Tapentadol prolonged release for patients with multiple myeloma suffering from moderate-to-severe cancer pain due to bone disease

Abstract

ContextMyeloma bone disease (MBD) is a devastating complication of multiple myeloma that leads to severe pain.ObjectivesThe aim of this study was to evaluate the efficacy and tolerability of tapentadol prolonged release (PR) in the management of patients with MBD suffering from moderate-to-severe cancer pain.MethodsA 12-week prospective study was carried out in 25 opioid-naïve MBD patients. Patients initially received twice-daily doses of tapentadol PR 50 mg. Doses were then managed to maintain adequate relief or dose-limiting toxicity. The following parameters were recorded at weekly intervals for 4 weeks, and then at weeks 8 and 12: pain, opioid-related adverse effects, use of other analgesics, DN4 (Douleur Neuropathique 4) score. Quality of life (SF-36 [36-item short-form health survey]) was measured at baseline and at final evaluation.ResultsOf 25 patients, 22 completed the study. Pain intensity significantly decreased from baseline to all the week intervals (P<0.01). Quality of life significantly improved with respect to all SF-36 subscale parameters (P<0.01), and so did both the physical and mental status (P<0.01). Tapentadol PR significantly reduced DN4 mean value (P<0.01) and the number of patients with neuropathic component (DN4 ≥4) (P<0.01). After 8 weeks of treatment, all patients were negative for the DN4 score. Tapentadol PR was well tolerated, and the use of other analgesics was reduced during the study period.ConclusionTapentadol PR started in doses of 100 mg/day was effective and well tolerated in opioid-naïve MBD patients with moderate-to-severe pain. Tapentadol PR can be considered a first-choice opioid in cancer patients suffering from mixed pain with a neuropathic component.

Bone pain mechanism in osteoporosis: a narrative review

“…In this situation, often a single agent is not enough and multiple mechanisms of action provide a rational basis for the use of combination therapy. In bone cancer pain, dual therapy with mu opioid receptor agonists and noradrenaline reuptake inhibitors (MOR/NRI) was shown to be effective in reducing neuropathic component of mixed pain (49). A balanced and early multimodal pain therapy including opioids, as necessary, even in case of acute pain, improve the functional capacity of patients and helps to prevent neurological alterations, which seem to contribute in a significant way in causing irreversible pain chronic syndromes (50).…”

Tapentadol extended release for the management of chronic neck pain

“…Conversely, the innovative dual-acting drug tapentadol ER was effective in other forms of mixed pain, such as LBP with a neuropathic component30 and cancer pain arising from bone metastases 38. To our knowledge, this is the first report of the efficacy of tapentadol ER in patients with chronic moderate–severe neck pain.…”

Tapentadol for Cancer Pain Management: A Narrative Review

“…Nine studies were found with the aforementioned characteristics (4 randomized clinical trials and five nonrandomized, open‐label trials or clinical practice studies) (see Flow Diagram in Figure , Tables and ). Of the randomized trials, one of them is an open‐label, phase III study, conducted in Japan, to evaluate the efficacy and tolerability of conversion to oral tapentadol ER (50 to 250 mg twice daily) from previous around‐the‐clock strong opioids in subjects with moderate‐to‐severe, chronic cancer pain, with the aim of being able to recommend this change if necessary in clinical practice .…”

“…Our appraisal of literature has also found five prospective, nonrandomized, open‐label trials or clinical practice studies about tapentadol ER involving 371 patients with cancer (see Table ) . Most studies reflect the experience of a relatively limited number of centers.…”

“…One of these is a subgroup analysis of a noninterventional study that investigated the administration of tapentadol ER for the treatment of severe chronic tumor pain in routine clinical practice in Germany . The remaining four articles are prospective open‐label studies that assessed the efficacy and tolerability of tapentadol ER in the management of cancer pain, tolerance with respect to other opioids, the rotation from morphine ER to tapentadol ER, or several outcomes in routine clinical practice . Overall, in these prospective open‐label cohort studies, median treatment duration was between 8 and 12 weeks .…”