Targinact, licensed for severe pain, is a formulation of prolonged‐release oxycodone with the addition of naloxone to improve opioid‐induced bowel dysfunction. Here, the authors discuss the clinical data relating to its efficacy and adverse effects, and describe its place in treatment. Copyright © 2009 Wiley Interface Ltd.

Chronic pain is common, and opioid therapy is often required for pain management. Unfortunately, opioid-induced bowel dysfunction (OIBD) is a frequent and debilitating side-effect of opioid use. A new prolonged-release (PR) preparation of oxycodone/naloxone has been developed for moderate-to-severe pain that reduces OIBD in patients. In this article, we consider the mode of action and efficacy of this combination opioid therapy for chronic pain. C hronic pain, which can be defined as pain that persists or progresses over a prolonged period, 1 is a widespread problem affecting 19% of adults across Europe. 2 In a large-scale telephone sur vey involving 46 394 respondents in 15 European countries and Israel, the most common source of chronic pain was low back pain (24%), which was most often due to osteoarthritis (34%). 2 More in-depth interviews took place with 4839 of those who had reported chronic pain. This showed that 66% had moderate pain assessed by a Visual Analogue Score (VAS) of 5-7 (rating 1 as being no pain and 10 as the worst pain imaginable), 34% had severe pain (VAS of 8-10), 46% had constant pain and 54% had intermittent pain. 2 For many people, the duration of pain was prolonged: 59% had pain for 2-15 years, while 21% had pain for more than 20 years. CHRONIC PAIN AND USE OF OPIOIDSNonsteroidal anti-inflammator y drugs (NSAIDs), anticonvulsants, antidepressants, membrane stabilisers and opioids are all used to treat chronic pain. Careful dose titration and management of side-effects are essential for optimal pharmacotherapy. The World Health Organization (WHO) recommends opioids for managing moderate-tosevere cancer pain, but the role of opioids in chronic non-cancer pain is less established; they are increasingly being used to treat chronic non-cancer pain. 3 Breivik et al found that only 5% of those taking prescription medications for pain were taking a strong opioid. 2 There may be a need to optimise opioid use for those patients who do not respond to other analgesic regimens including pharmacological and non-drug therapies. Opioids may be useful for neuropathic and nociceptive pain if other strategies fail to provide adequate analgesia within a reasonable time. 4 Opioids are an important treatment option but they must be carefully prescribed and their use managed appropriately.A large meta-analysis of 41 randomised trials involving 6019 patients with nociceptive pain (osteoarthritis, rheumatoid arthritis or back pain), neuropathic pain Prolonged-release oxycodone/ naloxone for chronic pain Naloxone binds selectively to intestinal opioid receptors, without blocking the analgesic effect of oxycodone. SCIENCE PHOTO LIBRARY

New results from three phase III clinical studies for the novel centrally-acting analgesic tapentadol show similar high efficacy of tapentadol immediate release tablets (IR) compared with standard opioid oxycodone IR, among patients treated for severe pain. Those taking tapentadol, however, benefited from lower incidences of side effects, particularly gastrointestinal (GI) side-effects.