Main thing is I don't want to become dependent. If I ever had to stop them cold turkey it could be a painful experience. I know a week or two is my limit because after being on them for two weeks due to a big event in my life that needed my full attention, the passing of my father. Then stopping once I didn't need to stand and things the withdrawals were not pleasant at all. I can't even imagine how bad it could be if I had been on them for a long time at large amounts.

I need to find something else to get me through the hard painful times from events out of my control.

Marty as I mentioned above its 400mg per day. It depend if its slow release 2 x 200mg or 8x50mg either way the max prescribed is 400mg/day

Just to be clear the maximum dosage is 100mg at a time unless its slow release where its 200mg at a time

I found long term use at 400mg/day is the sweet spot for me

Hello, I am new to the boards. I have been on Nucynta ER 200mg 2xs a day since early Feb for SFPN.

It helps. It does not completely take the pain away for me. It took 3 weeks for it kick in and during that time I was calling my dr telling them the crap don't work and he kept telling me wait it out, all the sudden I had energy and my the burning and tingling dropped down quite a bit and I was like wow, I was even in a great mood.

Right now I think I need a dose adjustment because the burning and humming are coming back. I was on 3600mg of Gabapentin with the nucynta and still having pain so they just switched me to Lyrica 150mg 3xs a day. Whoa they are worried about the opiates being abused, heck I get more zonked on Lyrica than I ever had on opiates.

But long story short it helps enough that I have no desire to go off of it and try something different. I am just using it in combo with other meds and when the combo works it's great.

Welcome Ouchiefeet.

The topamax (50mg-but you can go higher-that's all I needed) took away most of the tingling and all of the pain and pressure in my feet. They felt like normal again for the most part. I stopped taking the topamax when I discovered that the dextromethorphan (120 mg) I was taking for my back pain worked just as well on my neuropathy.

Do you feel that Nucynta ER has a high degree of a risk for dependancy?

Sometimes it helps to understand the process of tolerance better.

With pain receptors in the brain, it has recently been found that the glia cells around the neurons which actually support the neurons, somehow stimulate the mu receptors (pain receptors) to increase in numbers when they are all filled with drug.

So what happens is the pain returns because those new extra receptors are empty until YOU increase your dose, or change drugs etc. Then in the end, if you decide to stop the drug, then you are left with all those extra new receptors and the perception of pain is HIGHER than when you started out. It becomes a never ending spiral.

Now, studies do not yet explain what happens next, as this is quite new information. The new receptors may atrophy away with time, or not. Given the high rate of relapse in addicts from rehab, I suspect not, or it may be a long time necessary and many people just cannot stand this long period and then they start using again. (studies for non-addicts are not as numerous as for addicts-- so I am not implying that opiate pain relief for PNers is addictive, the studies are just not there yet for chronic painers).

Sorry—I was talking about opioids in general—not just tramadol.

Doc

Honestly no, it is nothing like traditional pain pills, I feel nothing from it other than the relief I got after it got in my system.

It really does help calm the burning and humming so much as I said in my other post I would hate to think about going off of it for fear the pain would come back. So I am dependant on it for the pain relief but if it stopped working I wouldn't hesitate to kick it to the curb to try something else and I wouldn't feel I needed it after it was gone. (I don't think anyways)

Like I said takes about 3 weeks to work and in that 3 weeks before it works you will swear it is the worst drug it doesn't work blah blah then all the sudden you will notice that you aren't walking on the sides of your feet to keep from touching the pads and your mood is good. I told the NP I hadn't been in this good a mood in years.

Marty, I don't know of any prescription pain medications used regularly that don't produce dependence eventually. Even the antiseizure meds (gabapentin, pregabalin, topiramate) and the SSRI/SNRI antidepressants do that. Rotation may help retard tolerance, but dependence will still be there.

It may be a choice of the least of many evils. I realize you're in SLC, but have you been following the CBD thread?

Doc