Do any of you have any thoughts on using Nucynta for a limited period of time in patients with a history of substance abuse? I have not heard of it having any street value, or of people become addicted to it. But then, it is a new drug. Look how long it took for cases of tramadol abuse to become known. It is DEA level 2 in Arizona. Since it has limited euphoric effects I am reasonong it would be useful for patients in need of acute pain management. I would appreciate any input
Nucynta and substance abuse
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I would probably provide Tramadol before Nucynta for cost reasons and b/c most pts who strike me as seekers want nothing to do with tramadol.
I have seen positive anecdotes on here regarding Nucynta but use it little myself.
What kind of acute pain are we talking about?
I have seen positive anecdotes on here regarding Nucynta but use it little myself.
What kind of acute pain are we talking about?
People with acute pain such as post radiofrequency pain or an exacerbation of existing sciatica. I am afraid to give these folks even a few weeks of hydro or oxy codone because of their history. I can think of one in particular. Tramodol does nothing but she likes Nucynta. I don't know if I'm being played. Thats why I was wondering if any of you folks have seen substance abuse with this
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post-RF pain=NSAID x 3-7 days
sciatic pain=non-opioid for my pts, anticonvuls or antidepress
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Opiates are opiates. Mu binding affinity is 1/50 that of MSO4 in published data and 1/18 in unpublished data. Analgesia with Nucynta is partially opiate based on partially SNRI based. Addicts will abuse Nucynta. It is not the drug but the person you need to worry about.
Acute pain is not chronic pain and the two are so far apart as far as treatment algorithms and risk strategies. If a known heroin addict come in with a pelvic fracture from MVA- I think a PCA of MSO4 is reasonable and 1 week of Percocet or Lortab or Dilaudid or Nucynta or MSO4 is quite reasonable regardless of the chronic substance abuse problem. It just means that when the week (or two) is up, that the Rx stops. When the heroin addict comes in for his chronic low back pain and he just took the last pill from the other guy- it is not the same thing and the treatment is one of due diligence and addiction referral, but no Rx.
My concern is pain docs discussing this in an open forum and the complete failure of training for not making this easy breezy and something we all know and get. My training prepared me for this but not for the acute pain side (hospital stuff- regional, PCA).
It always comed down to needing ur own residency and wrestling away training from academic a-holes who exist to do bench research (good) and protect their turf for $$$ for the department.
Can't we ever do anything as a specialty for the good of the future patients?
Acute pain is not chronic pain and the two are so far apart as far as treatment algorithms and risk strategies. If a known heroin addict come in with a pelvic fracture from MVA- I think a PCA of MSO4 is reasonable and 1 week of Percocet or Lortab or Dilaudid or Nucynta or MSO4 is quite reasonable regardless of the chronic substance abuse problem. It just means that when the week (or two) is up, that the Rx stops. When the heroin addict comes in for his chronic low back pain and he just took the last pill from the other guy- it is not the same thing and the treatment is one of due diligence and addiction referral, but no Rx.
My concern is pain docs discussing this in an open forum and the complete failure of training for not making this easy breezy and something we all know and get. My training prepared me for this but not for the acute pain side (hospital stuff- regional, PCA).
It always comed down to needing ur own residency and wrestling away training from academic a-holes who exist to do bench research (good) and protect their turf for $$$ for the department.
Can't we ever do anything as a specialty for the good of the future patients?
Agree with steve. It is not the drug..it is the individual and individuals will abuse anything with even 1/1000 binding affinity to the mu receptor. Nucynta doesnt have a track record for abuse yet but it is new. There is nothing that I know about the drug that makes make feel that it is immune to abuse. And for all of you folks that use tramadol in your high risk patients, you need to be aware that it has a high abuse potential. I have seen several patients and several MD's that have had serious problems with tramadol. In addition the abusers seize off of it as well. It makes no sense to me why you would give tramadol in a patient that you were reluctant to give hydrocodone to.
The heroin addict with a hip fracture MUST be treated for pain. Of course you will keep a close eye on them but you must treat them.
Hello all. I am new to the forum. I actually saw this post and wanted to be able to respond, so I signed up. I know I am a little late to the party, but your discussion piqued my interest. FYI: I am neither a doctor, nor am I a medical student. I am simply a 30 year old female suffering from Fibromyalgia and I thought perhaps you could use a patients point of view.
I am currently seeing a pain management doctor every few months. When I went to him at the advice of my rheumatologist, he told me about Nucynta and asked if I would be opposed to trying it. I had no qualms about it. If he felt there was a good chance it would work, I was all in. However, I of course went home and researched the hell out of it before I even filled the prescription. I need to know what I am putting in my body and how it works; or should work. Nucynta appealed to me because of the lesser side effects of other opiate agonists. While I was in serious need of pain relief; narcotics still made me a little nervous.
