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sleeprgirlssleeprgirl Posts: 695
edited 06/11/2012 - 8:47 AM in Chronic Pain
Hi all! My PM doc wants me to do my research on nucynta and consider taking it. I welcome all comments about any personal experiences with this drug. We are trying to find the right drug for me, so it's not set in stone that I will be taking it...so..the good, bad, and ugly please :-)

Thanks in advance!!!!



  • Hi Lisa!

    There is an existing thread somewhere on this forum about Nucynta. I tried Nucynta rather enthusiastically since it is a newer Schedule II drug and I've been limping along on Hydrocodone for a long time.

    Within 36 hours of taking it, my pain transformed somehow. Instead of my usual rather focused pain in my lower back and rear, I now felt like my entire rear and leg was on fire. It was pretty scary. I called the doctor and he said to go back to the Hydrocodone. I very quickly felt much better.

    I don't have all of the facts about the composition of Nucynta, but I had heard described as a more potent formula of Tramadol. That made sense to me since my body cannot tolerate Tramadol and I obtain no pain relief from it, either.

    It may be worth a try for you. I tried 50mg, but I read that you can take up to 100mg (I think) if prescribed.

    Best wishes, my friend!

  • Reformed, are you sure that wasn't withdrawal effects (I recall them telling you you wouldn't have any, but...).

    Because basically that's what they felt like for me- like the pain spread and became more burning.
  • Happy has a point. Nucynta really should be used as an adjunct for pain control. Were you still taking the hydrocodone or did you stop it that day?

    I did try Ultram and continued my percocet for daily rescue back in August before I started having endoscopic surgeries. Ultram did help slightly, but once I had the surgeries, I've need much higher doses of percocet, since the pain has been wicked!!

    My pm doc is having me write down a pain diary for his review in 2 weeks during my next lysis of adhesion procedure. He mentioned me looking at nucynta. I asked about adding oxycontin (small dose) to the present regimen. He said he would rather me use a Fentanyl patch...but, I'm not mentally ready for that yet. I took oxycontin 10mg with my percocet for my postop fusion regimen, and it worked great...

    He has increased my percocet dosage, but it has just been like a roller coaster with the pain. Hopefully my PM doc will work with me in time. I've only had the 3 procedures, and otherwise, he really doesn't know me, or my pain pattern. I just can't go through another procedure without tweaking the pain meds to better help me through the recovery and beyond.

    Dave, how is your new PM doc working out for you?

    Happy, how are you doing today?

  • The nucynta is supposed to be much more effective than ultram. In trials they got pain relief similar to hydrocodone (but that doesn't mean it will halt withdrawals from hydrocodone, it's not a pure opiate).

    But I seem to recall someone else posting that they had some side effects, so you might want to do a search.

  • I looked at the full prescribing information, and I have concerns about the drug for me personally. It is actually contraindicated for me. Luckily, there are many others to choose from, and honestly, I'm looking for an extended release drug for more steady state pain control.

    Thanks always for your input :-)

  • I was clearly told to take Nucynta in lieu of Hydrocodone. This was prescribed by a PA and not a doctor. I will say that the PA seemed very thoughtful and very knowledgeable and he presented this as "let's give it a try".

    I agree that I seemed to have suffered from withdrawal because I spent most of the time in the bathroom. I usually have the opposite problem with Hydrocodone (constipation). The fact that I felt better very quickly upon resuming Hydrocodone does seem to suggest that it was withdrawal as well.

    I understand the Percocet rollercoaster issue as well. You get a bunch of medicine in the first hour or so and then by the third hour you wonder where all of the medicine went. I'm also amazed at the apparently broad misconception that Percocet is so incredibly powerful. It isn't. I continue to have a lot of pain after my latest nerve block, and my new PM doc wanted to prescribe 5mg of Oxycodone to give me a boost in lieu of 10mg of Hydrocodone. I told him that my experience has been that 5mg of Oxy does nothing for me. He said that we could try 7.5 of Oxy and here is where I apparently crossed the line with him -- I told him the 7.5 wouldn't be any more effective than the current 10mg of Hydrocodone. He got very testy and said "then you can go and try and find a new doctor who is willing to give you 10mg". I was dumbfounded. I apologized profusely and told him that I was just saying this based upon my experience -- that Oxycodone is only slightly more potent than Hydrocodone. He strongly disagreed and said "No, it's three times as strong". At that point I just shut up and took the prescription for 7.5. He told me to call him on Monday and let him know how it's working. Guess what? I feel almost no improvement in pain. Maybe a very slight improvement. Regardless, I think he now has me pegged as a drug seeker, so I won't dare ask for anything else. I'll just tell him I'm getting by.

    It bothers me that I couldn't have a dialogue with him about what works and what doesn't, but I am not going to keep hopping from doctor to doctor. In my next visit, I guess I'll need to stroke his huge ego a bit. In my heart, I wish I could correct him about the "three times more effective" nonsense. Who teaches this to doctors and PA's? It seems to be a widespread misconception. Either that, or maybe my body doesn't handle these meds in a "normal" manner?

