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Nucynta and Methadone questions...
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TheBJP posted:
As pain goes, we all have different types, from neuropathic, to that from a defect (congenital or otherwise) or other issue. From what I've seen is that different medications work better for different people, and a good way to increase the chances of a successful outcome and proper treatment is to identify the kind of pain that is causing the issue.

Since Nucynta just came out, I was wondering more information. I didn't want to be my doctor's first patient on it when offering it to me, especially since they had cards for "free samples" or discounts once they prescribe it (to give to the pharmacy). People who have tried it, would you mind sharing with me any advice that comes from taking it? What were the decisions and reasons why it was taken and if it was effective for you?

The other question is about methadone as I have noticed its become more prevelant in the field of pain management and is losing the stigma of being a medicine to treat heroine abuse. Because of its 18 hour half life and other unique (or seemingly unique) ways of operating inside the body, is this a way to go for some pain that hasn't been really effectively treated through other medications? Can you take breakthrough medicines? Should someone be titrated on to either methadone or nucynta? Besides the neurontin/lyrica/cymbalta/TCA's, would either nucynta or methadone get results with long standing neuropathic pain as well as the pain thats eminates from the structural abnormality (which is usually effected by oxycodone, but leaving the neuropathic pain unphased)....

Thank you for your help everyone and if there are other resources that would be helpful on this, please feel free to share with me.

One last thing, I saw a study that had interested me because of the results it was talking about. I'll share the title as I'm not sure if you can post links here. I'm sure if you search for this study it could be found. I implore many to read it and see if theres any useful anifo to be extracted.


"Severe Chronic Pain is a Killer — Study Finds "
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meaningfulc1952 responded:
Hi, I can answer some questions you have about methadone. I am not familiar with the other med you mentioned. I have been taking methadone for about 6 yrs. now. At first, the dr. I had prescribed so little of the medicine, that it really did not help much. Then I changed to a shrink, and chronic pain dr. and he has been so helpful. He finally started me on 40mg. of methadone every 8 hours with Oxy IR 30mg. for breakthru pain. Also take 2 different muscle relaxants and lexapro. With this combo of meds, I have finally received adequate pain relief. I am not pain free by any means, just much more comfortable. I have chronic pain with my neck, headaches, jaw, and back. I would like to mention that at one time he prescribed lyrica for me and I gained weight immediately. I went from 125 lbs. to 166 lbs. I still have not been able to lose much weight. I need help with that too. Good luck with your meds. If you need to change drs., find another, but be careful because I think that with their sspecialty of pain management that they probably know each other maybe. meaningfulc
 
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charlie5454 responded:
i can add some info about methadone to go along with meaningful 1952. i have been taking it for 3 yrs. after a knee replacement that gave me nerve damage to my left foot. i started out taking 20 mg every 6 hours and oxocodone for b/t pain as needed. i was also put on lyrica which had no effect. after 6 months of the lyrica i started to get side affects of swelling in my feet so we stopped it. after about 14 months the methadone dose was increased as it was not working as well as it had when i first started it. at that time i went up to 30 mg every six hours and 10 mg before sleep. this worked well until just recently when i needed to increase it again this time 3 at night before sleep. as far as pain control the methadone is very effective treating my nerve pain. my concern is the increasing of the dosage.what happens in another 5 years? one other note, i gained 40 pds since using methadone. anyway i hope i added some helpful info and as pain free as can be. god bless,charlie
 
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TheBJP responded:
Thanks for your responses! I really appreciate the input. I would like to ask follow up questions if you don't mind answering them to help me make sure I pursue the correct path for the pain that I am experiencing.

First, I'm really surprised that nobody has commented on trying Nucynta. I went to the webpage and looked up some prescribing information on it which said it was a mu-opioid agonist as well as having affinity for norepinephrine (noradrenaline) receptors, too, which is supposedly gives an additional avenue of controlling the pain by effecting the person's mental status (as some antidepressents (SNRI's etc.) increase norepinphrine in the synaptic gap). I'm also aware that another pain medicine, Ultram/Tramadol, also has posted on their prescribing information about having a small affinity for norepinephrine receptors. To my understanding of the information I read, it appears that's where the similarities end. Especially since Nucynta is a Schedule II and Tramadol is not Scheduled (at least by the DEA, last I checked). FYI - Nucynta's chemical name is TAPENTADOL if anyone has heard of it under that name (I first saw it on clinicaltrials.gov so someone may recognize it).

