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Morlion BJ, Margarit C, Wild I, Karra R, Liedgens H, Sohns M, Finco G. Bone fractures in patients using tapentadol or oxycodone: an exploratory US claims database study. Pain Manag 2020; 11:39-47. [PMID: 32996831 DOI: 10.2217/pmt-2020-0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To explore fracture outcomes with tapentadol or oxycodone, two opioids with differing mechanisms of action. Materials & methods: Retrospective cohort pilot study, using MarketScan® Commercial and Medicare Supplemental claims databases, on patients with postoperative pain, back pain, or osteoarthritis and ≥1 claim for tapentadol (n = 16,457), oxycodone (n = 1,356,920), or both (n = 15,893) between June 2009 and December 2015. Results: During 266,826 and 9,007,889 days of tapentadol and oxycodone treatment, patients evidenced 1080 and 72,275 fractures, respectively. Fracture rates per treatment-year were 1.512 for tapentadol and 3.013 for oxycodone. Conclusion: Examination of administrative claims has inherent limitations, but this exploratory analysis indicates a lower fracture rate with tapentadol than oxycodone in the analyzed dataset, which needs confirmation by further clinical trials.
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Affiliation(s)
- Bart J Morlion
- Leuven Centre for Algology & Pain Management, Anaesthesiology & Algology, Department of Cardiovascular Sciences, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | - César Margarit
- Pain Unit, Health Department of Alicante-General Hospital, Alicante, Spain.,Neuropharmacology on Pain (NED), Alicante Institute for Health & Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - Imane Wild
- Global Medical Affairs, Grünenthal GmbH, Aachen, Germany
| | - Ravi Karra
- Global Medical Affairs, Grünenthal GmbH, Aachen, Germany
| | - Hiltrud Liedgens
- Health Economics & Outcomes Research, Grünenthal GmbH, Aachen, Germany
| | - Melanie Sohns
- Grünenthal Innovation, Drug Development, Data Sciences, Grünenthal GmbH, Aachen, Germany
| | - Gabriele Finco
- Department of Medical Sciences & Public Health, University of Cagliari, Azienda Ospedaliera Universitaria of Cagliari, Cagliari, Italy
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Pergolizzi JV, Taylor R, LeQuang JA, Raffa RB, Bisney J. Tapentadol Extended Release in the Treatment of Severe Chronic Low Back Pain and Osteoarthritis Pain. Pain Ther 2018; 7:37-57. [PMID: 29623654 PMCID: PMC5993688 DOI: 10.1007/s40122-018-0095-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Indexed: 12/28/2022] Open
Abstract
Tapentadol is a novel pain reliever with apparently synergistic dual mechanisms of action, capable of addressing both nociceptive and neuropathic components of chronic pain. As an effective analgesic with good tolerability, tapentadol may be appropriate for patients suffering from severe chronic pain associated with low back pain (LBP) or osteoarthritis (OA). Efficacy studies of tapentadol in populations of patients with severe chronic LBP or OA pain suggest that tapentadol is non-inferior to oxycodone. Its tolerability, especially with respect to gastrointestinal (GI) side effects, may be better than that of other strong opioids in clinical trials and analyses of multiple trials. Patient satisfaction with tapentadol extended release for chronic noncancer pain syndromes is good. Although tapentadol has an opioid component with abuse liability, it appears to be a difficult opioid for tampering with less appeal to abusers than other opioids. For patients with severe LBP and OA pain, tapentadol appears to hold promise as a safe, effective therapeutic option.
