"20  years in the evening for lupus (sle), rheumatoid arthritis and now avn (a vascular necrosis, from steroid use and the sle).  i have been on exalgo 16 mg, nucynta 100 mg every 12 hrs for breakthrough pain. the exalgo was sufficient. nucynta takes pain away for a short time, and does make me sleepy, combined with the fatigue from lupus.  once in a while i get headaches and jittery, don&#039;t know if it&#039;s from the nucynta. (better described like a painful spot in my head, instead of a headache)."