TAPENTADOL THERAPY IN CHRONIC PAIN MANAGEMENT: OUR EXPERIENCE

Tapentadol je novi lijek registriran u retard obliku za umjerenu i jaku kroničnu bol koji svojim spektrom djelovanja pokriva i nociceptivnu i neuropatsku komponentu boli. Analgetski se učinak postiže djelovanjem dvaju sinergističkih mehanizama: agonističkim učinkom na mi opioidne receptore (MOR-agonizam) i inhibicijom ponovnog preuzimanja noradrenalina (NRI). Cilj: Usporediti naša iskustva o učinkovitosti i podnošljivosti tapentadola s iskustvima drugih istraživača u svijetu. Metode: U istraživanje su uključena 92 bolesnika iz naše ambulante za bol, kojima je bilo indicirano propisati tapentadol-retard u dozi od dva puta 50 mg ili višoj. Pratili smo povoljni učinak na smanjenje bolova prema vizualno-analognoj ljestvici (VAS) te vrstu i učestalost neželjenih učinaka lijeka. Bilježene su i daljnje preporuke za prilagodbu doze odnosno prekid terapije. Rezultati: Pojava povoljnog djelovanja tapentadola na smanjenje kronične boli kod različitih bolnih sindroma pokazala se u 66 %, ispitanika. Postotak nuspojava, od blažih do težih, iskazalo je 43 % bolesnika. Pedeset i četiri % korisnika tapentadola odustalo je od terapije, 37 % zbog nuspojava, 15 % zbog nezadovoljstva kontrolom boli i 2 % zbog neodobravanja obiteljskog liječnika. Zaključak: Našim istraživanjem potvrđena je dobra učinkovitost tapentadola na smanjenje boli. Nuspojave se u ukupnom broju javljaju sličnom učestalošću kao u podatcima iz literature, i to rjeđe nego kod terapije klasičnim opioidima. Uočena je visoka stopa prekida terapije što je u prvom redu pripisano pojavi neželjenih učinaka.Tapentadol is a novel analgesic registered in slow-release form for medium-intensity and intense chronic pain, which targets both the nociceptive and neuropathic component of the pain signal. It utilizes two synergistic mechanisms: MOR – mu opioid receptor agonism and NRI – norepinephrine reuptake inhibition. The goal of this study was to compare the effectiveness of pain management and tolerability of tapentadol in our clinical experience with existing reports from abroad. The study included 92 patients from our pain management clinic who were prescribed slow-release tapentadol in doses of at least 50 mg twice daily. We tracked the effectiveness of pain management recorded using the visual analog scale, as well as the appearance and type of adverse effects. Further directions for dose adjustment or discontinuation of therapy were also recorded. In our experience, 66% of patients reported a satisfactory analgesic effect. The adverse effect rate was 43%; 54% of patients discontinued tapentadol therapy, i.e. 37% due to adverse effects, 15% because of inadequate pain management, and 2% because of a negative attitude of their primary care physician. Our study confi rmed the effi cacy of pain management with tapentadol. The total adverse effect rate was comparable to reports found in the literature and was lower than with classical opioid therapy. A relatively high therapy discontinuation rate was noted primarily due to adverse effects