Opioids Tapentadol / Palexia / Nucynta - Chronic Nerve Pain Management

[Rybee]

Has anyone taken Tapentadol (AKA Palexia/Nucynta) for chronic nerve pain?

I'm currently taking MS Contin, Oxycodone and Dosulepin for chronic nerve pain management and my pain consultant wants to shift taper off the MS Contin and Oxycodone and move onto Tapentadol and increase the Dosulepin as a long-term solution.

To be honest it's a fairly new medication and I've never really heard anything about it.

If anyone's taken it, I'd love to hear about your experience on it.

Thanks,

 

[ErgicMergic]

Yes, I have been prescribed the 100mg IR 3-4 times daily since 2011, but the script has been on-and-off since then, only 9 months of daily usage since 2011.

Tapentadol is basically O-Desmethyltramadol, look at both chemical structures and you will see they are almost identical. I would not abuse this medication, as the side effects from the NMDA antagonism and NRI properties become very apparent and dissociatively scary when taking more than 200mg.

It is a much better medication for nerve pain compared to traditional opioids such as morphine and oxycodone, but since most of my pain is muscoskeletal, I always found myself switching back to hydrocodone, Kratom, Poppy Seed Tea, or Buprenorphine.

So, to recap, it is a very effective medication for nerve pain, do not abuse it due to the unknown and subjectively scary experiences that come from taking too much NRI/NMDA-antagonistic-based drugs, is almost identical to O-Desmethyltramadol, and 100mg Tapentadol = 30mg hydrocodone = 20mg oxycodone.

 

[Rybee]

Yes, I have been prescribed the 100mg IR 3-4 times daily since 2011, but the script has been on-and-off since then, only 9 months of daily usage since 2011.

Tapentadol is basically O-Desmethyltramadol, look at both chemical structures and you will see they are almost identical. I would not abuse this medication, as the side effects from the NMDA antagonism and NRI properties become very apparent and dissociatively scary when taking more than 200mg.

It is a much better medication for nerve pain compared to traditional opioids such as morphine and oxycodone, but since most of my pain is muscoskeletal, I always found myself switching back to hydrocodone, Kratom, Poppy Seed Tea, or Buprenorphine.

So, to recap, it is a very effective medication for nerve pain, do not abuse it due to the unknown and subjectively scary experiences that come from taking too much NRI/NMDA-antagonistic-based drugs, is almost identical to O-Desmethyltramadol, and 100mg Tapentadol = 30mg hydrocodone = 20mg oxycodone.

Thanks for taking the time to reply, really appreciate it. That kind of echo's the positives I've heard about it.

I've just not responded well to Morphine, Methdone, Fentanyl or Oxycodone so Tapentadol was thrown up as a suggestion to tackle the issue from a different angle. I've literally no intent of abusing it, I just need to reduce the pain that I'm in and on paper it sounds like it'll do a good job. From what I've read about the facts of it, it doesn't have that much abuse potential? Compared to 'traditional' opiates/opioids like Morphine/Oxycodone/Fentanyl etc...

My pain doc said it was similar to Tramadol, which I always favoured over the other weaker opiates like Codeine/DHC so that sounds promising.

I got the impression that I would take the Dosulepin and Tapentadol daily, but the more I read about it, the more I read that it's commonly used for breakthrough pain in the instant release tablets. May I ask whether you treated it as a daily painkiller, like MS Contin, or just for breakthrough?

I have given up with the common opiates so when it was suggested it perked me up a bit, I kind of feel my pain was a lost cause until I discovered this.

 

[Numb19]

My dr prescribed them to me as a way to try something different and milder than oxycodone/percocet.

They didn't do a whole lot and I personally did not like them as they made me feel weird and spaced out, though it did improve my mood a little bit. And that's the other issue, if my issue is pain, then why would I want to take something with anti-depressant properties. If I am dealing with a pain and a nerve issue then I would rather not artificially play with my brain's serotonin levels if not needed for my condition.

 

[Rybee]

My dr prescribed them to me as a way to try something different and milder than oxycodone/percocet.

