Mercadante, S., Porzio, G., Ferrera, P., Aielli, F., Adile, C., Ficorella, C., . . . Casuccio, A. (2012). Tapentadol in cancer pain management: A prospective open-label study. Current Medical Research and Opinion, 28, 1775–1779.
To evaluate the efficacy and tolerability of tapentadol (TP) in the management of cancer pain
Fifty consecutive patients with advanced cancer and moderate-to-severe pain initially were given 50 mg doses of slow-release TP twice a day, along with oral morphine 5 mg (initial dose) as breakthrough medication. Doses were managed to provide adequate pain relief or dose-limiting toxicity. Non-opioid medications were continued, provided they were tolerated. Adjuvant symptom relief medications were continued. Patients were visited or contacted at least weekly in order to change therapy. Parameters were assessed before starting therapy and at weekly intervals for four weeks. Parameters included pain intensity (0–10), symptoms associated with pain therapy, quality of life using the Spitzer scale, TP escalation index percent at week 4 ([TP maximum dose - TP starting dose] / TP starting dose / days x 100), and the presence of neuropathic pain using the PainDETECT questionnaire.
Pain intensity significantly decreased from baseline to all week intervals. Some symptoms varied in intensity during the study. Drowsiness increased in week 1 and decreased at week 4. Dry mouth increased from weeks 1–3 and decreased from weeks 1–4. No significant changes were seen in intensity of confusion, nausea, or constipation. Quality of life increased each week. TP escalation index (TPEI) percent and TPEI in mg were 1.78 and 2.26, respectively. No relationship was found between TPEI indexes and primary tumor, pain mechanism, PainDETECT, age, or gender. TPEI was lower in this study than in prior studies with a similar design. This may reflect less tolerability of TP in this study. TP had low discontinuation levels and was well tolerated.
Pain levels significantly decreased during the study. TPEI in this study was lower than in prior studies with a similar design that may reflect less tolerability of TP. TP was well tolerated with low discontinuation levels.
TP is not widely used in the United States and will require education of nurses on its use and side effects.