Tapentadol is effective in the management of moderate-to-severe cancer-related pain in opioid-naïve and opioid-tolerant patients: a retrospective study

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Abstract

Purpose

Tapentadol is a dual-acting mu-opioid receptor agonist and noradrenaline reuptake inhibitor with non-inferior analgesic efficacy to oxycodone and better gastrointestinal tolerability than full mu-opioid receptor agonists. Tapentadol is approved for cancer pain in Japan; however, real-world evidence on tapentadol’s effectiveness and safety for cancer-related pain in Japan is limited.

Methods

This retrospective study evaluated the effectiveness, safety, and tolerability of tapentadol (by patient type—opioid-naïve and opioid-tolerant) in 84 patients with moderate-to-severe cancer pain at Ichikawa General Hospital between September 2014 and August 2016.

Results

Almost 93% of patients achieved clinically relevant pain relief within 4 days (median). Over 90% of patients with neuropathic pain or mixed pain and all patients with nociceptive pain were responders. Pain intensity significantly decreased from baseline through to the end of maintenance period in opioid-naïve and opioid-tolerant patients. No patients discontinued tapentadol due to serious adverse events. No opioid-naïve patients experienced nausea or vomiting during tapentadol treatment. Only three opioid-tolerant patients experienced nausea which was considered to be related to tapentadol.

Conclusion

Tapentadol is effective and well tolerated in opioid-naïve and opioid-tolerant patients with cancer pain of varying pathophysiology, including those with nociceptive and/or neuropathic components. Tapentadol may be considered for first-line use in moderate-to-severe cancer-related pain.

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Most cited references 34

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Abstract The redefinition of neuropathic pain as “pain arising as a direct consequence of a lesion or disease affecting the somatosensory system,” which was suggested by the International Association for the Study of Pain (IASP) Special Interest Group on Neuropathic Pain (NeuPSIG) in 2008, has been widely accepted. In contrast, the proposed grading system of possible, probable, and definite neuropathic pain from 2008 has been used to a lesser extent. Here, we report a citation analysis of the original NeuPSIG grading paper of 2008, followed by an analysis of its use by an expert panel and recommendations for an improved grading system. As of February, 2015, 608 eligible articles in Scopus cited the paper, 414 of which cited the neuropathic pain definition. Of 220 clinical studies citing the paper, 56 had used the grading system. The percentage using the grading system increased from 5% in 2009 to 30% in 2014. Obstacles to a wider use of the grading system were identified, including (1) questions about the relative significance of confirmatory tests, (2) the role of screening tools, and (3) uncertainties about what is considered a neuroanatomically plausible pain distribution. Here, we present a revised grading system with an adjusted order, better reflecting clinical practice, improvements in the specifications, and a word of caution that even the “definite” level of neuropathic pain does not always indicate causality. In addition, we add a table illustrating the area of pain and sensory abnormalities in common neuropathic pain conditions and propose areas for further research.

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Author and article information

Contributors

Toshiya Koitabashi:

ORCID: http://orcid.org/0000-0003-1832-4540

koitabas@tdc.ac.jp

Journal

Journal ID (nlm-ta): J Anesth

Journal ID (iso-abbrev): J Anesth

Title: Journal of Anesthesia

Publisher: Springer Singapore (Singapore )

ISSN (Print): 0913-8668

ISSN (Electronic): 1438-8359

Publication date (Electronic): 9 July 2020

Publication date PMC-release: 9 July 2020

Publication date (Print): 2020

Volume: 34

Issue: 6

Pages: 834-840

Affiliations

GRID grid.265070.6, ISNI 0000 0001 1092 3624, Department of Palliative Care Medicine, , Ichikawa General Hospital, Tokyo Dental College, ; 5-11-13 Sugano, Chiba, Ichikawa-city 272-8513 Japan

Author information

Toshiya Koitabashi http://orcid.org/0000-0003-1832-4540

Article

Publisher ID: 2821

DOI: 10.1007/s00540-020-02821-8

PMC ID: 7674340

PubMed ID: 32648017

SO-VID: f9b90d7e-84da-404f-88bc-c9bf167d6f1c

License:

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