They didn't do a whole lot and I personally did not like them as they made me feel weird and spaced out, though it did improve my mood a little bit. And that's the other issue, if my issue is pain, then why would I want to take something with anti-depressant properties. If I am dealing with a pain and a nerve issue then I would rather not artificially play with my brain's serotonin levels if not needed for my condition.

Thanks for your reply, I really appreciate it.

This part worries me, I've had a history of chronic unipolar depression. I've seen a new clinical psychiatrist since last July and he's worked his magic and I've been very upbeat since November with little-to-no signs of depression. I threw him an email earlier asking for his advice on how the Tapentadol may affect my current stability and am just waiting for a reply before I next see him.

I'm just worried that it's going to upset my neurotransmitters and trip me back into a state of depression.

 

[Rybee]

Just bumped my Dosulepin, (think you guys call it Dothiepin or Prothiaden in the US?) up another 25mg to 75mg which I realise is still quite a small dose but bloody hell it's knocked me sideways, just feel completely exhausted 24/7. I had the same situation with Amitriptyline many years ago so I was kinda expecting it.

I do realise it'll take a while to properly kick in but ouch, still in a lot of pain. Been hesitant to reach for the Oxycodone or oral Morphine but gave in tonight. Seeing the pain doc shortly and I think trying Tapentadol is going to be inevitable at this rate.

Would still love to hear from more people who've taken it? I realise it's a novel opioid, (hell I don't even know if it's truly classed as an opioid?) and am trying to get a better understanding as to how it compares with Oxycodone and Morphine? So if anyone has any experience as to how equipotent it is with either, I'd really like to hear from you.

When first suggesting it to me, my anaesthetist/algiatrist said it was 'a very new drug that's had brilliant results in the treatment of lower back pain, being a norepinephrine re-uptake inhibitor with a tiny amount of opioid action in it' - but from what I read, it seems to have more opioid action in it than he initially gave away?

Also, just out of curiosity, what's it's abuse potential? Everywhere online says it's quite low and not always a nice experience. I imagine it to be similar to Tramadol which I used to love, actually.

 

[Rybee]

buump would like to hear more stories on tapentadol/nucynta x

 

[Lorne???]

^ I can't give you any stories about either of them, but I strongly advise you to at least keep oxycodone for breakthrough. They're are a lot of reasons, but mainly your gonna want to keep a "classical opioid" around.

Tapentadol is an opioid, don't let anyone tell you differently. It was made to mimic O-desmethyltramadol without requiring metabolic activation.
It's primary mode of action is Mu agonism, and if I'm not mistaken it's highly Mu selective, just like tramadol/desmethyltramadol.

I believe it's a little less potent than M1 in terms of binding affinity(in fact I know it is) but should give roughly similar effect.

If you liked tramadol, you'll like this, though it's not as effective an anti-depressant in it's own right, as it's more like M1 than tramadol itself. In the end, you'll have to try it and see.

Sorry, haven't noticed this thread until now.

(M1=desmethyltramadol )

 

[Rybee]

^ I can't give you any stories about either of them, but I strongly advise you to at least keep oxycodone for breakthrough. They're are a lot of reasons, but mainly your gonna want to keep a "classical opioid" around.

Tapentadol is an opioid, don't let anyone tell you differently. It was made to mimic O-desmethyltramadol without requiring metabolic activation.
It's primary mode of action is Mu agonism, and if I'm not mistaken it's highly Mu selective, just like tramadol/desmethyltramadol.

I believe it's a little less potent than M1 in terms of binding affinity(in fact I know it is) but should give roughly similar effect.

If you liked tramadol, you'll like this, though it's not as effective an anti-depressant in it's own right, as it's more like M1 than tramadol itself. In the end, you'll have to try it and see.

Sorry, haven't noticed this thread until now.

(M1=desmethyltramadol )

Thanks Lorne, the problem is my pain doc wants me completely off of all 'opiates' MS Contin/Oxycodone (Tapentadol excluded)... and I know when I ask for another script of Oxycodone he's going to say no. T

he only reason I would be genuinely requesting it, even in a small amount is because:
A - the Dosulepin I'm taking doesn't seem to have helped with pain.
B - I'm worried the Tapentadol wont work as effective as the Oxycodone currently does. Thus I'll be left in a lot of pain until I see him again.

