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    Please help me...
    An_245792 posted:
    Hi, I am a 32 year old woman with fibromyalgia As well as peripheral neuropathy. I have been on the Butrans pain patch for over a year, I also take Lyrica. I have Been on assorted pain pills over the past year to help Deal with my pain, such as Vicodin and Percocet. I Also tried opana ER but that did nothing. Now the dr has Prescribed nucynta ER 50 mg. I've read about the Interactions and side effects. I take lamictal & 120 mg Of cymbalta (for depression). Over the past 3 years, I've had Stomach problems that keep getting worse. Gastritis, GERD, gastroparesis, & Ibs. Shouldn't the dr have reviewed my history more carefully?
    KimberlyAnneJurns responded:
    I forgot to add, he said nucynta is so powerful @ 50x2, I could take Off my butrans patch (20 mcg, highest dose) right off With no withdrawal.
    Anon_160307 replied to KimberlyAnneJurns's response:
    With all of your GI issues, sticking to the Butrans patch was probably a better fit for you. I have not heard that Nucynta was that potent. The Butrans patch is a step down from Fentanyl in terms of strength. Issue is the patch contains Buprenephrine in a range of low doses. Suboxone/Subutex contains Buprenephrine in much higher doses but it is tailored more for the treatment of addiction.

    The Opana ER you were prescribed is the strongest pain medication in pill form based on pharmacology. The problem could have been the dose was not strong enough for you. Doses go up to 40 mg bid and some take it tid if determined necessary. What was your dose on Opana ER?

    Keep in mind, Opana ER has been reformulated with plastic binders so that they can't be crushed and snorted. Many are discovering the medicine isn't as effective as it was before alteration. So sticking with the Butrans patch or the Nucynta ER might be a safer route. However, some claim Opana ER is 1/2 as effective so perhaps taking 2x the dose of the new formula would equal the old formula and provide adequate analgesia??? This all depends on what dose you were on previously. If you were on the 40 mg tabs, your doctor would be very relunctant to double up on that high of a dose. And there is always a chance that it could be effective for you at a therapeutic dose that is comparable to the dosing that would have been therapeutic under the old formula. Unfortunately, some doctors that prescribe Opana ER like to prescribe it at 5 mg or 10 mg bid which is equal to approx. 10 mg or 20 mg bid of oxycodone, respectively. This is fine as long as they are open to titration once the initial adjustment period is over. Some doctors are not open to titration. Is this similar to your scenario?

    The fact that the Opana ER didn't cause you significant stomach distress, as you state you stopped taking it because it didn't work not because it was causing GI stress, is probably why the doctor thought Nucynta ER would be a good fit for you. Typically, patients with a lot of GI issues have to stick with only immediate release opioids and long acting meds in patch form. Some have ended up in the ER after ingesting just one Opana ER pill.

    I hope the Nucynta ER helps. Please let us know how it is working for you. I have read that its chemical makeup is similar to Tramadol but much stronger...similar in strength to morphine. Whereas, Tramadol is similar in strength to codeine.
    David Maine, MD responded:
    Thank you for your post. A careful history and exam are always important. The treatment of Fibromyalgia normally consist of patient education, specific medications, cardiovascular exercise, cognitive behavioral therapy (CBT) and other psychological therapies. These all been shown to results in some short and long term benefit. Opioids are typically not used for the treatment of pain from Fibromyalgia. In addition, with your GI issues - the role of opioids can be even more problematic. You should discuss all if the issues with your doctor. I hope that helps. Good luck.
    annette030 responded:
    The treatment of FMS is different for everyone. Also treating depression can be difficult. Do you have peripheral neuropathy due to diabetes or other reasons? If it is from diabetes, it may be very important to keep your blood sugars tightly regulated so it does not get worse.

    If you have gastroparesis, the pain meds that you take orally may not be getting absorbed properly. Do you take anything for that diagnosis at this time?

    I agree that all of these things require treatment, and opiates may or may not be part of a successful treatment plan. I have had great luck with cognitive behavioral therapy.

    Take care, Annette

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