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TAPENTADOL (NUCYNTA)

Tapentadol is a prescription narcotic analgesic for patients 18yrs of age and older suffering from moderate to severe acute pain for short term use. It should be avoided in patients with lung, certain gastrointestinal diseases, or patients taking certain medications such as antidepressant that inhibits monoamine oxidase (MAOI), or ANY medications that may make you sleepy –general anesthetics, sedatives, hypnotics, and phenothiazine tranquilizers. Patients who have recently sustained a head injury, have liver , gall bladder, pancreas or kidney problems , history of seizures must use caution with tapentadol. The drug should be avoided in patients with severe lung problems-asthma, COPD (chronic obstructive pulmonary disease, severe obesity, sleep apnea, kyphoscoliosis (abnormal spine curvature which restricts lung expansion) or certain motility diseases of the intestines.

Tapentadol exerts its centrally acting analgesic effect by Mu receptor agonist action and inhibition of norepinephrine reuptake at receptors, being 2-3 times less potent than morphine .in analgesia. It may be reversed by naloxone at the Mu receptor and norepinephrine modulation.

The dosage of 50, 75 or 100mg orally every 4-6 hours with or without food, should be individualized based upon patient pain intensity, and previous exposure/response to similar class analgesics. Patients with mild kidney or liver impairment do not require dosage adjustments. Side effects include respiratory depression, dizziness, nausea, vomiting, headache, dry mouth, gastric irritation, fatigue, flushing sensation, itching, rash, anxiety and excessive sweating. Tapentadol may lower blood pressure, cause urinary hesitation, restlessness, and agitation, sensation of heavy’ muscles, abdominal cramping fullness, increase or decrease in heart rate In the absence of adequate studies should be used with great caution in pregnancy only if the benefits outweigh fetal risks and not be used in nursing mothers.

The use of tapentadol in joint disease and joint surgery(bunionectomy-large toe joint restoration surgery) has proven to provide a 50% reduction in pain in a 48 hour period. The drug provides excellent well tolerated analgesic in properly selected patients with appropriate indications for short term use.

References

The Medication Guide, NUCYNTA, June 2010, Ortho-McNeil-Janssen Pharmaceuticals

MPR. MONTHLY PRESCRIBING GUIDE, 2011 EDITION, PAIN MANAGEMENT POCKET GUIDE

ADDITIONAL REFERENCES

Drugs.com

National Institutes of Health

MedlinePlus

ORTHOTICS for multiple types of foot pain best buy in a pre-made orthotic click link below



ORTHOTICS for heel and arch pain for those who must wear dress shoes click link below

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NY

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NJ

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Fla

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Ontario, Canada

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Fla.

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New York

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Memphis, TN

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Scotland

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J. Simmons

(location unknown)

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Dear Dr. Mitnick, The orthotics arrived four days ago and I slipped them into my shoes immediately. I was skeptical as to the usefulness of the item, they really didn't look very exotic. I have to say though, after using them for just four days, I have experienced grand relief from my foot pain. Even the very first day, I was able to do a lot of work while on my feet with at least a 75% reduction of pain. It has only gotten better every day, and I go nowhere without my shoes with the orthotics. I had been experiencing extreme heel and sole pain for about six months and had to take extended breaks off my feet many times a day as well as regular doses of Ibuprofen. Since getting the orthotics, my life has returned to normal and I feel good again. Just wanted to say thanks for the recommendation for a very effective item, I had no idea what a change this item could affect.

Yours truly,

J.C. Forbes

Tennessee

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Thanks for the Response, you hit it on the head.

Steve

Redondo Beach, CA

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Thank you for your time and expertise in answering my question…..

LH

(location unknown)

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First, thanks for putting together this website. Its the most informative site I have found dealing with foot problems. Last June I started having pain and swelling at …….

Joe

(location unknown)

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Pete M.