So from what I am understanding from both responses is that methadone does work effectively for pain relief. That, while most opioids do not treat neuropathic pain from nerve damage or a pinched nerve, methadone is actually a medicine to consider for relief. Please correct me if I am misunderstanding - I have been told many different things about many different medicines by patients, doctors, pharmacists, etc. How long does the methadone usually last? From what was written I couldn't really gauge how long it took to work, if it effected any of the other medications listed (that you wrote you take), and also if you have had any issue getting medications after taking the methadone? My concern is that if I try this and it doesn't work, then I won't be able to try other medications as PM dr's are notorious for finding excuses (lying about what they can or can't do, what they will or won't do, and I appreciated that my past two doctors didn't do this to me, especially as I have prosthetics in my back).. I have heard horror stories from people who said it was hard to get off of methadone, but they were given nothing else. They were moving or other scenerio where they weren't sure where their next prescription was going to come from so they asked to be taken off the methadone to avoid withdrawal during moving, but it was "a nightmare" I was told. I suspected it was due to the long half life. I'm really just trying to gather the most information to make a well informed decision as we all know: one mistake, either forgetting a dose or missing medicine, can have a ripple effect for hours and days of pain later.

Did anyone check out that article I put a link to? I didn't want to state it was 100% what I believe, but I do think they are right about the fact that if you are in chronic pain, there will be a statistically shorter life-span. Many in chronic pain are because its a symptom of something bigger (ie cancer or degenerative disease like ALS), but also because this world is not made for those with neurological pain, physical limitations, and .... I think the point is made. -- if you didn't get to read the study, please check it out and tell me what you think as the idea behind it is of major importance to most of us here.

I was also talked to about a SCS. I figure the trial should be enough to see if it works. I was hoping to get direction, knowing where I will be in 3, 6, 12 months, confident that I will have relief (don't really care the method at this point, as long as it doesn't shorten my lifespan or endanger anybody).. It seems that almost every time you leave the dr's, you get a new dx, new tx plan, and new reasons, with only a chance of getting the relief, even tho they're specialists for treating a symptom, not a disease.
 
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annette030 replied to TheBJP's response:
I am not sure where all you have gotten your info up to now. Methadone and other opioids are commonly used for all kinds of pain including neuropathic pain. I have read in one or two sources that methadone may have a slight edge on other opioids for treating neuropathic pain, but not to the point that the others do not work at all. As a nurse, I have given all kinds of opioids to patients with many kinds of pain with varying response.

In my personal experience methadone works for both neurologic pain and pain caused by other problems. My husband took it for hip pain while he was waiting for a hip replacement surgery due to another medical problem. I now take it for pain related to a neurological problem. I used to take morphine and switched due to financial reasons with my insurance company. Both drugs work fine for me.

Methadone worked well for my husband and he tapered off without any problem at all after he had the hip replaced. No withdrawals at all. This was also my experience when I worked many years ago in a heroin treatment facility where we used methadone as one treatment.

Methadone has a half life of 8-59 hours according to my drug manual for nurses, by the way. Much more than you mentioned in your post above for most people. Some people take methadone every 12 hours for chronic pain, some every 8 hours, depends on their response. During the initial period of use the dosing may be different than once they have adjusted to it. The dose may be lowered after 3-5 days to avoid CNS changes as the drug accumulates in the system with time due to the long half life of the drug.

This drug is more complicated to dose than the other opiates due to the long half life. I would see a doctor who has a lot of experience prescribing it.

I read the article you provided a link to. I am not sure I agree entirely. It was an interesting read. Thanks for posting the link.

Take care, Annette
 
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TheBJP replied to annette030's response:
Annette,

You wrote: "I am not sure where all you have gotten your info up to now."