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Affiliation(s)
| | | | | | - Robert B Raffa
- University of Arizona College of Pharmacy, Tucson, AZ, USA.,Temple University School of Pharmacy, Philadelphia, PA, USA
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Meng Z, Yu J, Acuff M, Luo C, Wang S, Yu L, Huang R. Tolerability of Opioid Analgesia for Chronic Pain: A Network Meta-Analysis. Sci Rep 2017; 7:1995. [PMID: 28515426 PMCID: PMC5435686 DOI: 10.1038/s41598-017-02209-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 04/07/2017] [Indexed: 12/17/2022] Open
Abstract
Aim of this study was to study the tolerability of opioid analgesia by performing a network meta-analysis (NMA) of randomized-controlled trials (RCTs) which investigated effectiveness of opioids for the management of chronic pain. Research articles reporting outcomes of RCT/s comparing 2 or more opioid analgesics for the management of chronic pain were obtained by database search. Bayesian NMAs were performed to combine direct comparisons between treatments with that of indirect simulated evidence. Study endpoints were: incidence of adverse events, incidence of constipation, trial withdrawal rate, and patient satisfaction with treatment. Outcomes were also compared with conventional meta-analyses. Thirty-two studies investigating 10 opioid drugs fulfilled the eligibility criteria. Tapentadol treatment was top-ranking owing to lower incidence of overall adverse events, constipation, and least trial withdrawal rate. Tapentadol was followed by oxycodone-naloxone combination in providing better tolerability and less trial withdrawal rate. Patient satisfaction was found to be higher with oxycodone-naloxone followed by fentanyl and tapentadol. These results were in agreement with those achieved with conventional meta-analyses. Tapentadol and oxycodone-naloxone are found to exhibit better tolerability characteristics in comparison with other opioid drugs for the management of chronic pain and are associated with low trial withdrawal rate and better patient satisfaction.
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Affiliation(s)
- Zengdong Meng
- Department of Orthopaedics, First People's Hospital of YunNan Province, YunNan, P.R. China
| | - Jing Yu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael Acuff
- Rusk Rehabilitation Center, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Chong Luo
- Department of Orthopaedics, First People's Hospital of YunNan Province, YunNan, P.R. China
| | - Sanrong Wang
- Department of Rehabilitation Medicine, The second Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China.,Department of Pain Medicine, The second Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Lehua Yu
- Department of Rehabilitation Medicine, The second Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China.,Department of Pain Medicine, The second Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Rongzhong Huang
- Department of Rehabilitation Medicine, The second Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China. .,Department of Pain Medicine, The second Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China.
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Xiao JP, Li AL, Feng BM, Ye Y, Wang GJ. Efficacy and Safety of Tapentadol Immediate Release Assessment in Treatment of Moderate to Severe Pain: A Systematic Review and Meta-Analysis. PAIN MEDICINE 2016; 18:14-24. [DOI: 10.1093/pm/pnw154] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Gonçalves L, Friend LV, Dickenson AH. The influence of μ-opioid and noradrenaline reuptake inhibition in the modulation of pain responsive neurones in the central amygdala by tapentadol in rats with neuropathy. Eur J Pharmacol 2015; 749:151-60. [PMID: 25576174 PMCID: PMC4339205 DOI: 10.1016/j.ejphar.2014.11.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 11/10/2014] [Accepted: 11/16/2014] [Indexed: 11/29/2022]
Abstract
Treatments for neuropathic pain are either not fully effective or have problematic side effects. Combinations of drugs are often used. Tapentadol is a newer molecule that produces analgesia in various pain models through two inhibitory mechanisms, namely central μ-opioid receptor (MOR) agonism and noradrenaline reuptake inhibition. These two components interact synergistically, resulting in levels of analgesia similar to opioid analgesics such as oxycodone and morphine, but with more tolerable side effects. The right central nucleus of the amygdala (CeA) is critical for the lateral spinal ascending pain pathway, regulates descending pain pathways and is key in the emotional-affective components of pain. Few studies have investigated the pharmacology of limbic brain areas in pain models. Here we determined the actions of systemic tapentadol on right CeA neurones of animals with neuropathy and which component of tapentadol contributes to its effect. Neuronal responses to multimodal peripheral stimulation of animals with spinal nerve ligation or sham surgery were recorded before and after two doses of tapentadol. After the higher dose of tapentadol either naloxone or yohimbine were administered. Systemic tapentadol resulted in dose-dependent decrease in right CeA neuronal activity only in neuropathy. Both naloxone and yohimbine reversed this effect to an extent that was modality selective. The interactions of the components of tapentadol are not limited to the synergy between the MOR and α2-adrenoceptors seen at spinal levels, but are seen at this supraspinal site where suppression of responses may relate to the ability of the drug to alter affective components of pain.
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Affiliation(s)
- Leonor Gonçalves
- Neuroscience Physiology & Pharmacology, Medical Sciences Building, University College London, Gower St, London WC1E 6BT, UK.
| | - Lauren V Friend
- Neuroscience Physiology & Pharmacology, Medical Sciences Building, University College London, Gower St, London WC1E 6BT, UK.
| | - Anthony H Dickenson
- Neuroscience Physiology & Pharmacology, Medical Sciences Building, University College London, Gower St, London WC1E 6BT, UK.
