The efficacy of tapentadol prolonged release in the treatment of mixed cancer pain

Abstract

Pain can be experienced at every stage of cancer and its treatment (50% to 90%); about 19–39.1% of patients suffer from neuropathic pain and 75% from mixed pain. Due to different treatment strategy a proper diagnosis of pain is of high importance. Opioids with a pure agonist effect are used to treat moderate and severe nociceptive pain and adjuvant drugs in the first line treatment of neuropathic pain. Tapentadol is the only centrally acting opioid that combines two mechanisms of action — mu-opioid receptor (MO­R)-agonist and norepinephrine reuptake inhibitor (NRI) activities. This specificity of action particularly predisposes tapentadol for use in mixed pain as well as in the therapy of various pain syndromes, both in the mechanism of re­ceptor and neuropathic pain. The indication for the use of tapentadol is the treatment of chronic pain of high severity in adults, which can be properly controlled only after the use of opioid analgesics. In experimental and clinical studies, the efficacy and good safety profile of tapentadol was proofed, both in acute (somatic and visceral) and chronic pain syndromes, including neuropathic pain. Most of the studies concern chronic non-cancer pain. In the present case, the aspect of the occurrence of mixed cancer pain in course of pancreatic cancer with coexisting chemotherapy-induced neuropathy (treated with gabapentin) is emphasized. Due to the lack of good visceral control the combined method was used with opioids i.e. fentanyl TTS and oxycodone. Neurolysis of the celiac plexus was performed, followed by followed by main opioid rotation for tapentadol PR, resulting in a reduction in basic (visceral and neuropathic pain), and a reduction in the severity of breakthrough pain episodes, which were controlled by rapid-acting transmucosal fentanyl.