    Best wishes, Lisa. I'm glad your doctor is at least having a dialogue with you about your pain and which medications could help you.

    Take Care,
  • Dave, I'm so sorry he totally didn't get what you were saying. I hope greatly that as he gets to know you and is assured that you're not a seeker (this sometimes takes months), that dialogue will come for you.

    Yes, oxy is 3x stronger. Except for that thing we've all found called "medicines are individual and sometimes what works for one person doesn't work for another."

    It's a heartbreak that any of us have to walk into an office and work so hard to shed the "seeker" image.
  • why I am having to complete a pain diary. It is difficult to understand why when you describe your pain that it is not taken seriously.

    You are right HB, I do think it takes time for a dr to trust. In the meantime, we are left in horrible pain.

    Dave, has your doctor had you do a pain diary??

    In my situation, I am a chronic pain patient, that has had 3 extensive procedures in 6 weeks causing acute pain as well that is not being supported. I have another procedure scheduled for Oct 28th, but don't think I can go thru with it without my doctor understanding and treating my pain. I am in need of the surgery since he has released almost all the adhesions...a little to go...but the postop pain is almost as bad as when I had my fusion...

    I am going to give my PM doc the pain diary 2 days before my surgery, and tell him that he must do something in addition to the short acting drug or I can not physically or emotionally do this again. I'm 5 days postop today, and I feel like I've been run over by a bulldozer...

    How much pain must we endure????
  • It seems that it would be logical as doctors for them to assume "non-seeker" and go from there. It seems they do the opposite.

    I was reading some posts from a few days ago from someone I don't know who claimed to be in the pharmacy business, and the attitude was exactly the same. What, you have an issue I haven't seen? Seeker. You ran out of meds? Seeker. In pain? Asking for individual treatment? Don't like the status quo? Seeker, addict, liar.

    For me, who has been accused of having an (ahem) overactive sense of justice and doing what's right, that is SO hard. The merest thought that someone feels that way about me feels so offensive, it's hard not to get angry.
  • this is all new to me, since I did not have pain before last Nov. when I had my fusion.

    Before starting with this PM doc 2 months ago, I was dealing with a medical assistant of my NS for all my medication needs. She has no formal knowledge of pharmacodynamics/pharmcokinetics. She made a mistake on my refill, and the pharmacist at a large local chain, screamed at me to make sure that this refill lasted 12 days, when the error was not even my fault. I was horrified, and it was my first encounter with people thinking that I was a drug seeker.

    I am going thru a very pro-active, but grueling course of procedures that will not end until the first of the year. I'm committed to this approach...all in the attempt to decrease my pain. If I just wanted drugs, I would NEVER go thru this pain and suffering. One year ago, life was great, amazing career; I looked great...now, a fusion and 3 new procedures later, I look and feel like crap, but have to be patient, and hopefully have some improvement.

    I have contemplated this mind set of "drug seeker" attitude. When I was giving anesthesia, it seemed that was the general thought of the patients having blocks. I always felt that when a chronic pain patient needed surgery or a procedure, that they needed their pain managed appropriately, but I did not once take the time to really learn about chronic pain and how it effects the body as a whole. My journey has opened my eyes, and I have been given a healthy dose of humility.

    I know exactly what Dave is talking about as far as just not mentioning your pain with your dr. I resent being at their mercy; especially from an intellectual standpoint, when I can articulate the quantity and quality of my pain, my daily pain pattern, not to mention, my desire to be pain free.

    That is where I am. HB do you see anything that I have not addressed, or can do to help facilitate getting appropriate treatment???


  • You know, though, that's the problem- drug seekers will. They'll go through anything. Or, at least that's the perception, I don't know how many drug seekers have ever done these procedures.

    But I was just reading this article that said up to 20% of the primary care population has substance abuse problems. So maybe we fall in to the "if you hear hooves behind you, think horses, not zebras." We consider ourselves the horses, the obvious option given a choice "pain sufferer or seeker," but maybe really it's not- maybe we're the zebras.

    It makes me want to walk around with my MRI films in my pocket.
  • it would not make a difference if you did have your images with you. Unless people can feel your pain, or walk in your shoes, it is not appreciated.
  • Sorry to go back to this, because the conversation has moved on to other things. I'm still concerned about why Oxycodone is not very effective for me. I had read somewhere that 10mg of Hydrocodone is equivalent to 7.5 mg of Oxycodone. That seems consistent with my experience. If it was 3 times as effective, then I should only need 3.3mg of Oxycodone to equal the Hydrocodone that I have been taking. That would not even be close to being correct based upon my experience.

    I will never, ever get into this kind of conversation with my doctor again, but when I was hurting badly from a procedure that he recommended, I felt like I needed to assert myself about what I know to be effective/ineffective.

    I would still like to know what legitimate medical information is being used by doctors to make them think that Oxycodone is so much more potent than Hydrocodone.

