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How do you choose the best med from imperfect choices?

Lala329LLala329 Posts: 283
edited 06/11/2012 - 8:45 AM in Pain Medications
Hi Spineys,

I am in that process of trying to figure out my baseline meds. I am starting school again in August, so the goal with all of this is to come up with a med with minimal sedation/cognitive impairment. After trying several meds over the years I'm just not sure which will be *best* since they all have their pros and cons. My next PM appointment will involve making a decision on this, so any feedback is appreciated (and yes, I know I over think these things) :)

1) Nucynta: Great pain relief and minimal sedation, but it is supposed to last 6 hours and I only get about 3 hours relief out of it. It is also new and expensive.

2) Hydrocodone: Great pain relief, but more sedating than the Nucynta and randomly causes nausea.

3) Tramadol IR: Moderate pain relief (not as good as the other 2), but I like the idea of a non-narcotic.

4) Tramadol ER: I haven't tried this, but my pharmacist recommended that I ask my PM doc about it- My concern is how sedated/druggy I'll feel around the clock being on an ER drug, but the pharmacist thought it could perhaps cause less cognitive impairment than the IR drugs b/c of tolerance (yes, I've had a few post debating the IR vs. ER approach). Does anyone know how long it takes to "test" a drug like this (as in, how long to develop enough tolerance to really know how you'll feel on it long-term?)

I never knew how hard it would be to figure out the best drug. I know none are perfect, so I'm not sure how to pick among these since they are so different in their effectiveness and side effects...


  • one thing about Er drugs is that there is a continual level of pain medication in your system.. i have been on ER medications for several years now and do not notice any impairment at all once i adjusted to the medication, in fact i feel very normal,except that i don't have any pain.. there is also only a need to take two or three pills a day.. and with the patch that is only several times a week.. quite a difference from IR pain medications.. tolerance differs in everybody with evey medication.. but Er medications brought me freedom from constant pill taking and the up and downs of pain control. Jenny
  • One thing to remember about opiates is that even though hydrocodone is the "weakest," they all will affect us differently. So you might ask your dr. about trying Oxy before you start school, to see if you react better to it than Hydro. I only say that because I don't have any of those side effects with Hydrocodone, but Oxycodone gives me terrible gastro effects, while I know people here who are the exact opposite. And you may very well have a finals week or something during which none of the non-opiates are enough.

    OK, so back to the others. Aren't nucynta and tramadol in the same class? So Tramadol's benefit over Nucynta is cost and availablilty of an ER, correct?

    I did not see Cymbalta added to the mix- have you tried it? It can also be helpful for chronic pain, but if you do try it, you're limited in how much Tramadol you can take because of the risk of serotonin syndrome. I always found a lot of issues with the interactions of my medications.

    I never had any sedation from Tramadol at all, either from IR or ER.

  • Thanks for the feedback :)

    To answer your questions:

    1) I cannot take cymbalta- I had an anaphylactic reaction and we never figured out which med caused it, so we discontinued all the meds I was on at the time of the reaction (I took the cymbalta a few minutes before my throat closed, so we're pretty sure it was the one).

    2) Nucynta is similar to tramadol, but stronger. You're correct that the benefit of tramadol to Nucynta is availability of an ER and cost, but Nucynta does work better as far as pain relief.

    3) I'll have to ask my doctor about oxy- he did mention that around 25% of people can't take hydrocodone dt side effects, and that for those people oxycodone is usually better tolerated. It also sounds worthwhile to ask about the tramadol ER as it sounds like sedation may not be an issue...

    Thanks for the feedback, and I'd appreciate anyone else who has an opinion. You guys are such a huge help as I process through all this...
  • How about the new med, Savella? Is it too similar to be worth trying?

    Just trying to spend your college fund on brand spanking new medications ;)

    I think you're not really going to know what works in that environment until you get there, and adjust as you go.
  • Just have a little thing to say about Oxy. I took Oxycodone with no sideffects at all it just didn't last,the Doc switched me to Oxycontin for more controlled relief. The first couple weeks were rough it wasn't quite strong enough to cover the pain but I was terribly drowsy. The drowsiness has subsided and we have the dosage at the right level and it is working well for me. So if you do try Oxy you might need a little time to get it worked out but it has done well for me. It's so great your going back to school.
  • I have been trying to releive my pain with nonopiod drugs for the past 2 years, I have a SCS but am getting to the poiny=t that something else needs to bre tried, Im tired of the 24/7 dsily grindTramadol or oxyicotine may do wonders for me.
  • Oxycontin is not a non-opioid drug. It's a very strong extended-release opiate, very effective for chronic pain.

    You guys both saw the new med approved, Butrans, right? I think it sounds like it might work for you.
  • I saw your posting about Butrans it sounds interesting. I am wondering if I should even bring it up to my PM doc since my current med dose seems to be working ok??
  • It won't be out for a while, after approval it takes a while to get on the market most of the time (although since it's been on the market in europe, maybe not?

  • dilaurodilauro ConnecticutPosts: 9,859
    only take the word of your doctor(s) or pharmacists as actual medical facts. You should always discuss your medicine situation with your doctor. Talk about your concerns, what has worked, which hasnt, school coming up, etc.

    All that can be factored into what medicines your doctor will put you on. Many times it is a trial and error basis to see which ones work best for you and keep you at the clarity level you need to be at.

    Everyone has great intentions and can talk about their own personal experiences. However, no two people will react the same to the same medication.

    Trust in your doctor.
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • Indeed, that's what they are there for. I'm thanking my lucky stars daily for mine lately, but as soon as that new medication is out I will be asking him about it!

    (by the way, Lala was asking about starting points for her conversation with her doctor and people's individual experiences with different meds, not what medications she should be taking. Doctors decide what medication we should take, not people on websites. Hopefully everyone on the thread was clear on that).
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