Managing cancer pain with tapentadol PR: our clinical practice

Abstract

Background: Chronic pain is one of the most common symptoms experienced by patients with tumors and is associated with a substantial negative impact on patient quality of life, daily activities, and wellbeing. For the management of moderate to severe cancer pain, we decided to evaluate efficacy and tolerability of tapentadol PR in our daily clinical practice. Tapentadol is a centrally acting analgesic with two synergistic mechanisms of action, mu-opioid receptor agonism and noradrenaline reuptake inhibition, in a single molecule. Due to a substance-specific pharmacodynamic/ pharmacokinetic profile, it has a low risk of drug interactions and a potential favourable tolerability profile which can be very useful in cancer patients. Patients and Methods: An observational study was conducted in adult patients, of both sexes, suffering from moderate to severe cancer pain. The initial dose of tapentadol PR was 50 or 100 mg BID, in case of ineffectiveness the dosage was gradually increased up to 250 mg BID. All other analgesics, BTcP's drugs or cancer therapies were gathered. The observation period was 2 months and 5 visits were performed.Mean pain intensity using a 11-point NRS from 0 to 10, quality of sleep (4-point scale), self-government, physical and psychological wellbeing (3-point scale), number and reason of drop-out were considered for the evaluation of effectiveness. All adverse events and any dose changes of the analgesic treatment were recorded. Result(s): 54 patients (41%M/59%F, mean age 68 +/- 11 years) suffering from cancer pain, mainly due to breast (37%) and prostate (22%) tumors with Karnofsky between 50 and 100 and metastasis in 45 cases were enrolled. At baseline mean pain intensity was NRS 6.7 +/- 1.6. Thanks to tapentadol PR the reduction of pain intensity was clinically (-4.8 points NRS) and statistically significant (p <0.01). 70% patients have recovered a night's rest and got welfare: self-government, physical and psychological wellbeing scores all improved. At the end of the study, the treatment with tapentadol PR was judged effective in 44 patients and the tolerability was good in all cases. These results were obtained with doses of tapentadol PR between 100 and 200 mg/day, stable after titration. Conclusion(s): Tapentadol PR was useful in the management of moderate to severe cancer pain: the reduction in pain intensity was strong and tolerability, even gastrointestinal, was good.