Billeci Domenico, Coluzzi Flaminia
Division of Neurosurgery, Ca'Foncello Hospital, University of Padova, Treviso.
Department of Medical and Surgical Sciences and Biotechnologies, Unit of Anaesthesiology, Intensive Care Medicine, and Pain Therapy, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy.
J Pain Res. 2017 Mar 2;10:495-505. doi: 10.2147/JPR.S129056. eCollection 2017.
The role of opioids in the management of chronic neck pain is still poorly investigated. No data are available on tapentadol extended release (ER). In this article, we present 54 patients with moderate-to-severe chronic neck pain treated with tapentadol ER.
Patients received tapentadol ER 100 mg/day; dosage was then adjusted according to clinical needs. The following parameters were recorded: pain; Douleur Neuropathique 4 score; Neck Disability Index score; range of motion; pain-associated sleep interference; quality of life (Short Form [36] Health Survey); Patient Global Impression of Change (PGIC); Clinician GIC; opioid-related adverse effects; and need for other analgesics.
A total of 44 of 54 patients completed the 12-week observation. Tapentadol ER daily doses increased from 100 mg/day to a mean (standard deviation) dosage of 204.5 (102.8) mg/day at the final evaluation. Mean pain intensity at movement significantly decreased from baseline (8.1 [1.1]) to all time points (<0.01). At baseline, 70% of patients presented a positive neuropathic component. This percentage dropped to 23% after 12 weeks. Tapentadol improved Neck Disability Index scores from 55.6 (18.6) at baseline to 19.7 (20.9) at the final evaluation (<0.01). Tapentadol significantly improved neck range of motion in all three planes of motion, particularly in lateral flexion. Quality of life significantly improved in all Short Form (36) Health Survey subscales (<0.01) and in both physical and mental status (<0.01). Based on PGIC results, approximately 90% of patients rated their overall condition as much/very much improved. Tapentadol was well tolerated: no patients discontinued due to side effects. The use of other analgesics was reduced during the observed period.
Our results suggest that tapentadol ER, started at 100 mg/day, is effective and well tolerated in patients with moderate-to-severe chronic neck pain, including opioid-naïve subjects. Patients can expect a decrease in pain, an improvement in neck function, and a decrease in neuropathic symptoms.
阿片类药物在慢性颈部疼痛管理中的作用仍研究不足。关于缓释曲马多（ER）尚无相关数据。在本文中，我们介绍了54例接受缓释曲马多治疗的中重度慢性颈部疼痛患者。
患者接受每日100毫克的缓释曲马多治疗；随后根据临床需求调整剂量。记录了以下参数：疼痛；神经病理性疼痛4分；颈部功能障碍指数评分；活动范围；与疼痛相关的睡眠干扰；生活质量（简短形式[36]健康调查）；患者总体变化印象（PGIC）；临床医生总体变化印象（GIC）；与阿片类药物相关的不良反应；以及对其他镇痛药的需求。
54例患者中有44例完成了12周的观察。在最终评估时，缓释曲马多的每日剂量从100毫克/天增加到平均（标准差）剂量204.5（102.8）毫克/天。运动时的平均疼痛强度从基线时的8.1（1.1）显著下降至所有时间点（<0.01）。基线时，70%的患者存在阳性神经病理性成分。12周后，这一比例降至23%。缓释曲马多将颈部功能障碍指数评分从基线时的55.6（18.6）提高到最终评估时的19.7（20.9）（<0.01）。缓释曲马多在所有三个运动平面上均显著改善了颈部活动范围，尤其是在侧屈方面。在所有简短形式（36）健康调查子量表（<0.01）以及身体和心理状态方面（<0.01），生活质量均显著改善。根据PGIC结果，约90%的患者将其总体状况评为改善很多/非常多。缓释曲马多耐受性良好：没有患者因副作用而停药。在观察期内，其他镇痛药的使用减少。
我们的结果表明，起始剂量为每日100毫克的缓释曲马多对中重度慢性颈部疼痛患者有效且耐受性良好，包括未使用过阿片类药物的患者。患者有望疼痛减轻、颈部功能改善且神经病理性症状减少。
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