Thanks for the info - I've read a lot about it being similar to Tramadol, which I've always liked in the past.

I think I'm just going to have to beg him for an Oxy script, even if it's just for a few backup pills.

 

[xtcgrrrl]

I have an appointment with a new neurosurgeon soon, one my FIL picked out because he thinks all the doctors in Brooklyn are crap. Well, I'm not giving up my Brooklyn doctors, but hopefully this new doctor can make my FIL see that I'm in tons of pain, especially in the mornings when I wake up (I've trained myself not to sleep on my stomach, I wake up in excruciating pain, but sleeping on my back doesn't seem to be any better.) my FIL is going to trash me to this new doctor, say that I'm an addict, that I'm a worthless piece of crap, etcetera. But if I ask for Tapentadol that doesn't sound like addict behavior at all. I'll tell him that I don't care what he gives me, as long as the pain goes away. Which it almost never does. If I take a large dose of oxy I might be ok for a few hours then back to status quo.

Not to mention that I might have fibro or Lyme disease or some such thing. All the muscles and joints in my body ache. I have an appointment with a rheumatologist on June 9th. Hope we can figure out what this is! My knees are almost as bad as my back now!

 

[Rybee]

I have an appointment with a new neurosurgeon soon, one my FIL picked out because he thinks all the doctors in Brooklyn are crap. Well, I'm not giving up my Brooklyn doctors, but hopefully this new doctor can make my FIL see that I'm in tons of pain, especially in the mornings when I wake up (I've trained myself not to sleep on my stomach, I wake up in excruciating pain, but sleeping on my back doesn't seem to be any better.) my FIL is going to trash me to this new doctor, say that I'm an addict, that I'm a worthless piece of crap, etcetera. But if I ask for Tapentadol that doesn't sound like addict behavior at all. I'll tell him that I don't care what he gives me, as long as the pain goes away. Which it almost never does. If I take a large dose of oxy I might be ok for a few hours then back to status quo.

Not to mention that I might have fibro or Lyme disease or some such thing. All the muscles and joints in my body ache. I have an appointment with a rheumatologist on June 9th. Hope we can figure out what this is! My knees are almost as bad as my back now!

Hey xtcgrrrl!

Thanks for taking the time to reply. Never spoke to you on here but I do follow your posts in the pain management mega thread so I know you can definitely relate to the pain that I'm in... So hi!

What's a 'FIL' by the way!? You've confused me from the off!?

Apart from opiates, do you take anything like TCAs/SSRIs/SNRIs/Pregabalin/Gabapentin for your pain?

I have a history of depression and would not touch SSRIs/SNRIs again with a bargepole. I also don't tolerate Gabapentin/Pregabalin well, even at low doses.

I'm currently taking Dosulepin/Dothiepin, which I was very hesitant to try, and the side effects are awful, I feel like absolute shit every day. I'm sticking on in there to hope that they wear off but I'm really struggling. Massive lethargy/fatigue and weirdly enough a feeling of slight amnesia. My memory is awful, I really have to think hard about what I was doing, where I was, who I was with 2/3 days ago... It's a little bit worrisome.


Also, I can't find a definitive answer to this.... At the moment I can take as much MS Contin/Oral Morphine/Oxycodone as I can handle until it reduces my pain, without too much risk of overdose/side effects. I always found Tramadol effective for pain relief but once my tolerance grow, 400mg just didn't cut it anymore and I was scared to take more than 400mg in case I risked a seizure. Even at 400mg I always took just 5mg of Diazepam 60 minutes before to raise the threshold... Just paranoia I guess.

So basically, since Tapentadol is based on Tramadol, is there a risk of seizure at higher doses? At the moment 40mg Oxycodone will kill my pain, and is quite a safe dose to take. I'm just worried that Tapentadol will have a limit on it that I couldn't take more than. The reviews of Tapentadol seem very welcoming so I'm quite eager to try it.

 

[Gurl]

FIL = Father-in-Law