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

Shoichiro Sazuka,Toshiya Koitabashi

doi:10.1007/s00540-020-02821-8

Shoichiro Sazuka, Toshiya Koitabashi

Open Access

https://doi.org/10.1007/s00540-020-02821-8

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Abstract

PurposeTapentadol 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.MethodsThis 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.ResultsAlmost 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.ConclusionTapentadol 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.

Highlights

Pain affects up to 70% of patients with cancer, especially those in the advanced stages of the disease [1]
41, 37, and 23% of patients were assessed as having mixed pain, neuropathic pain, and nociceptive pain, respectively
This study aimed to evaluate the effectiveness, safety, and tolerability of tapentadol in Japanese patients with moderate-to-severe cancer pain

Summary

Introduction

Pain affects up to 70% of patients with cancer, especially those in the advanced stages of the disease [1]. Cancer pain often involves a “mixed” pain type arising from both nociceptive and neuropathic pain [3]. The prevalence of cancerrelated neuropathic pain is variable and ranges between 20 and 40% [4,5,6,7], whereas that for cancer-related mixed pain is reported to be up to 40% [4]. Neuropathic pain is defined by the International Association for the Study of Pain as “pain that arises directly from a lesion or diseases affecting the somatosensory system” [8]. Pharmacological options for cancer-related neuropathic pain include treatment with opioids, non-opioids, and adjuvant therapies such as tricyclic antidepressants or anticonvulsants [10]. Neuropathic pain remains a challenge to treat as effective management hinges on the reliable diagnosis, detection, and selection of the appropriate pharmacological agent by the primary physician [10, 11]

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