title: Practical considerations for the use of tapentadol prolonged release for the management of severe chronic pain.
abstract: OBJECTIVE
  Chronic pain is often challenging to address appropriately. Although patients with severe chronic pain may respond to treatment with an opioid analgesic, opioids are often associated with adverse effects that may lead patients to disrupt or discontinue therapy. In addition, opioid analgesics alone may not be effective for all types of chronic pain, including neuropathic pain. Tapentadol prolonged release (PR), a centrally acting analgesic with 2 mechanisms of action (μ-opioid receptor agonism and noradrenaline reuptake inhibition), provides strong and reliable analgesia across a range of indications, including nociceptive, neuropathic, and mixed types of chronic pain, and is associated with an improved tolerability profile relative to classic opioid analgesics. The purpose of this article was to review the recent literature on different aspects related to the clinical use of tapentadol PR.
  
  
  METHODS
  A review was conducted of the current literature and relevant unpublished data on initiation and titration of tapentadol PR, switching from classic strong opioids, risk of withdrawal after discontinuation, long-term treatment, coadministration with other medications, and risk of abuse and diversion.
  
  
  RESULTS
  Tapentadol PR may provide clinically meaningful benefits over classic opioid analgesics, including ease of initiating and titrating tapentadol PR treatment in opioid-naive and opioid-experienced patients, low risk of withdrawal after cessation of tapentadol PR therapy, a favorable pharmacokinetic profile (allowing for coadministration with other medications) of tapentadol PR, and low potential for tapentadol PR abuse.
  
  
  CONCLUSIONS
  The broad analgesic efficacy of tapentadol PR may simplify chronic pain management by allowing for the treatment of different types of pain with a single analgesic. In addition, tapentadol is associated with a low risk of pharmacokinetic interactions, which permits its use in patients taking multiple medications. Furthermore, the favorable tolerability profile of tapentadol PR may result in improved patient compliance and allow for easy titration and rotation from previous strong opioids.
authors.affiliation: Pain Center, Hospital Costa del Sol, Marbella, Spain.
authors.forename: Manuel J
authors.initials: MJ
authors.lastname: Sánchez Del Águila
authors.affiliation: Community Havelhöhe, Center for Pain and Palliative Care, Berlin, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Schenk
authors.affiliation: Institute of Pain Medicine/Pain Practice, Wiesbaden, Germany.
authors.forename: Kai-Uwe
authors.initials: KU
authors.lastname: Kern
authors.affiliation: Grünenthal GmbH, Aachen, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Drost
authors.affiliation: Grünenthal GmbH, Aachen, Germany. Electronic address: ilona.steigerwald@grunenthal.com.
authors.forename: Ilona
authors.initials: I
authors.lastname: Steigerwald
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D059350:Chronic Pain / Q000175:diagnosis / Q000188:drug therapy*; D003692:Delayed-Action Preparations / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D010147:Pain Measurement; D010636:Phenols / Q000008:administration & dosage / Q000627:therapeutic use*; D000077432:Tapentadol
chemical_list: D000701:Analgesics, Opioid; D003692:Delayed-Action Preparations; D010636:Phenols; D000077432:Tapentadol
keywords: pain management; prolonged release; severe chronic pain; tapentadol