(location unknown)

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Madison, Alabama

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Denison, TX

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Dr. Marc, Thank you so much for your reply which seemed to be right on. I have researched many sites but you put me on the right path to the possible answer. My foot pain may not rule the rest of my life after all! I believe I'll make a sign that reads, "THE END IS NEAR!" Thanks Very Much,

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West lafayette, IN

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Tampa, Florida 33624

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Texas

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Tampa, Florida 33624

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UK

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Dear Dr.Mitnick

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I thank you for putting together this incredible website.

Regards,

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Edmonton,Canada

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South Africa

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Mansfield Ctr, CT

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First, I'd like to thank you for all the information that you provide on your website and the opportunity to write to you.

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Placentia, California

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First, I want to let you know that you have the best web site I've found related to foot issues. (The only thing I had difficulty finding was the "ask a question" page.)

Unknown

Unknown location

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I received the orthotics Monday afternoon and began wearing them Tuesday. After two days I would say that I have noticed a huge improvement in the discomfort I have been experiencing. My foot feels better than it has in months.

Ric J.

Unknown location

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Pacific Grove, CA

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Alameda, California

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Anonymous

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Thank you for your very interesting and informative site!

Anonymous

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Thanks very much for the wonderful informative site.

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New Zealand

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Thank You for my answer! I have been schedule for a bone density scan, allingment, and I am in the process of getting orthotics made, and checking out the natural remedies. Thank again! What a great web site!

Sincerely

Josette

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Yes I want both pair of orthotics. You don't have an option of ordering 2 at one time so I had to place the order twice. Thanks. My husband likes these and wants to put them in all of his shoes. (referring to Superstep orthotics)

Cindy H.

Arizona

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I searched the internet everywhere for a clear description and illustration of my symptoms/problem. https://www.foot-pain-explained.com/ was where I ended my search with answers. If I lived in Jersey (left 30 years ago) and didn't live in Florida I would definetly make an appointment with Dr. Mitnick.

Thanks, Kathy

Florida

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1st of all THANKS A LOT for your great site......

Anna

Poland

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M P

South Carolina

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Natalie

unknown location

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...Thanks for your fantastic service.

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Arlington, VA

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Thank you so very much, that would be much appreciated. I love those insoles, by the way. (referring to Superstep orthotics)

Kelly W.

San Clemente, CA

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Dr Marc is fantastic...He seems to know exactly what you are feeling with the problems you are having. I wish he was in my home town so I could go to him with my problems!!!!!!!!!!!!!

Pam

location unknown

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Great insights! Thanks Doc, you're the best.

Glen

location unknown

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Bre

location unknown

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Dr. Mitnick, Thank you so much for your reply. I did let my physician know and they took an x-ray - all is well! Also, thank you for providing this wonderful site, it is very helpful with lots of useful information! I appreciate your gift of time! God bless.

anonymous

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Dr. Mitnick, Thank you, you were 100% correct. The pain finally brought me to the ER. I spent 8 days in the hospital. The Doppler you spoke of was able to show that there was no pulse in that foot. This was an arterial clot that split and traveled throughout my leg. My leg was almost amputated. I am in rough shape but have all my parts intact!! You certainly know what you are talking about. Thank you for taking the time to answer. Yours Truly!

anonymous

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Poland

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Seattle, WA

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location unknown

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Also, and importantly, just want to praise this web site. Thorough and thoughtfully presented, it certainly must be of considerable assistance to anyone with a foot problem. Terrific -- and very interesting.I trust the address comes up easily for those seeking information.

Bill

New Jersey

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Thanks so much for answering my question. You've been more help to me than my own Dr. has been lately. Thanks again....I hope to be able to walk without pain someday.

Debbie

location unknown

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Chrissy

location unknown

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Thanks so much for this website Dr. Marc! It is so nice that you have this ask the doctor feature..I'm sure I'ts been helpful for alot of people. I will try what you suggested and see if it helps...thanks again!

Tracy

Evansville, IA

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Dear Marc

I just want to say thank you for the quick response and the good info. I find it amazing and a super nice thing that you do here by answering medical questions at no charge.

