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曲马多:对其在疼痛管理中作用的全面综述。

Tapentadol: A Comprehensive Review of Its Role in Pain Management.

作者信息

Zavaleta-Monestel Esteban, Anchía-Alfaro Adriana, Villalobos-Madriz Jorge, Munich Amil, García-Montero Jonathan, Quesada-Villaseñor Ricardo, Arguedas-Chacón Sebastián, Hernández-Ortiz Andrés, Rodríguez-Miranda Roberto

机构信息

Pharmacy, Hospital Clínica Bíblica, San José, CRI.

Research, Hospital Clínica Bíblica, San José, CRI.

出版信息

Cureus. 2024 Nov 23;16(11):e74307. doi: 10.7759/cureus.74307. eCollection 2024 Nov.

DOI:10.7759/cureus.74307
PMID:39717323
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11666300/
Abstract

Pain is a prevalent issue among patients, requiring effective management to prevent the transition of acute pain into chronic pain and to mitigate significant clinical and socioeconomic impacts, such as increased morbidity, mortality, prolonged recovery, unplanned readmissions, and diminished quality of life. Despite advancements in pain management guidelines, achieving consistent pain relief remains challenging due to individual differences in pain thresholds, the nature of surgical procedures, patient age, and existing comorbidities. Tapentadol, an opioid that acts as both a μ-opioid receptor agonist and a noradrenaline reuptake inhibitor, presents a promising option for pain management. Approved by the FDA in 2008 for immediate release and in 2011 for extended release, tapentadol effectively addresses both nociceptive and neuropathic pain, offering a more favorable efficacy-safety profile compared to traditional opioids such as tramadol. Additionally, tapentadol is gaining recognition as a preferred option for managing significant pain in cancer patients due to its effectiveness and reduced side effects. This review evaluates tapentadol's clinical and pharmacological attributes, systematically analyzing literature on its efficacy, safety, pharmacokinetics, and comparative effectiveness, suggesting that tapentadol is a viable option for effective pain management with potential for broader clinical applications.

摘要

疼痛是患者中普遍存在的问题,需要进行有效管理,以防止急性疼痛转变为慢性疼痛,并减轻重大的临床和社会经济影响,如发病率和死亡率增加、恢复时间延长、计划外再入院以及生活质量下降。尽管疼痛管理指南有所进步,但由于疼痛阈值的个体差异、手术程序的性质、患者年龄和现有合并症,实现持续的疼痛缓解仍然具有挑战性。曲马多是一种兼具μ-阿片受体激动剂和去甲肾上腺素再摄取抑制剂作用的阿片类药物,为疼痛管理提供了一个有前景的选择。曲马多于2008年获美国食品药品监督管理局批准用于速释剂型,2011年批准用于缓释剂型,它能有效解决伤害性疼痛和神经性疼痛,与曲马多等传统阿片类药物相比,具有更有利的疗效-安全性概况。此外,由于其有效性和副作用减少,曲马多正逐渐被视为管理癌症患者重度疼痛的首选药物。本综述评估了曲马多的临床和药理学特性,系统分析了关于其疗效、安全性、药代动力学和比较有效性的文献,表明曲马多是有效疼痛管理的可行选择,具有更广泛临床应用的潜力。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6a58/11666300/2d87f0945487/cureus-0016-00000074307-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6a58/11666300/7d399900be02/cureus-0016-00000074307-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6a58/11666300/298faf454ad8/cureus-0016-00000074307-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6a58/11666300/2d87f0945487/cureus-0016-00000074307-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6a58/11666300/7d399900be02/cureus-0016-00000074307-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6a58/11666300/298faf454ad8/cureus-0016-00000074307-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6a58/11666300/2d87f0945487/cureus-0016-00000074307-i03.jpg

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本文引用的文献

1
Differences in the Analgesic Effect of Opioids on Pain in Cancer Patients With Spinal Metastases.阿片类药物对脊髓转移癌患者疼痛镇痛效果的差异
Palliat Med Rep. 2023 Aug 9;4(1):220-230. doi: 10.1089/pmr.2023.0018. eCollection 2023.
2
Tapentadol: A Review of Experimental Pharmacology Studies, Clinical Trials, and Recent Findings.曲马多:实验药理学研究、临床试验和最新发现的综述。
Drug Des Devel Ther. 2023 Mar 21;17:851-861. doi: 10.2147/DDDT.S402362. eCollection 2023.
3
Tapentadol for the management of cancer pain in adults: an update.
盐酸他喷他多治疗成人癌痛的临床应用进展
Curr Opin Support Palliat Care. 2023 Jun 1;17(2):90-97. doi: 10.1097/SPC.0000000000000641. Epub 2023 Mar 15.
4
Post-operative pain assessment, management compliance with WHO guidelines and its barriers in hospitals of West Shoa zone, central of Ethiopia, 2021.2021年埃塞俄比亚中部西绍阿地区医院的术后疼痛评估、符合世界卫生组织指南的管理情况及其障碍
Ann Med Surg (Lond). 2022 Nov 24;84:104901. doi: 10.1016/j.amsu.2022.104901. eCollection 2022 Dec.
5
Sex Differences in Oxycodone/Naloxone vs. Tapentadol in Chronic Non-Cancer Pain: An Observational Real-World Study.羟考酮/纳洛酮与曲马多治疗慢性非癌性疼痛的性别差异:一项观察性真实世界研究
Biomedicines. 2022 Oct 2;10(10):2468. doi: 10.3390/biomedicines10102468.
6
Cancer Pain and Opioid Use Disorder.癌症疼痛与阿片类药物使用障碍。
Oncology (Williston Park). 2022 Sep 7;36(9):535-541. doi: 10.46883/2022.25920973.
7
Oxycodone/naloxone versus tapentadol in real-world chronic non-cancer pain management: an observational and pharmacogenetic study.盐酸羟考酮/纳洛酮与酒石酸布托啡诺用于真实世界慢性非癌痛治疗的比较:一项观察性和药物遗传学研究。
Sci Rep. 2022 Jun 16;12(1):10126. doi: 10.1038/s41598-022-13085-5.
8
A prospective, multicenter, open-label study of the clinical efficacy of tapentadol extended-release in the treatment of cancer-related pain and improvement in the quality of life of opioid-naïve or opioid-resistant patients.一项关于曲马多缓释片治疗癌症相关性疼痛的临床疗效和改善阿片类药物初治或耐药患者生活质量的前瞻性、多中心、开放性研究。
Support Care Cancer. 2022 Jul;30(7):6103-6112. doi: 10.1007/s00520-022-06992-w. Epub 2022 Apr 14.
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Tapentadol in Cancer Patients with Neuropathic Pain: A Comparison of Methadone, Oxycodone, Fentanyl, and Hydromorphone.曲马多在癌症合并神经病理性疼痛患者中的应用:与美沙酮、羟考酮、芬太尼和氢吗啡酮的比较。
Biol Pharm Bull. 2021;44(9):1286-1293. doi: 10.1248/bpb.b21-00212.
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The effects of tapentadol and oxycodone on central processing of tonic pain.曲马多和羟考酮对强直性疼痛中枢处理的影响。
Clin Neurophysiol. 2021 Oct;132(10):2342-2350. doi: 10.1016/j.clinph.2021.07.021. Epub 2021 Aug 17.