As far as I am concerned, between the Cymbalta and the Nucynta, I have my life somewhat back. I only take the Nucynta when I have an attack; as they do still have some side effects. I love the fact that they do not impair me like most of the other medications did; and it does a perfectly good job of keeping my pain under control when my FM rears its ugly, inconvenient head. That is a HUGE plus for me because I have a job and a new husband and I NEED to be able to function normally. The last few weeks have been difficult for me and I have used them more than I normally do. I have 50mg pills and can take 2 at a time if the pain is that bad; though I cannot take more than 4 in one day.
The Tramadol did not work for me AT ALL, but the Nucynta is like a gift from God. I can tell you that with the increase over the last few weeks, my only real complaint is constipation. I have been taking it for approximately 8 or 9 months as needed, and I see no decrease in its effects. I have read much about it and other patient's opinions and experiences: they are varied. A friend of mine who also suffers from FM tried it as well. She did not like it at all. When I asked her why, she proceeded to tell me that to her, "it felt like a DIRTY high", though I was not 100% sure as to what she meant at the time. My response to her was, "I'm not taking it to get high. I am taking it to make my pain go away": and that exactly what it does for me. She has since started taking percocet, and for her, I guess it works. My fear was that since there is no cure for FM, I would exhaust all my options because of tolerance and wind up a 50 year old drug addict. Not having to continually increase the dosage is nice, and I do not get "high": I can still function. My thought processes DO noticeably slow down when I take 2; but not nearly as much as it does when I was on other medications.
I know it is expensive, but for myself, it is 150% worth it. My doctor has discount cards so I often don't pay more than $20 for it. Any prescription can be abused; but I am in agreement with those who posted prior to me: its the individual who causes the problem, not the medication. I noticed that people who shy away from trying it, often seem to be the ones doing it for the "high". I don't know if all this helped in any way, but thats my little story about Nucynta; and now its time for bed. Good night all!
I am currently seeing a pain management doctor every few months. When I went to him at the advice of my rheumatologist, he told me about Nucynta and asked if I would be opposed to trying it. I had no qualms about it. If he felt there was a good chance it would work, I was all in. However, I of course went home and researched the hell out of it before I even filled the prescription. I need to know what I am putting in my body and how it works; or should work. Nucynta appealed to me because of the lesser side effects of other opiate agonists. While I was in serious need of pain relief; narcotics still made me a little nervous.
As far as I am concerned, between the Cymbalta and the Nucynta, I have my life somewhat back. I only take the Nucynta when I have an attack; as they do still have some side effects. I love the fact that they do not impair me like most of the other medications did; and it does a perfectly good job of keeping my pain under control when my FM rears its ugly, inconvenient head. That is a HUGE plus for me because I have a job and a new husband and I NEED to be able to function normally. The last few weeks have been difficult for me and I have used them more than I normally do. I have 50mg pills and can take 2 at a time if the pain is that bad; though I cannot take more than 4 in one day.
The Tramadol did not work for me AT ALL, but the Nucynta is like a gift from God. I can tell you that with the increase over the last few weeks, my only real complaint is constipation. I have been taking it for approximately 8 or 9 months as needed, and I see no decrease in its effects. I have read much about it and other patient's opinions and experiences: they are varied. A friend of mine who also suffers from FM tried it as well. She did not like it at all. When I asked her why, she proceeded to tell me that to her, "it felt like a DIRTY high", though I was not 100% sure as to what she meant at the time. My response to her was, "I'm not taking it to get high. I am taking it to make my pain go away": and that exactly what it does for me. She has since started taking percocet, and for her, I guess it works. My fear was that since there is no cure for FM, I would exhaust all my options because of tolerance and wind up a 50 year old drug addict. Not having to continually increase the dosage is nice, and I do not get "high": I can still function. My thought processes DO noticeably slow down when I take 2; but not nearly as much as it does when I was on other medications.
I know it is expensive, but for myself, it is 150% worth it. My doctor has discount cards so I often don't pay more than $20 for it. Any prescription can be abused; but I am in agreement with those who posted prior to me: its the individual who causes the problem, not the medication. I noticed that people who shy away from trying it, often seem to be the ones doing it for the "high". I don't know if all this helped in any way, but thats my little story about Nucynta; and now its time for bed. Good night all!
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Your post was not offensive, it is just that these forums are for medical professionals. I appreciate your perspective and you stated your case very well. Please understand that these forums are not designed for patient/physician interactions. Good luck to you.
History of drug abuse doesn't always mean that your patient will abuse the meds you RX. There is drug abuse and there is drug abuse with "drug seeking behivour". Some GAD patients get RXed GABAergics and they get hooked on but they can manage to stay on the RXed dose for years. Sure we can call this "history of drug (ab)use" but those people actually aren't looking for a high, they simply get addicted and can't get off. People who have drug seeking behivour can abuse anything you can think. I've seen patients abusing buspirone just becuz they heard "it's a benzodiazepine-like med" from their friends😱