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Abstract
INTRODUCTION Centrally acting opioids are well established in the treatment of acute, surgical and cancer pain. However, their use in chronic noncancer pain (CNCP) is controversial because of side effects such as tolerance, somnolence, respiratory depression, confusion, constipation and addiction. Chronic arthritis and other musculoskeletal diseases are among the leading causes of CNCP. AREAS COVERED This manuscript will discuss the role of conventional opioids in chronic arthritis. In addition, future developments and strategies exploiting peripheral effects of opioids on pain and inflammation will be outlined. EXPERT OPINION Aims in drug development include the design of peripherally restricted opioid agonists, selective targeting of endogenous opioids to sites of painful injury and the augmentation of peripheral ligand and receptor synthesis, for example, by gene therapy. Although a large number of peripherally acting opioid compounds have been developed, clinical Phase III studies have not been published so far. Another strategy is to augment the effects of endogenously released opioid peptides by the inhibition of their degrading enzymes. Technology-oriented research is needed to find novel ways of peripheral restriction of opioids. Such analgesics would be desirable for their lack of central side effects and of adverse effects typical of nonsteroidal anti-inflammatory drugs (gastrointestinal ulcers, bleeding, myocardial infarction and stroke).
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Affiliation(s)
- Christoph Stein
- Freie Universitaet Berlin, Charite Campus Benjamin Franklin, Department of Anaesthesiology and Critical Care Medicine , Berlin , Germany
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Torres-Sanchez S, Alba-Delgado C, Llorca-Torralba M, Mico JA, Berrocoso E. Effect of tapentadol on neurons in the locus coeruleus. Neuropharmacology 2013; 72:250-8. [DOI: 10.1016/j.neuropharm.2013.04.053] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 04/04/2013] [Accepted: 04/24/2013] [Indexed: 11/17/2022]
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Saraghi M, Hersh EV. Three newly approved analgesics: an update. Anesth Prog 2013; 60:178-87. [PMID: 24423420 PMCID: PMC3891458 DOI: 10.2344/0003-3006-60.4.178] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 08/29/2013] [Indexed: 11/11/2022] Open
Abstract
Abstract Since 2008, three new analgesic entities, tapentadol immediate release (Nucynta) diclofenac potassium soft gelatin capsules (Zipsor), and bupivacaine liposome injectable suspension (EXPAREL) were granted US Food and Drug Administration (FDA) approval to treat acute pain. Tapentadol immediate-release is a both a mu-opioid agonist and a norepinephrine reuptake inhibitor, and is indicated for the treatment of moderate to severe pain. Diclofenac potassium soft gelatin capsules are a novel formulation of diclofenac potassium, which is a nonsteroidal anti-inflammatory drug (NSAID), and its putative mechanism of action is through inhibition of cyclooxygenase enzymes. This novel formulation of diclofenac allows for improved absorption at lower doses. Liposomal bupivacaine is a new formulation of bupivacaine intended for single-dose infiltration at the surgical site for postoperative analgesia. Bupivacaine is slowly released from this liposomal vehicle and can provide prolonged analgesia at the surgical site. By utilizing NSAIDs and local anesthetics to decrease the transmission of afferent pain signals, less opioid analgesics are needed to achieve analgesia. Since drug-related adverse events are frequently dose related, lower doses from different drug classes may be employed to reduce the incidence of adverse effects, while producing synergistic analgesia as part of a multimodal analgesic approach to acute pain.
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Affiliation(s)
- Mana Saraghi
- Department of Periodontics, Division of Pediatric Dentistry, Department of Oral & Maxiollofacial Surgery/Pharmacology, University of Pennsylvania School of Dental Medicine
| | - Elliot V. Hersh
- Department of Oral & Maxillofacial Surgery, Pharmacology Director, Division of Pharmacology, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
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Tang S, Mullins ME, Braun BM, Hock KG, Scott MG, Guarino AH, Brasington RD. Can tapentadol cause a false-positive urine drug screen result for amphetamine? Clin Toxicol (Phila) 2012; 50:1174-5. [PMID: 23088194 DOI: 10.3109/15563650.2012.735367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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