Preventing opiate dependence (Nucynta) for chronic pain patients?

[ElleAZ]

Hello. About a year ago I had an enormous surgery that left me dependent on opiates and benzoes simultaneously. I went off both at great discomfort and have been using pot and motrin for the pain. I have neurological, orthopedic, and autoimmune diseases.

My new pain doctor feels that opiates are our only option because of the wide variety of issues. He gave me Nucynta. I am on the lowest rx of 50mg 2 x day. This med is effective in reducing pain, and features mood elevation and I want to use it. But I never want to go through w/d again. So I only take it 2 or 3 nights a week, just one pill, to sleep.

Can I potentially avoid dependence this way? Nucynta also works as an anti depressant so I am equally concerned about it hijacking my brain. I don't have depression.

I can't have these conversations with doctors or the pharmacist because they only know how to distribute. They were no help when I came off.

 

[T. Calderone]

I've never taken Nucynta, closest being Tramadol but I'm of the belief that if you shouldn't have to walk around in pain if you don't have to. If you're only taking one pill a couple times a week, I would say your risk of dependence is low. However, only you can say for sure if you will become dependent on this drug. I wish you luck!

 

[aspiringchemist]

I was prescribed tapentadol 50mg PRN for chronic pain. I took it for about 3 months. It felt very much like tramadol but with much more pronounced opioid effects. I don't tolerate the serotonergic effects of tramadol well and it was the same with tapentadol.

I hold the same belief as T. Calderone that people shouldn't have to walk around in pain. However I understand and respect the fear of developing dependency having been there many times myself.

With that said 50mg twice daily is a very low dose. Taken daily at this dose you are likely to develop a small dependency and subsequent withdrawal but my educated guess is that severity of withdrawl would be minor. Taken 2 or 3 nights a week you are highly unlikely to become dependent. Everyone is different though and you know yourself best.

Have you tried kratom? If you have access to this I would suggest giving it a try. I suffer from a variety of chronic illnesses and have found kratom to be rather effective in managing pain on a daily basis. I had a heavy opioid, ultimately heroin, habit for quite a few years so like I said I understand and respect the fear.

Good luck!

 

[Keif' Richards]

Hey there OP! So sorry to hear that you're dealing with the absolute bitch of post-surgical pain. I've been through a few surgeries myself from 4 severely impacted wisdom teeth to straight up reconstruction of my skull. I don't think she would mind if I said so, but T. Calderone also has a wealth of experience and knowledge regarding the treatment of post-surgical pain while also maintaining "philosophical" sobriety, that is, not using solely for the pleasurable effects of the drugs.

I was a Heroin addict for several years but got mostly clean years ago. Since, I have had a few surgeries and have had my pain treated with Hydromorphone 4mg Q4. Every time I would end up going through the prescription quick. I didn't return to Heroin, sure, but I definitely indulged in my medication and knew exactly what I was doing.

People here on the forums are often looking for fairly specific answers to issues that are really too esoteric to define verbally. We're dealing with emotions here. So, with that in mind, when one asks the question "how long until I develop a dependence/addiction?", they're asking a question that they are probably best at answering themselves.

Essentially, there will be a moment where you consider taking an extra pill because:

You had a hard day at work

Your girlfriend hates you

YOU DESERVE IT

When it comes time to make that certain decision, it's up to you whether you take it further or stay stationary at your current dose. The physical aspect of dependence is not as important as the psychological aspect of addiction. Typically, if you're willing to make that "one bad decision", statistically speaking, you're likely to progress through to complete dependence. I'm not saying it's a certainty, but what we know historically about addiction tells us that you're either all in or all out.

If you stick to this dose, you will be fine. Do not escalate dosage without the expressed approval of your provider. Continue to use Cannabis in conjunction with your Opioids. Cannabis has demonstrated great ability to produce analgesia synergistically with many Opioids. I hope this helps.

 

[ElleAZ]

Thank you very much. I have rapid tolerance to meds. It's likely genetic as both parents were alcoholics and my only sibling was addicted to heroin. So walking that line is my priority. Took 5 weeks to get hooked on those drugs and as long to come off. Then months of muscle spasms, nausea, teeth grinding, etc. We're all so different this way.