whole thing.

Any advice appreciated~!

Thanks for those tips. It would be nice if they told newbies things like that! Also, I never expected total pain relief. I haven't gotten 50% yet. Unfortunately I had a PCP that believed that she knew more about my habits, pain and lifestyle than I did. She was downright nasty to me. (I only saw her twice, she will not be long term on my team). Total lack of respect for anything I had to say, any knowledge I had, things I had tried, research I had done. She was younger than me and clearly offended that I take control of my own health care. She even said "Well, I AM a Doctor you know." Excuse me? What am I supposed to say to that? I wasn't going to stoop to her level, but I have 22 years experience in the medical field, 5 as a military corpsman, 13 as a licensed massage therapist and a recent pre-med degree. She may have a "DO", but she's been out of school and residency 2 years, I far outweigh her on independent clinical experience and treatment planning. However, I didn't throw that around, but believe me, I wanted to. She clearly held the belief that all patients in need of pain medication are future addicts and death statistics, and said as much.

She would cut me off in description of my problem and just lecture me on how ibuprofen, PT and lifestyle were the answer to everything. She grudgingly ordered an MRI and even "predicted" that the results would be normal and everything would come back to PT referral. (Been there, done that, along with a bunch of other modalities). So, when my MRI didn't come back "normal" she hid the results from me, refused to discuss them with me, and kept making phone calls to radiology trying to get someone to change the results to suit her predetermined outcomes. I wish I was making this up, but I'm not. I had to get a copy of the disc, download a reader and look at the films myself to find the report and get my chiropractor to go over them with me. The PM doc was the first to actually discuss my MRI with me and give me a diagnosis. Even after that, this PCP is still sending me messages that she is in the process of getting my report changed....can she do that legally? What the What the?

I see the back and spine program in our nearby major city today. It will be an NP who does only back and spine, they are staffed by a physical medicine doc, a PA and an NP and this is all they do. Their goal is to get multiple aspects of treatment going at once and coordinate all appts and referrals through their office. So, they will go over MRI, discuss if therapy is an option, and make referral to Neurosurgeon if needed. I sure as heck hope this gets me in the right direction. I've had to do all this as self referrals since my Doctor wouldn't do squat for me. She even downplayed my MRI results telling me I had "mild arthritis" in my neck and "a possibly a mildly pinched nerve from C5 to C7". That isn't what the report says at all. It's one thing to put it in laymans terms, it's another to change the meaning entirely to suit your own biases! UGH! Thanks, needed to vent!

Post Edited (JustanotherMom) : 12/30/2015 8:07:57 AM (GMT-7)

tidalmouse said...
Hey JustanotherMom.Welcome to HW.


Nucynta was a med I took for about 6 months.When I was switched from Norco to Nucynta I actually went through withdrawals.

The Nucynta did provide some pain relief but I was sleeping about 15 hours a day.I like sleep so that was OK for a while.But I finally decided it would be in my better interest not to sleep that much.

Hi Rick, Thanks for response...curious, was the nucynta that made you sleep that much the extended release or the 8 hour that you can take "as needed"? I've been prescribed the 8 hour "non extended release" one which is what I prefer. Thankfully no pain med has ever given me enough relief to take it enough to go through withdrawal yet. I seem to be one who rarely gets a "high" feeling from opiates, so there isn't any "payoff" to taking them beside pain relief, which seems to be elusive at this point!

Just so you know, stenosis is simply a word meaning narrowing....what's important is the whether the narrowing is located, either the for Amina , or the central canal, and whether or not it is causing any contact with either the cord or the nerve roots.
Spondylosis is another term meaning inflammation and is commonly referred to as arthritis in the spine.
Degenerative disc disease is a normal process of getting older. It's name implies that there is some disease process going on that is debilitating or will be debilitating, but is is in most cases, not considered to be a serious finding unless the disc dehydration is significantly more advanced than it would be for someone in your same age range. If they were to do MRI's on everyone, most of us between the ages of 18 and up are going to have some signs of DDD in our spines.
I am not trying to minimize the pain you are experiencing or the report, but rather to reassure you and hopefully the injections and therapy will relieve your symptoms.

