Analgesic efficacy in head and neck cancer patients using tapentadol vs tramadol plus paracetamol

Abstract

Background: We aimed to assess the pain control and tolerance to drug induced emesis in Head and Neck Squamous cell carcinoma (HNSCC) with progressive disease post-concurrent Chemoradiation using single agent tapentadol vs. oral tramadol plus paracetamol. Methods: HNSCC patients with progressive disease post concurrent chemoradiation experiencing severe pain were randomised to three groups (20 patients in each group). Group-A received tapentadol 50mg twice daily; dose was increased up 200mg with 6 hours interval, if pain persisted. Group-B received tramadol plus paracetamol with antiemetics. Group-C received tramadol plus paracetamol without antiemetics. Patients were evaluated on 3 and 4 weeks of treatment for pain using Visual Analogue Scale. Results: In Group-A, 18 (90%) patients had good pain relief with pain score0-1 of which 31 patients showed pain relief with 50mg twice daily and 4 had dose escalation of 50mg four times daily, 1 patient showed skin allergy with good pain control, 4 patients were switched to morphine 10gm 4 hourly. In group-B, 17 (85%) patients had good pain relief with pain score 0-1, but 5 patients did not tolerate due to emesis and sedation, in spite of good pain relief; these 5 patients were switched to morphine 10mg 4 hourly. In group-C only 4 (20%) patients had pain relief; others did not tolerate emesis and sedation and were given symptomatic care. Conclusions: Single agent Tapentadol provided statistically superior pain control than combined tramadol with paracetamol, and was tolerated better by the patients without emesis.