Effects of tapentadol on pain, motor symptoms and cognitive functions in Parkinson’s disease

Abstract

BackgroundPain is a common and undertreated non-motor symptom in patients with Parkinson’s disease (PD). Opioids have been seldom used in PD because they could worsen cognitive and motor functions.ObjectiveWe aimed to assess efficacy and tolerability of tapentadol in PD patients.MethodsWe retrospectively reviewed 21 PD patients treated with tapentadol extended release (ER) for chronic pain. Patients were evaluated before treatment and at 3 and 6 months during treatment for pain intensity (current, 24-hour average, and minimum and worst) with a 0–10 Numerical Rating Scale and the painDETECT questionnaire; for motor symptom severity with the Unified PD Rating Scale part III and the Hoehn and Yahr scale; for cognitive functions with Mini-Mental Status Examination, Corsi’s Block-Tapping test, Digit Span test, Digit-Symbol Substitution test, FAS test, Rey’s Auditory Verbal Learning test, Trail-Making test A and B and the 9-Hole Peg test; for anxiety and depression with the Hospital Anxiety and Depression Scale; and for the quality of life with the Short Form-12. Data were analyzed by 1-way analysis of variance and paired t-test, and by Friedman’s and Wilcoxon’s tests. Statistical significance was taken in all cases as P<0.05.ResultsPain intensity decreased over the course of treatment. No differences were found in PD symptom severity and dopaminergic drug dosages between pretreatment and treatment evaluations. No decrement in cognitive neuropsychological performances was found and an improvement was observed in Digit Span test, Digit-Symbol Substitution test, and FAS test. The levels of anxiety, depression, and quality of life improved. Overall, tapentadol ER was well tolerated and most patients reported no or mild and short-lived gastroenterological and neurological side effects.ConclusionThese results indicate the potential efficacy and tolerability of medium–high doses of tapentadol ER for the treatment of pain in PD.

Anticholinergic medicines use among older adults before and after initiating dementia medicines

“…For instance, concurrent use of anticholinergic medicines is not recommended with cholinesterase inhibitors; however, the primary pharmacological management for behavioural and psychological disturbances in dementia are antipsychotics such as risperidone. 15,18,[28][29][30][31][32] In our study, the antipsychotic risperidone was the most commonly dispensed medicine with anticholinergic effects both before and after initiating dementia medicines. Under PBS restrictions, risperidone formulations are only eligible for government subsidy for managing behavioural and psychological symptoms of dementia; thus accounting for the substantial number of dispensings captured in our data.…”

“…This leads to increased challenges for clinicians with ever‐extensive clinical responsibilities and makes it difficult to determine what approach to take. For instance, concurrent use of anticholinergic medicines is not recommended with cholinesterase inhibitors; however, the primary pharmacological management for behavioural and psychological disturbances in dementia are antipsychotics such as risperidone …”

“…In an attempt to reduce variation in the management of dementia and to improve quality of care, best practice guidelines including those of the National Institute for Health and Care Excellence and American Psychiatric Association now recommend medicine reviews at the time of diagnosis to reduced irrational medicine use in patients with dementia . These reviews also provide an opportunity to identify and rule out any reversible cause of confusion such as adverse effects of other medicines or untreated comorbidities .…”

“…14 In an attempt to reduce variation in the management of dementia and to improve quality of care, best practice guidelines including those of the National Institute for Health and Care Excellence and American Psychiatric Association now recommend medicine reviews at the time of diagnosis to reduced irrational medicine use in patients with dementia. [15][16][17][18][19] These reviews also provide an opportunity to identify and rule out any reversible cause of confusion such as adverse effects of other medicines or untreated comorbidities. 20 Recommendations on improving clinical outcomes have been updated; however, decisions on reducing potentially inappropriate combinations of medicines, such as concomitant use of dementia and anticholinergic medicines are challenging due to lack of clarity in guidelines for managing comorbidities in patients with dementia.…”

Receptor Ligands as Helping Hands to L-DOPA in the Treatment of Parkinson’s Disease

“…Tapentadol , a µ opioid receptor agonist with a serotonin/noradrenaline reuptake inhibitor activity, efficaciously reduced pain and was well tolerated in PD patients [336] (Figure 17).…”