Studies suggest that around 20% of adults in Europe experience chronic pain, which not only has a considerable impact on their quality of life but also imposes a substantial economic burden on society. More than one-third of these people feel that their pain is inadequately managed. A range of analgesic drugs is currently available, but recent guidelines recommend that NSAIDs and COX-2 inhibitors should be prescribed cautiously. Although the short-term efficacy of opioids is good, adverse events are common and doses are frequently limited by tolerability problems. There is a perceived need for improved pharmacological treatment options. Currently, many treatment decisions are based solely on pain intensity. However, chronic pain is multifactorial and this apaproach ignores the fact that different causative mechanisms may be involved. The presence of more than one causative mechanism means that chronic pain can seldom be controlled by a single agent. Therefore, combining drugs with different analgesic actions increases the probability of interrupting the pain signal, but is often associated with an increased risk of drug/drug interactions, low compliance and increased side effects. Tapentadol combines μ-opioid receptor agonism and noradrenaline reuptake inhibition in a single molecule, with both mechanisms contributing to its analgesic effects. Preclinical testing has shown that μ-opioid agonism is primarily responsible for analgesia in acute pain, whereas noradrenaline reuptake inhibition is more important in chronic pain. In clinical trials in patients with chronic pain, the efficacy of tapentadol was similar to that of oxycodone, but it produced significantly fewer gastrointestinal side-effects and treatment discontinuations. Pain relief remained stable throughout a 1-year safety study. Thus, tapentadol could possibly overcome some of the limitations of currently available analgesics for the treatment of chronic pain.
Instrucciones de citación para el artículo / Citation instructions for the article:Oteo Álvaro Ángel. Abordaje del dolor agudo en traumatología / Acute pain management in orthopedics. Rev. Soc. Esp. Dolor. 2017. doi: 10.20986/resed.2017.3639/2017 Este es un archivo PDF de un manuscrito inédito que ha sido aceptado para su publicación en la Revista de la Sociedad Española del Dolor. Como un servicio a nuestros clientes estamos proporcionando esta primera versión del manuscrito en estado de prepublicación. El manuscrito será sometido a la corrección de estilo final, composición y revisión de la prueba resultante antes de que se publique en su forma final. Tenga en cuenta que durante el proceso de producción se pueden dar errores lo que podría afectar el contenido final. El copyright y todos los derechos legales que se aplican al artículo pertenecen a la Revista de la Sociedad Española de Dolor.
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