hey everyone. I have medial nerve branch chronic pain from a crushed L5 (prior military) and I've been on Nucynta 75mgs for over 2 years now. I had 2 temporal opioid rotations, as after about 10 months to a year, the tolerance does finally begin to build.
With that being said, I have quite a wealth of personal experience, and me and my doctor agree that despite some cons, the pros WELL outweigh the cons.
Its 100 percent true that the disassociative mental effects do happen at 150mgs.......even after a few months into treatment, though not as severe. That's my breakthrough pain dosing, and I will try to get by with a 3rd extra of a pill vs 2 full ones because the mental effects seem to drastically above 100 mgs (even between 75 and 100mgs you can notice a difference). With that being said for moderately severe pain, 75mgs will make it fairly tolerable, apx 100mgs will squash over 2 hours and at 150mgs, it will bring my pain down to zero in about 60-90 minutes.
I'm also prescribed a low dose of adderall for ADHD (only 5mgs 1 or 2x a day). At that low dose, the medication complement each other. However, I've had what felt like mild seratonin syndrome a few times after taking the second 5mg adderall and a breakthrough dosing amount of Nucynta. Its is NOT a fun experience. You will get the sweats, naseau, anxiety, auditory halucination, mild but noticable perceptive visual abnormalities, and STRONG vivid closed eye visuals that are hard to explain.
Again, at 75mgs and my normal split dosing of 5 mg adderall, I have VERY few issues. It seems there's a thin line between theraputic and theraputic with not so cool side effects with this medication.
The LACK of tolerance building with this medication is exceptional!! It seems to build tolerance at about 1/3rd the rate hydrocodone does (personal opinion). On the potency scale, I'd say 1 75mg Nucynta is roughly equal to 20mgs of hydrocodone and 10mgs of oxycodone in terms of pain relief. It does have some euphoric effects, and its addiction risk is probably best assessed as a C-III, not C-II as this stuff certainly doesn't have the same potential as oxycodone or hydromorphone but I would say it has more of a risk of abuse than tramadol does. Overall its not that recreational.....which is a good thing for us pain patients since everything else has been demonized.
For those in chronic pain looking for a lower risk medication that can still get the job done, its worth a try
Its NRI effects are fairly potent and its Mu effects are certainly an upgrade from its predecessor. It lasts for about 5 to 6 hours of relief. The original study had considered it to be about 1/3rd as potent as oral morphine.....and perhaps for nerve pain, that evaluation is correct. Its very effective for nerve pain and works better than hydrocodone for that purpose.
Its also worth noting the gastro effects are less than most opioids. Less stomach irritation and constipation, though the latter occurs sometimes. Its more stimulating than most opioids so becareful taking it just before bed. Also, it WILL dehydrate you, so take it with atleast 2-3 full glasses of water.
I hope this helps