  • Lisa, i saw your post, and had to quikly reply (i am leaving for NS 6 week check), the same "doc" who administered my discogram, placed me on a trial of this in May,which at the time I was on vicodin HP 10mg ever 4-6 hour. He thought it would have less side effects, I had been on the vicodin for 6 months solid at that point. Which by the way, I was content with my.current meds, I was functioning & working.I
    he gave me 10 pills,.said they would last longer compared to current vicodin.
    I will be honest, I did NOT read any of the other posts, I am pressed for time, for ME this pill nearly gave me a heart attack along with obviously a panic attack. Went right back to my faithful vicodin.
    All the best,
  • Oh, yes, I think you're right- not 3x, 3/2 x. I looked it up once, but no I didn't find a good site. Just lots of references.

    Please, Reformed- it is not your fault you can't have this discussion with your doctor. This is HIS problem, not yours. You're just coping with it until you're in a place to find a doctor you can talk to. Hug.
  • I don't think that is the right drug for me either. There are too many potential side effects for me to consider taking it.

    Dave, it almost seems we are seeing the same doctor, because I have had the same conversation, same reaction, and left his office feeling exactly as you.

    I took pharmacology in grad school for goodness sakes. Surely I should be able to be a participant in my pain management.

    What I discussed with my doctor are meds that have worked for me in the past; tried and true; safe for me. I do get scared when I try new drugs. I was a very conservative practioner, and want the same for my own care. However...I'm in severe pain...Chronic pain, and acute postop pain...I should be kept comfortable...what part of this do we not understand?

    I am exhausted from the pain, but like Dave, very intimidated to call my doctor.


  • Our pain management should be a two way street, not everyone reacts the same to ANYTHING, from food preference, style, ethics, morals, movies, books and YES PAIN MEDS!

    These docs need to get their heads out of their drug books and their hands out of the pockets of the last pharmaceutical rep that left their office.
    instead, they need look at us a humans living in chronic and often debilitating PAIN. We need to be proactive in our treatment plans! NO DRUG seeker would do that.

    Dave, I found a cool pain med comparison website, that uses a 1-10 scale, I will post it in this thread (hope that's ok).

    When I filled the nucynta rx, pharmasist did make me sign a waiver stating I would not take my vicodin while taking the nucynta. I finally graduated to oxy, even pre op. The mix in vicodin & percs do a number on you, which is why I went off them. Nucynta did not have all the extras, was more ala carte (lol)

    Lisa, you are very educated in meds and NO ONE knows you better then YOU DO.:o)

    Ps, I do not take oxycitin ER, did not last for me, I was taking far to many oxycodone breakthroughs. Oxycodone every 4 hours works for me.
    My new PM doc can be brutal, but he listened and heard and now I am managing my pain I thank god I found him, I wish the same for all of you.

  • Maybe this might help, again, I stumbled on this and CAN NOT ENSURE ACCURACY, just thought it may shed some light or help with your debate.


    Good Night all!
  • When you get to the strong opioids - morphine, oxycodone, methadone, diamorphine, hydromorphone, fentanyl, etc. - there isn't that much difference in effectiveness, as long as an equianalgesic dose is given. More important is the individual patient's response to any given drug, and the route of administration that is deemed most appropriate for a particular patient or situation. Milligram for milligram, fentanyl may be much stronger than hydromorphone, which in turn is (weight/weight) more potent than morphine or oxycodone, but equally good pain relief can be achieved with all of them at the right dosage.

    A lot of it comes down to what is most effective and best tolerated by the patient. For example, if a strong opioid is needed in tablet or capsule form, oxycodone is often preferred over morphine due to oxycodone's superior oral bioavailability. However, if an IV opioid is required, morphine is often the drug of choice.
  • Nucynta for me was HELL. Took one pill, had a massive "panic attack" and my heart was racing, and was really really dizzy. It was awful!!! I tried this for 2 days, ugh....then my doc finally realized I was having an allergic reaction. Definitly not the medicine for me. :)
  • norepinephrine reuptake inhibitor...which can cause the adverse effects that you had. It really isn't an allergy per se, it is part of the pharmacodynamics of the drug.

    Pretty scary adverse effects I'm sure!
  • My pain management Dr. put me on Nucynta for a while. It is stronger than the Lortab 10/500 pills I use for breakthrough pain. But I use a pharmacy owned by the company I work for and they didn't carry Nucynta yet.

    So, Walgreen's charged me $35 a month, after a $20 price cut with a card from the manufacturer. Well, after three months, that was going to end so I talked to my doctor about it. It didn't want to face $55 a month versus $7.50 a month for Lortab generic (hydrocodone).

    We decided to up my Oxycontin dose from 20mg 2x a day to 30mg 2x a day and put me back on the Lortab 10/500 pills for breakthrough pain.

    In short, Nucynta was stronger than my Lortabs and kicked the pain down a lot, but the price of this newer pill was what drove me to another option after talking it over with my Dr.

    I had no side effects with Nucynta.
  • ive been on nucynta 100mg since october 2010 and so far its worked ok it doesnt give u the foggy side effects like alot of other PM do. your also much less likely to become addicted or dependant on it like with other opiods. i hope others find relief with it
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