| Introduction: Tapentadol (TP) has two mechanisms of action: mu-opioid receptor agonism and noradrenaline reuptake inhibition. Since TP has been developed for the management of chronic pain, there is paucity of information regarding the efficacy and tolerability in cancer pain management. We demonstrated the benefit ratio of TP appears to be better compared to other opioids at 2015 ASA annual meeting (1). The present study was performed to clarify the clinical impact of TP therapy for the opioid naïve patients with cancer pain.
Methods: After obtaining IRB approval, opioid naïve patients with cancer pain in whom TP was prescribed within 15 months were enrolled. This study was conducted retrospectively. TP was prescribed to treat either moderate to severe nociceptive or neuropathic pain. Pain intensity was evaluated using numerical rating scale (NRS; 0-10) before and after administering TP.
Results: Thirty-two patients were enrolled and TP, initial dose of 50-200 mg/day, was prescribed. Two patients were excluded from the analysis due to oral intake failure caused by general physical health deterioration within a few days following TP prescription. Mixed pain mechanisms (nociceptive and neuropathic pain) were found in 9 patients, pure neuropathic and nociceptive pain mechanisms were observed in 14 and 9 patients, respectively. The pain relief could be achieved within 1-11 (median 3) days following TP administration in 27 patients. The median NRS scores were 8 and 2 before and after TP treatment, respectively. Additional pain relief was obtained in 19 patients by increasing doses and their median NRS was 1. There were no nausea and vomiting in opioid naive patients during the treatments.
Discussion: TP as an initial opioid was effective and well tolerated in the management of cancer pain. From baseline to the final assessment, individual reductions in pain intensity of at least 50%, were achieved by 90% of the patients. TP had no nausea and vomiting, indicating a better gastrointestinal tolerability profile than other opioids. Conclusion: We conclude TP should be prescribed as an initial opioid for cancer pain treatment. Reference: (1) Anesthesiology 2015; 123: A4248 |
