Efficacy and tolerability of tapentadol prolonged release in the elderly and fragile patient: an observational study.

Abstract

The incidence of chronic pain increases with age and comorbidities, a particularly relevant issue in the elderly over the age of 80 years. Thus, the choice of the best analgesic treatment is difficult to make. The therapeutic priority in elderly patients is to favor the least invasive route of administration, and the minimum effective dose, with a gradual and slow up-titration, if needed. Tapentadol with its dual mechanism of action, combining synergistically a reduced load (<40% that of strong opioids) of μ-opioid receptor agonism (MOR) with noradrenaline reuptake inhibition (NRI), can be an interesting analgesic option for geriatric patients, because of its easy manageability, the lower rate of adverse effects, the good level of analgesia, and the ability of improving the overall quality of life of elderly patients. A total of 49 elderly patients (>80 years) with chronic pain from different etiologies received tapentadol PR daily over 8 weeks. At the end of the study, responders to treatment were 43% (20/47 patients). Compared with baseline, pain intensity, both at rest and during loading, decreased by 60% and by 55%, respectively (p<0.0001). Tolerability was high throughout the study period, with 92% of patients grading it either good or excellent during follow-up. In total, 16 episodes of side effects were reported, with five considered severe and leading to therapy discontinuation. Ten cases of therapy discontinuation occurred, most of them (five patients, 10%) due to the ineffectiveness of analgesic treatment. Tapentadol PR, adequately titrated according to patients' need, are safe and effective to control pain in most elderly patients.