Is Nucynta Better Than Other Pain Meds?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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One of the bright new changes in pain medications over the last few years were two medications: Ultram (tramadol) and now Nucynta (tapentadol). These are different from Vicodin (hydrocodone/acetaminophen), Percocet (oxycodone/acetaminophen), and Tylenol #3 (codeine/acetaminophen) in many ways and are considered much “gentler.” So, is Nucynta better? Lets look.

Ten points about Nucynta and Ultram you need to know:

  1.  Nucynta (Tapentadol) and Ultram (Tramadol) are similar in that they are considered “different” than the classic opioid meds: Vicodin, Percocet, or Tylenol with codeine.

  2.  Tramadol is like a baby Nucynta (tapentadol). Tramadol works as a relatively weak opioid receptor agonist. Tramadol also inhibits norepinephrine and serotonin reuptake which contributes to pain relief. It’s not as “strong” as Nucynta.

  3.  Nucynta (tapentadol) comes in an immediate or extended release pill (Nucynta ER). Nucynta’s effect on the opioid receptor is several-fold greater than tramadol’s, with more prominent norepinephrine reuptake inhibition.

  4.  Tramadol is perfect for pain conditions where a strong opioid component is not needed—and it has the benefit of a low abuse potential. Nucynta, a schedule II controlled substance, is well-suited for pain conditions requiring a strong opioid component (post-operative pain, pain where other medications have failed you) and it has the benefit of greater gastrointestinal tolerability compared to classical strong opioids.

  5.  Is Nucynta (tapentadol) as good as oxycodone? Studies have shown that Nucynta works as well as oxycodone for spinal compression fractures and the pain relief provided is similar to oxycodone and morphine.

  6.  Nucynta has been well studied and shown to be effective for chronic back pain, diabetic neuropathy, and post-operative pain.

  7.  Less nausea and vomiting? Yep. Nucynta scores points too for being better tolerated by the gut, so it has less nausea and vomiting compared to other opioids like Dilaudid, morphine or fentanyl.

  8.  Is it less addictive? Yes. Nucynta appears to have a low level of abuse in post-marketing studies.

  9.  Nucynta is a schedule II drug, so it requires a triplicate prescription, whereas tramadol (Ultram) does not, so tramadol is easier to refill and easier to acquire from the doctor.

  10.  Cost, not SO bad. Nucynta and Nucynta ER are new and brand-name-only drugs so they will be pricey and more expensive than tramadol, which is the generic form of Ultram.

Worth considering . . .

Dr O.

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