Here is an example of where I have gotten some of my info. I picked a webmd site to avoid dispute.
"Unfortunately, neuropathic pain often responds poorly to standard pain treatments " - http://www.webmd.com/pain-management/guide/neuropathic-pain

I have read what you have written quite often on this site. If you would like to know, I get much of my information from experts in the field, top doctors (chief surgeons, professors, as well as fellow doctors invovled in published, peer-reviewed studies who have received extensive work in pain managment with mutliple post-doctorate degrees, from engaging in fellowship programs, board certifications in neurology, neurosurgery, orthopaedics, anesthesiology, rehabilitative medicine, physiatry, psychosomatic disorders, cognitive behavioral therapy, psychiatry, and psychology).

Where I live has had a growth of various medical establishments and has been the site of many medical discoveries. I spend a great deal of time reading journals and being on top of developments. My assessment from everything I've read, consicely, is that everybody is different in regards to the tx of pain. I do my part, I try to at least, spend time with my fellow pain suffers, accompanying to dr's appointments, and sharing my knowledge with those who don't have the time or ability to understand all the medical information. Off hand, I have counted 4-5 times where there were potentially, very serious contraindications that were missed by dr's and pharmacists in treatment of myself and other people. From a (I believe it was either a nurse (not sure if a technical RN) or PA or what) who said to mix cimetidine with naproxen which can cause the H2 receptor antagonist to facilitate lower intestine of release of naproxen which can lead to unwanted results, to complete ignorance by a professional who prescribed drugs that impacted the renal state of a seriously ill person (as they claimed it wouldn't yet the rx maker posted this issue on their medication's homepage!).

I have a late uncle, blessed be his memory, who had stage 4 cancer and when refilling his vicodin prescription, the DEA visited his dr, his pharmacy, and this raised some eyebrows. He was lucky in that he had connections, found the head special agent for his district, and with some language (not for use here) in regards to interfering his treatment and quality of life, got the federal govt away from the professionals who works so hard to keep him alive. I can't find a way to see this is necessary or right.

I am probably like many others reading this board. I have been a pain patient for a considerable time, limited improvement, multiple procedures (from 6 hours of surgery to multiple injections), tried chiropractic/accupuncture/PT/TENS and other modalities. What has me upset, to be honest, is that regardless of the kind of pain, the sufferer's condition, or the desired result, is the gravity of preconcieved notions which unexpectedly or undesireably effect the quality of life. Many, if not most, of the pain patients who visit this site, are taking drugs on the DEA schedule list (whether IV or II). Families get torn apart, people confuse use with abuse, and the cycle repeats with no LONG TERM benefit reached for the patient. This is very disturbing.

Personally, I would like to see the most effective tx's with the most effective results for each person followed, regardless of how the DEA would look at it. If methadone, morphine, oxycodone, or other medications are necessary to ensure that a trip to get groceries, a sandwich, or going to the dr is not an experience that gives a glimpse of the agony expected in hell, then I must say to those dr's that suspect the DEA is right behind you: "stop practicing and refer your patients to someone who can really help restore their lives, giving them the dignitiy and honor you would want for yourself."
 
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BrenBren30813 responded:
Hey there, thanks for posting this link. I bookmarked the site for future visits as well. I think Charles had posted this link too, or at least an article similar - check under tips or resources - ok, just checked it out and he did post the exact same article. Charles is a member who actually helped me. He would give very well-founded advice based on research and his lifetime of experiences in dealing with chronic pain...he knows so muck about the benefits/drawbacks of many different med's. Look out for him, as he visits from time to time: "CWEINBL" is his screen name. He is quite the scientist with such soft empathy - I miss seeing him on here.

You remind me a lot of him. You're very wise in the amount of research you do before taking on a new medication. I would advise you, as an amateur (me), to not switch your medications before receiving your SCS trial. This could interfere with your comfort level and abilities to actually detect the effects the stimulator has on you; plus, if you are thinking of switching to methadone and pursue the trial, you are putting yourself at risk for experiencing discomfort (aka minor withdrawls) when they taper you off very rapidly to see if that implant is going to work. I recently had a pain eval to see if I was a candidate for the SCS and the psychiatrist said, the doc that does the implants in his facility weens patients off all meds, and does the trial without prescribing any opiates....I would be more concerned about the doc's method right now if that is what you are looking into in the near future. Don't worry about the methadone for now, or at least that's what I would do.

Like I said, I am an amateur in this pain management stuff, but I love to learn about everyone's condition who visits this board, just so I can offer comfort and understand what each person is going through. It's a great place filled with all kinds of chronic pain sufferers, whom will most likely reach out to you than reject you.