Well, I saw the NP from back and spine today. The primary doc did get an "ammendment" added to the MRI report stating that it was supposed to say "No" in front of "High Grade Narrowing" which makes no sense. She went over the results with me, but was "downplaying" what she was seeing also. Told me that I am "Not a surgical candidate". Wait a minute...how can anyone but a surgeon definitively say that? The interventional anesthesiologist I am seeing for pain management didn't feel that way at all. He says I'm NOT a candidate for PT based on how reactive my neck was even to his exam. He felt I had a high chance of needing to get in to a surgeon. The NP from back and spine just wants me to do PT again with their "Spine specialist" PT's. I did get an EMG for my left arm arranged, but I had to push for it. I'd like to know why it's weak and painful before I just commit to more PT. If the MRI missed an impingement, this should help. Wish I could bill insurance for my own services as my advocate!!!!

Hey Mom.I'll add one more thing.Surgeons like to do surgery.There are good Surgeons out there that will be honest enough to tell you that you're not to the point of surgery.

But a huge percentage don't want to talk to you unless you're willing to go under the knife.

If you see a Surgeon and he recommends surgery right away,you may want a 2nd opinion.

I'm holding out as long as I can on Lumbar Surgery.

I get what you're talking about referring to the young Doctor talking down to you.These are the hoops that Chronic Pain Patients have to jump through.

Good Luck and God Bless.

Rick

Hi Susie,
Thanks for that, sorry so long to reply, my account accidently got frozen and I had to wait for site owner to let me back in. (It happens! ) Anyway, I did have the EMG done this week, and it showed same as the one I did have 7 years ago...carpal tunnel syndrome. It didn't show any permanent nerve damage from neck, but the neuro who did it did tell me that means nothing in terms of whether my pain is coming from a nerve being irritated. I've had one call from the spine clinics nurse coordinator saying they had "recommendations" for me, but my call back was never returned again over 2 days. Anyhow, I've been putting this carpal tunnel off for years, so it is on my to do list, before any of this other pain happened. I've made an appt with our family orthopaedic surgeon who is "not" quick to cut and very conservative. He's done both my hubby's CT's on both hands, as well as a tendon repair and a knee repair. I've seen him for many things and he's always managed to get around surgery (injections, conservative treatment, etc). He isn't a spine surgeon, but I would trust one he referred me to. We seem to have more orthopedic spine surgeons dedicated to spine surgery than we do neurosurgeons around here, and the neuros we do have are focused more on actual brain surgery and neurological surgery than on spine repair. I'd rather have him tell me which of these ortho spine specialists he's had good results with than to shoot blind. Someone asked how I ended up at Back and Spine program, I self referred. I actually scheduled the appt with them and the PM appt in one day of phone calls. I just happened to see PM first. I will continue with his recommendations, as back and spine program ended up being my "second opinion". (Not much help since her opinion conflicted so much with his, but I felt he spent the time to understand what I had going on, whereas spine clinic NP came in with a predetermined agenda. (I've worked in medicine in some capacity for 22 years, I can smell an agenda a mile away!)

As to pain, the cervical epidural injection didn't help. By 5 days after, it was evident all pain was back. Not sure, but it may have even made my arm a bit worse. The switch to Nucynta didn't end well, after 10 days on it, it was affecting my moods poorly (likely interacting with the SNRI I take) and a consult with the PM clinic we collectively decided to revert back to Butrans until my next appt. It was better than the nucynta with less side effects. (Just goes to show you, when you think it's bad, it can always be worse and you find out what you had when it's gone!) I also have an appt with my VA neurologist for migraines next week, they already know I am bringing my MRI to ask his thoughts, since he manages my migraines. So many opinions! I suspect he will recommend the spine physical therapy, and if so that is something the VA can provide to me at no charge, so I'll do it there and let my PM doc oversee the result. What a ride~ Thanks for the tips!