Russ W.

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Your website is full of a lot of helpful information, and I am very impressed with the time in which you responded to my post. Thank you again for your time and consideration in your response.

-Sunny.

location unknown

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Thank you very much for the information, I will consider it. Excellent web site.

Jackie

San Diego, CA

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Dr. Mitnick, Just want to say thank you so very much for your quick response and very informative reply! After reading what you had to say, I called the doctor's office and was able to get in and see him the same day as my injury. Toe was x-rayed and luckily, it is not broken or fractured. Very badly bruised and will probably lose the toe nail. And although my toe and toe nail are still very black and blue and very sore, they ARE both starting to feel a little better. So again, thank you! I am so very happy that I came across your website. The service you provide is outstanding and immeasurable!

Rivi,

Albany, NY

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Thank you so much for all of your advice. In searching the web for people dealing with this same issue i can tell you that you are a Knight In shining Armor! If I lived in Jersey I would gladly be your Spokesperson. Hopefully next time you hear from me it will be good news. God Bless,

Jill S.

location unknown

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THANK YOU SO VERY MUCH FOR YOUR TIME AND EFFORTS, YOU ARE SO VERY APPRECIATED. THANK YOU FOR ALL YOU DO.

Jackie

Whichita, KS

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thanks again, this site is very helpful.

mark

Boston, MA

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Like others have stated...This site is amazing and I am so thankful that it was created.

....Keep up what your doing. Your a life saver.

Michelle

Colorado

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Thanks again for the information provided on your site. It's easy for non-medical folk to understand your writing, and helps provide better communication between patient and doctor.

annielou

Colorado

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Wonderful advice

by: Anonymous

This is the best site for foot problem info.

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Thank you for this information. This description fits my pain and inflammation behind my 2nd toe perfectly.

by: Max

location unknown

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Again, I really appreciate that you responded to my inquiry, and that your mention of Parkinson's helped me to find my way to a diagnosis of this difficult to diagnose disease. Most patients see on average 16 doctors before they are diagnosed. I hope that you can help other people that ask for your expertise in the future.

Barb D.

Canada

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I just wanted to say that I am very greatful for this website!! I have had a fusion in my rt foot and am finally getting a little bit better......

Bonnie

location unknown

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Again, Thank you from the bottom of my heart for taking the time to answer my question....your an angel!

Nancie

Wisconsin

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Thank you for your response. You have provided some great insight (to my question)....

Julie

location unknown

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Thank-you so very much for responding so quickly and in such detail to my question!! I will give my surgeon a call today!! This website is terrific!!!! Thank-you again!

Renae

North Carolina

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Many Thanks Dr Marc!
Thank you for your response. It sounds like a good plan to me. He did not cut the wart out first ...

KG

location unknown

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Thanks again doc for having this website and we STILL need qualified Podiatrists in beautiful sunny Tampa Bay (Bradenton) Florida.

Bessie Mae

Florida

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Dear Dr. Mitnick, Thank you so very much for taking your time to answer my question. You have greatly relieved my anxiety related to the continual tingly I feel in my feet. I will share your response with my podiatrist next week. God bless you for having this question and answer page on your website! Most gratefully,

Lynne T.

location unknown

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Your webpage is excellent, I commend you on sharing your knowledge to the public.

Robert

New Jersey

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Thank you. you were more detailed than what others have told me they finally called from the last xrays and my son is now in a cast for 2 weeks he did have a fracture that was not noticeable.

a mom

location unknown

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I have read your website and I have to admit that I am amazed at all the information that is on here. I have learned more than the three years I have been going to several doctors that I have seen!!

Melody

Lenoir, NC

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Thank you so much Doc for a quick and thorough response!

Rustam

Bellevue, WA

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I cannot thank you enough for your response, opinion, and suggestions! I want you to know how much it means to me, and I'm sure everyone else who has ever asked you a question! I feel like you're a lifesaver and have empowered me to take a stronger role and stand up for myself and my feet!

Jodi

location unknown

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