Efficacy and tolerability of tapentadol for the treatment of chronic low back pain in elderly patients

Freo, Ulderico; Furnari, Maurizio; Ambrosio, Francesco; Navalesi, Paolo

doi:10.1007/s40520-020-01586-0

Cited by 11 publications

(20 citation statements)

References 40 publications

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“…Since even a short course with NSAIDs has been associated with severe adverse events, gastro-intestinal, renal, and cardiovascular side effects should be routinely monitored [ 4 , 5 ]. As NSAIDs are not indicated for chronic use, opioids have been the mainstay for the long-term treatment of chronic MSP [ 6 , 7 , 8 ]. However, in contrast to positive reports in young patients, there is a lack of well-designed specific studies on the efficacy and safety of opioids in the elderly patients [ 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Paracetamol: A Review of Guideline Recommendations

Freo

Ruocco

Valerio

et al. 2021

JCM

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108

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Musculoskeletal pain conditions are age-related, leading contributors to chronic pain and pain-related disability, which are expected to rise with the rapid global population aging. Current medical treatments provide only partial relief. Furthermore, non-steroidal anti-inflammatory drugs (NSAIDs) and opioids are effective in young and otherwise healthy individuals but are often contraindicated in elderly and frail patients. As a result of its favorable safety and tolerability record, paracetamol has long been the most common drug for treating pain. Strikingly, recent reports questioned its therapeutic value and safety. This review aims to present guideline recommendations. Paracetamol has been assessed in different conditions and demonstrated therapeutic efficacy on both acute and chronic pain. It is active as a single agent and is additive or synergistic with NSAIDs and opioids, improving their efficacy and safety. However, a lack of significant efficacy and hepatic toxicity have also been reported. Fast dissolving formulations of paracetamol provide superior and more extended pain relief that is similar to intravenous paracetamol. A dose reduction is recommended in patients with liver disease or malnourished. Genotyping may improve efficacy and safety. Within the current trend toward the minimization of opioid analgesia, it is consistently included in multimodal, non-opioid, or opioid-sparing therapies. Paracetamol is being recommended by guidelines as a first or second-line drug for acute pain and chronic pain, especially for patients with limited therapeutic options and for the elderly.

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Section: Introductionmentioning

confidence: 99%

Paracetamol: A Review of Guideline Recommendations

Freo

Ruocco

Valerio

et al. 2021

JCM

Self Cite

108

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“…29 ) to −5.3. 35 Data on sleep quality were available for 442 patients ( Table 3 ) and indicated that the percentages of patients reporting very disturbed sleep were lowered by tapentadol with a percent reduction ranging from 62.5% to 100%. Importantly, the documented significant pain relief from baseline ( Table 1 ) was paralleled by an increased proportion of patients reporting good/restful sleep following treatment with tapentadol in all the analysed studies ( Table 3 ), with a greater proportion of patients reporting good/restful sleep at the end of the study period compared to baseline (72.4% versus 25.3%; p <0.01) ( Figure 1 ).…”

Section: Resultsmentioning

confidence: 99%

Pain reduction induced by tapentadol in patients with musculoskeletal chronic pain fosters better sleep quality

Vellucci¹,

Rosa²,

Piraccini³

2021

DIC

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Background Poor sleep may predict the increase and intensification of pain over time with increased insomnia symptoms being both a predictor and an indicator of worse pain outcomes and physical functioning status over time. However, the impact of different analgesic therapies on quality of life, functional recovery and sleep has been poorly assessed to date, whereas these evaluations may greatly help clinicians in the selection of treatment when dealing with patients with chronic pain (CP). Methods To explore whether tapentadol-induced pain relief may drive improved sleep quality, we carried out a pooled analysis of real-world data collected from 487 patients with CP (mean age, 68.3 years; 57.7% women) suffering from a wide range of chronic musculoskeletal pain conditions and treated with tapentadol. Results Following tapentadol treatment, patients experienced an 80% reduction in the frequency of very disturbed sleep as well as a 50% reduction in the predominant sleep complaint reported by patients with CP – that is, nocturnal awakenings. A significantly greater proportion of patients reported good/restful sleep at the end of the study period compared to baseline (72.4% versus 25.3%; p <0.01). This benefit was observed regardless of the clinical setting, treatment duration, posology or patient age and was associated with a higher proportion of patients reporting an improved global health status and good tolerability. Conclusion The reduction in pain intensity provided by tapentadol fosters sleep quality and favours a better quality of life. Therefore, our findings provide the rationale for addressing sleep quality as a relevant outcome, complementary to pain relief in CP management.

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“…According to the SmPC of tapentadol and to recent data [34,35], no a priori dose adjustment is necessary in patients aged 65 years and older, in the absence of hepatic or renal impairment. In practice, a careful dose titration based on individual response is recommended in elderly patients treated with tapentadol [34].…”

Section: Dosage In Elderly Patientsmentioning

confidence: 99%

“…In recent years, elderly patients were included in several studies of tapentadol [34,35,[76][77][78], some of which were active-controlled trials [77]. Durations of follow-up were short (maximum of 4 months), and a high proportion of elderly patients discontinued tapentadol use because of adverse effects [34,77].…”

Section: Chronic Pain Of Non-cancer Origin In Elderly Patientsmentioning

confidence: 99%