I am on a very high dose of Nucynta; 200 mg extended release twice daily. I also have 50 mg regular tablets for break through pain with four available per day. On a bad day, that is 600 mg. I need to have another spinal surgery, a big one this time. With the new opioid guidelines, I would not be allowed ANY post op pain medicines due to the amount of Nucynta that I take each day. We hear about the opioid crisis on the news and the CDC in Atlanta has issued new guidelines. Once again, the actions of a few has taken away medicines needed for chronic and post-op pain. The upshot of this means that I will have to drop my Nucynta dosage to at least 200 mg per day so that I can make it through the surgery. I will start a step-down this week and will try to come back and post how it goes. I will be doing this under the supervision of my pain management doctor.