Hi Dr. Fudin,
First – thanks for all of the literature you contribute to. It’s great for patients like myself that want to understand their treatment options and allows me to better understand risks and benefits of chronic pain treatment.
I have hEDS that was dx’d ~10 years ago and regularly see IPM physician. Nucynta ER and IR were my mainstay for about 8 years – no dose changes, no side effects over this period. I used IR for BTP ~6-7 episodes per month with pretty good success. Insurance decides to drop this year and I’ve since switched to Belbuca 300mcg q12h. For BTP I’ve tried Norco 10/325 and Percocet 5/325. As I’m also a CYP2D6 UM, I get very short duration of relief from either Norco or Percocet (an hour or less) and not entirely that effective (although this is me comparing to 25mg of IR Nucynta). Nucynta even with PA is out of question due to the cost with my insurance. I spoke with PM regarding both of these and he is reluctant to try anything else (Codeine and Tramadol are also terrible with side effects due to UM) – he mentioned Dilaudid, but for cancer only. I’m at a cross roads as to what I should do next…are there any other options that, considering Belbuca, might be a good fit for BTP? Or is this really just something I have to deal with since there are no other options. Many of these BTP episodes interfere with my job and worsen anxiety for me. Controlling BTP was something I was good on Nucynta, but not so much anymore.
Your doctor can contact the insurance company for a prior authorization and exception with an explanation of why you need Nucynta. In that note, he/she should also make clear that they are otherwise forcing you on an unsafe alternative by requiring a full agonist opioid (hydrocodone) that has been proven to have a higher abuse potential compared to Nucynta. See Tapentadol: A Real-World Look at Misuse, Abuse, and Diversion, which your doctor can include. If this doesn’t work, contact the manufacturer, Collegium, and ask to speak to someone about a program for someone that’s been on the medication but can no longer afford it due to insurance changes.