So, welcom to the board! Please hang out for a while and offer more input, we could definately use it. Take good care and keep researching, B
 
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annette030 replied to TheBJP's response:
I did not mean to make you feel defensive. I just wondered where you got your info, that is all. We all come from a different background.

The article you posted a link to discussed the general treatment of neuropathic pain. They mentioned using drugs like morphine for neuropathic pain. I discussed that at the beginning of my post to you, the rest was my personal experience with methadone.

I personally rarely go to WebMD for research information, I tend to use Medscape. I found an error at WebMD some years ago regarding basilar migraine treatment, and emailed them. They admitted the error, but said they could not change it because they were under contract with the author.

They give good general information for the most part, but I prefer evidence based studies with a bit more information.

I live in Oregon, previously in NV, and Calif. I never felt the DEA was right behind my doctors, nor did they. Here in Oregon we have guidelines for the doctors to follow for prescribing opiates to chronic pain patients, and as long as they do, the doctors I have spoken to, have told me they do not feel under a microscope. I have never had any real difficulty in getting the treatment I need for my pain.

You and I have different experiences, but I feel both are valuable.

Take care, Annette
 
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greg8846 responded:
Hi BJP;

Well as far as Nucynta goes it a okay pain medication and as far as it goes with Methadone just because it has that stigma it still a good drug to help control pain. I also feel that Methadone has been give a very bad name over the past several years people look on it as a horrible drug and only drug addicts should be using it. You know what is really funny some of our famous and rich people have used Heroin for years and rather use it versus getting into to a treatment program. And yes i do believe that Severe Chronic Pain will cause for a early death, even if it is treated there are still under lying problems that must be dealth with as Coronary damage that is done. Hard to control blood pressure. And a whole laundry list of other problems. Well good luck on your voyeage. I wish you well.

Greg Armstrong
 
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greg8846 responded:
Hey BJP;

I hope you plan on sticking around for awhile i enjoyed the sites and i thought they were very informartive. Thank you and God Bless you.

Greg
 
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SweetRandi replied to greg8846's response:
HI BJP:
I am in the exact same place you were in 4 months ago. I need to decide to either try the nucynta or methadone. I have a nicked spinal nerve that has caused me intense pain for close to a decade. I have not done well on the Nurontin , lyrica, type medications due to terrbile constipation. I am leaving my state in a year..and my Pain Doctor and my Hepatis Doctor will both speak to my new Doctor out of state..BUT..I am afraid..I feel alone..and don't know what to do. I am not or have never been a drug addict..I got Hepatitis C from a blood transfusion with my older daughter..before there was hepatitis C..My liver is good and I am able to go on anything that will work..But I am on 8 vicoin..10/500 and it is OK..not great..so I am curious what you decided to do..and how it is working out for you.I am widowed and am re-marrying..thus the move..I wonder what the doses of each you are on...that can bring me my LIFE back. Thank you with all my heart.
Fondly and with much gratitude!
 
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SweetRandi replied to TheBJP's response:
Hi BJP,
This is my first time on this site and I made a mistake but my question to you is the last post. I would so appreciate it if you would read it and get back to me..Thank you so very much!
 
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bren_bren replied to SweetRandi's response:
Hello there SweetRandi,
I wanted to drop in and let you know something (since you're "sweet" and all). Don't be alarmed if these folks you directed your posts towards don't respond; since they posted, originally, 4 months ago.

It can be confusing to a newcomer when the "most popular" discussions are blaring right at you and the titles mesh with what's going on with you...anyways, welcome to the pain management board; hope to see you around more often. Let us know if we (older typers) can do anything to help you navigate this exchange a little easier in the future!

Take great care of yourself, B
 
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Andytara replied to bren_bren's response:
Nucynta, Valium and neurontin are working for me. They work on nerves not pain. Next step is to have a tens unit permanently installed in the epidural area with a battery install on my bum for replacement when it runs out. Tens works for me so I am looking forward to this procedure. Basically get the doctor working on nerve therapy not pain therapy
 
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Kelly_30 replied to Andytara's response:
Finally another chronic pain patient that takes valium for relief! I am no longer singled out and alone.

Kelly
Living one day at a time.


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