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Nucynta ER

dmk005ddmk005 Posts: 3
edited 10/28/2013 - 1:05 AM in Pain Medications
I have been taking a combination of Nucynta IR and hydrocodone for the past 7 years because of pain resulting from a car accident and a series of surgeries to my left arm, wrist and hand as well as back pain due to disc problems with my L4 & L5 discs. Over the last 3 years, I have successfully reduced my Nucynta doses from 100mg 4 times a day to 50mg, every 12 hours. My dose of Hydrocodone is 7.5/325 in the morning and 5/325 the last three doses of the day.

Here's what I am dealing with...Just like clockwork, 6 or 7 hours after my morning dose of Nucynta 50mg, my back pain returns with a debilitating amount of general malaise. I find concentration difficult and often need a nap in order to make it to my next dose. I get very little work done during hours 7-12 hours after my morning dose. Should I ask my doctor to switch me to Nucynta ER? I had also considered splitting the dose myself (25mg at 6am, then another 25mg at Noon but I am concerned the lower dose will be less effective.

Hank you for any assistance.

David
David
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Comments

  • It is never a good idea to cut a pill without the advice and permission from your doctor to do so. It might be worthwhile to discuss changing your dosage over to an extended release version since it does sound like you are using the immediate release version of the medication and those typically are meant to be dosed every 8 hours or so, depending on your physician's directions.
    An extended release version might work better for you.
    Sandi
  • Sandi,
    Thank you for your response. I discussed it with my doctor and he agreed to switch me to the ER formulation. We did an equal dose exchange (was 50 IR BID, am now on 50 ER BID). So far, my overall pain relief is slightly lower on the ER formulation but the last 4 hours of ever dose is not as painful as it was with the IR formulation. I wonder if I need a bump to 75 mg on the ER formulation to get the level of pain relief on I was used to on the IR formulation. I also take Hydrocodone 5/325 four times a day. I have been on these drugs for 7 years (albeit on lower doses) and I have a high stress sales job so slight modifications can make a high impact on my energy/ability to perform.

    David
    David
  • So the doctor basically doubled your immediate release dose into two extended release doses instead. Give it a few weeks before asking about a dosage increase. Most people when switching to an extended release medication need to adjust to the different delivery method. It is much smoother, less noticable onset of relief and that is why most PM doctors want a patient to give it a few weeks to see how it works for your pain levels.
    If , after a two weeks or so, you find that it's not working well to manage the pain levels, then it would be time to talk to the doctor about a small increase.
    Remember, less is more when it comes to managing long term pain since once it becomes chronic, it is not going to go away completely and we have to learn to cope with moderate pain relief rather than complete relief and not be overmedicated at the same time.
    Good luck David.
  • dmk005ddmk005 Posts: 3
    edited 11/04/2013 - 2:38 AM
    Sandi,

    Your point about balancing relief with over medication is one I have considered greatly over the years. I feel I have simply lost my ability to trust my comprehension of whether I am feeling injury pain or symptoms of withdrawal between doses. Over time, I have managed to reduce my pain meds from Nucynta IR - 100 mg QID plus Cymbalta plus Neurotin, plus Hydrocodone Apap. My only drugs left are Nucynta (50mg BID) and Hydrocodone Apap 5/325 QID. I underwent 4 surgeries on my dominant hand/wrist/elbow/forearm and countless back procedures leaving a double fusion off the table because the prognosis was questionable.

    My point is this: The drugs I am taking have me dependent on them to a point where I wish I could pause life long enough to try and live without them again in order to qualify my continued need for them. Your words have encouraged me to not give up and ask for more until I have fully adapted to the new formulation. If possible, I'd love to drop the Hydrocodone because the Nucynta ER is enough.
    David
  • What I have done over my years of dealing with chronic pain, is to discuss my options with my doctor and periodically, I have gone off all medications or even one at a time to see how I manage on my own , and it allows me to gauge where my pain levels really are at that point and time.
    Usually a month or two is enough , one to taper off whichever med it is that I want to try to decrease, and then a month to give my body time to acclimate to the lack of that particular med. Since I have done this several times over the years, my doctor knows me well enough to allow me to try and if I succeed, then we may not go back onto a med and if it doesn't work out so well, then we taper back up to a comfortable dose.....
    I wrote this some months ago to try to give an outline of the whole process in treating chronic back pain and it might be worthwhille to read....
    http://www.spine-health.com/forum/pain/chronic-pain/chronic-pain-treatment-step-step
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