Experience with Tapentadol (Nucynta) for pain management?

[StreuB1]

As the title states.

Wondering if anyone out there has any experience with Tapentadol, which goes by the brand name Nucynta, for pain management, chronic or otherwise?

This is for myself. I am enrolled in a pain management program for my lower back. I have degenerative disc disease and am in the phase where I am nearing the end of my ability to continue epidural steroid injections in my lower back, but not to the point where I am ready for RFA. I was told I was a candidate for tri-level fusion of the L3-S1 in November of last year. I am still pursuing a second opinion for surgical intervention as at my age (45), I am still quite young for such an invasive procedure.

I am currently taking naproxen daily and have been for about a year and tolerating it well. I am also on Norco 10/325 as needed, which I don't take all that often and when I do, I usually take half a pill and then if needed, the other half.

I have had (2) extreme flareups, once in 2021 and the other in 2022 where I was essentially paralyzed and unable to move due to the severity of the pain. Resorting to calling 911 and having emergency services remove me from my bed and taken to the ER. First time, I was given Toradol/Valium/1x Morphine which had no effect/2x Dilaudid which did have an effect, and was released 7 hours later.

The second time, I had to be given IV Fentanyl (100mcg citrate) to even move me from my bed and into the mobile chair to get me out of my house and to the ER. This time, the ER Dr. (different Dr. this time) refused Dilaudid and instead insisted on Morphine, which I told her had no effect last time. She said "We don't give anyone Dilaudid, thats for cancer patients or people with bones sticking out," I told her "hey, I don't care what I get, just make it stop!" Was given Toradol/Valium/2x Morphine and was released 4 hours later. This was after IV Fentanyl from the paramedics approx 90min prior. Seemed the Fentanyl had no real effect as I was screaming in pain when they were trying to get me into the chair.


So yeah, I have my next post-epidural follow-up appointment with my pain Dr.'s clinician on Thursday and I want to ask about trying something different. While norco kind of works, I am not keen on taking it as it makes me nauseous once it begins to kick in, that lasts for about 30min then goes away. Overall though, it doesn't seem to work all that well, unless I augment it with naproxen, which I would like to stop taking since I have been taking it OTC for a year now, the Naproxen that is.

I was watching some YT videos and heard a drug name I have not heard before, and this is Tapentadol. I looked it up and its pretty interesting as its not just an opioid, but also an NRI and has the added advantage of being less prone to dependence. Though I don't think I have much to worry about regarding dependence as I don't feel pleasure from taking pain meds, I am one of the lucky people out there whos brain chemistry just doesn't play that game.


So yeah, looking to see if anyone out there has any experience with this pain medication and if so, what your experiences was/is. Or, if you are a medical professional and have thoughts on this, or know a loved one or friend who was on it.

I would like to ask about it at my appointment this week but would like to hear some thoughts if anyone has any.

Apparently its a semi-popular pain medication in Australia for certain cancers that give more general discomfort instead of localized pain. Reading online, it is also used for back pain with good results.

Thanks!

 

[Joshua Smith]

Short answer: no I have no experience with it.

Long answer: I haven't heard of Tapentadol, tho I feel like I maybe saw a commercial for it once, based solely on the name Nucynta. My wife and I like to laugh at the new drug names. I looked it up, and it reminded me of Tramadol and apparently it's similar but less "anti-depressanty" and more "opioid-y". It's quite new (2008 in the US, 2010 in Aus). "The potency of tapentadol is somewhere between that of tramadol and morphine, with an analgesic efficacy comparable to that of oxycodone despite a lower incidence of side effects. It is generally regarded as a moderately strong opioid." Ironically, I can tell you that I've had tramadol, morphine, hydrocodone, and oxycodone. Tramadol is great for chronic pain and I will never take it again. If ur on it at 400mg/day for a while, the withdrawal is absolutely horrific. My worst withdrawals in descending horrificness: effexor, tramadol, oxycodone, hydrocodone. Morphine doesn't work on me, so was never on it long.

Interesting side note, Tapentadol is not a pro-drug (unlike almost all other drugs). You don't metabolize it to get the effect, you just get the effect. Makes me wonder if it would work well for me

I have however, taken nearly every pain medication that's widely available including stuff that's not covered by insurance (infusions etc) among other things. I've also had nearly every interventional procedure out there including RFA (3 times, I think, maybe twice). I'm barely older than you and I've had...counts on fingers...7 lumbar surgeries. A micro discectomy, a fusion (XLIF), a spinal cord stimulator implantation, 2 laminotomies/laminectomies, another fusion (level below the first one), and a DRG stimulator implantation. I won't list the meds I've tried, but I currently take Gabapentin (for nerve pain) and Meloxicam (NSAID), and I got off of hydrocodone/Vicodin recently for maybe the 8th time (well, if we count the oxycodone/Percocet times too). I've been in and out of pain management since 2007 or 8, but mostly the last 10 years.

I don't want to drone on, so PM me if you want me to get even more nerdy details, or talk about our experiences in more detail.

Josh