Istituto Prosperius Tiberino, Intensive Rehabilitation Centre, Umbertide, Perugia, Italy.
Eur Rev Med Pharmacol Sci. 2019 Nov;23(4 Suppl):21-26. doi: 10.26355/eurrev_201911_19376.
The treatment of chronic pain frequently combines pharmacologic and non-pharmacological options, and analgesia after surgery is of major importance. Tapentadol is both µ-opioid receptor agonist (with a 40% agonism on these receptors) and noradrenaline reuptake inhibitor, with similar analgesic efficacy to strong opioids, but fewer adverse effects. For these reasons, tapentadol may represent a valuable first choice option in the treatment of chronic, neuropathic, and mixed pain.
The primary endpoint of the present study was the proportion of responder patients, with ≥30% reduction in pain intensity during loading on the NRS; several additional endpoints were also evaluated.
Twenty-five adult patients were enrolled, with a rate of response to treatment of 100%. Moreover, pain reduction was as high as 50% in 23/25 patients (92%). The average NRS at rest at V0 was 7.2 ± 1.0, whereas the average NRS at loading was 7.7 ± 0.9; this score significantly decreased at all visits. The score of the Roland-Morris questionnaire, a score of disability, improved significantly throughout the study (p<0.0001), as well as the Barthel Index (p<0.0005), and the neuropathic component of pain, which was significantly reduced during the study, from 88% at V0 to 12% at V3. Sleep quality improved throughout the study, and the treatment was rated as good (91% of patients) or optimal (9%).
Our findings show that tapentadol PR may contribute to improve patients' quality of life, especially during rehabilitation after back surgery, when tapentadol PR treatment is effective and well tolerated.
慢性疼痛的治疗常结合药物和非药物选择，手术后的镇痛尤为重要。曲马多既是μ阿片受体激动剂（对这些受体有 40%的激动作用），也是去甲肾上腺素再摄取抑制剂，其镇痛效果与强阿片类药物相当，但不良反应较少。由于这些原因，曲马多可能是治疗慢性、神经性和混合性疼痛的有价值的首选药物。
本研究的主要终点是应答患者的比例，即 NRS 负荷时疼痛强度至少降低 30%；还评估了其他几个终点。
共纳入 25 例成年患者，治疗应答率为 100%。此外，23/25 例（92%）患者的疼痛缓解率高达 50%。V0 时静息状态下的平均 NRS 为 7.2±1.0，而负荷时的平均 NRS 为 7.7±0.9；所有随访时评分均显著降低。残疾评分罗伦兹-莫瑞斯问卷（Roland-Morris questionnaire）评分在整个研究过程中显著改善（p<0.0001），以及巴氏指数（Barthel Index）（p<0.0005）和疼痛的神经性成分也显著降低，从 V0 时的 88%降至 V3 时的 12%。整个研究过程中睡眠质量均有所改善，治疗效果被评为良好（91%的患者）或最佳（9%）。
我们的研究结果表明，曲马多控释片可能有助于改善患者的生活质量，尤其是在背部手术后的康复期间，此时曲马多控释片治疗有效且耐受性良好。
