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      Tapentadol in the treatment of osteoarthritis: pharmacological rationale and clinical evidence

      1 , 2 , 3

      Journal of Pain Research

      Dove

      osteoarthritis, pain, tapentadol

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          Abstract

          Osteoarthritis (OA) is the most prevalent joint disease in older people worldwide. Pain owing to OA is considered one of the most frequent causes of chronic pain; however, current pharmacological approaches have some limitations in terms of efficacy and safety. Of note, descending inhibitory pain pathways are often disrupted in chronic OA pain, and pharmacotherapies targeting those pathways – eg, those that block norepinephrine reuptake may be more appropriate for managing chronic pain than pure μ-opioid receptor (MOR) agonists. Tapentadol is an analgesic molecule, which combines two synergistic mechanisms of action, MOR, and norepinephrine reuptake inhibition. This narrative review will briefly discuss the mechanisms contributing to the onset and maintenance of pain in OA patients; clinical data on the use of tapentadol in this setting will then be presented and commented.

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          Most cited references 35

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          Sensitization in patients with painful knee osteoarthritis.

          Pain is the dominant symptom in osteoarthritis (OA) and sensitization may contribute to the pain severity. This study investigated the role of sensitization in patients with painful knee OA by measuring (1) pressure pain thresholds (PPTs); (2) spreading sensitization; (3) temporal summation to repeated pressure pain stimulation; (4) pain responses after intramuscular hypertonic saline; and (5) pressure pain modulation by heterotopic descending noxious inhibitory control (DNIC). Forty-eight patients with different degrees of knee OA and twenty-four age- and sex-matched control subjects participated. The patients were separated into strong/severe (VAS>or=6) and mild/moderate pain (VAS<6) groups. PPTs were measured from the peripatellar region, tibialis anterior (TA) and extensor carpi radialis longus muscles before, during and after DNIC. Temporal summation to pressure was measured at the most painful site in the peripatellar region and over TA. Patients with severely painful OA pain have significantly lower PPT than controls. For all locations (knee, leg, and arm) significantly negative correlations between VAS and PPT were found (more pain, more sensitization). OA patients showed a significant facilitation of temporal summation from both the knee and TA and had significantly less DNIC as compared with controls. No correlations were found between standard radiological findings and clinical/experimental pain parameters. However, patients with lesions in the lateral tibiofemoral knee compartment had higher pain ratings compared with those with intercondylar and medial lesions. This study highlights the importance of central sensitization as an important manifestation in knee OA.
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            Osteoarthritis pain: nociceptive or neuropathic?

            In this article, we present the case for the existence of a subgroup of patients with osteoarthritis (OA) who experience pain with neuropathic features. Recognizing these patients as a distinct subgroup will allow clinicians to improve the management of their symptoms. We discuss the diagnostic criteria for pain to be classed as neuropathic, then systematically examine the applicability of these criteria to the symptoms, signs and pathology of OA. What are the implications for the preclinical development and clinical use of analgesics for OA? How should existing treatment options be reassessed? Differences in the aetiology of OA and the pharmacological sensitivity of patients with OA pain with neuropathic features, compared with other patients with OA, might explain the frequent negative findings of clinical trials of treatments for symptomatic OA. If the global prevalence of OA pain with neuropathic features is accurately represented by reports from small experimental groups of patients, then a substantial unmet need to tailor diagnosis and therapy for these individuals exists.
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              AAOS clinical practice guideline: treatment of osteoarthritis of the knee: evidence-based guideline, 2nd edition.

               Greg A Brown (2013)
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                JPR
                jpainres
                Journal of Pain Research
                Dove
                1178-7090
                16 May 2019
                2019
                : 12
                : 1529-1536
                Affiliations
                [1 ]Dipartimento di Scienze Chirurgiche, s.c. Ortopedia e Traumatologia Università di Perugia, Ospedale S. Maria della Misericordia , 06100 Perugia, Italy
                [2 ]Department of Medicine, Sezione di Clinica Medica e Anatomia Patologia , Terni, Italy
                [3 ]Rehabilitation Department, ASST Pini-CTO , Milan, Italy
                Author notes
                Correspondence: Giuseppe RinonapoliDipartimento di Scienze Chirurgiche, s.c. Ortopedia e Traumatologia Università di Perugia, Ospedale S.Maria della Misericordia , Piazzale Menghini, 06100Perugia, ItalyEmail grinonapoli@ 123456yahoo.it
                Article
                190161
                10.2147/JPR.S190161
                6529616
                © 2019 Rinonapoli et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Categories
                Review

                Anesthesiology & Pain management

                tapentadol, pain, osteoarthritis

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