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Tapentadol potentiates descending pain inhibition in chronic pain patients with diabetic polyneuropathy.

Abstract：

BACKGROUND:Tapentadol is an analgesic agent for treatment of acute and chronic pain that activates the µ-opioid receptor combined with inhibition of neuronal norepinephrine reuptake. Both mechanisms are implicated in activation of descending inhibitory pain pathways. In this study, we investigated the influence of tapentadol on conditioned pain modulation (CPM, an experimental measure of endogenous pain inhibition that gates incoming pain signals as a consequence of a preceding tonic painful stimulus) and offset analgesia (OA, a test in which a disproportionally large amount of analgesia becomes apparent upon a slight decrease in noxious heat stimulation). METHODS:Twenty-four patients with diabetic polyneuropathy (DPN) were randomized to receive daily treatment with tapentadol sustained-release (SR) [average daily dose 433 (31) mg] or placebo for 4 weeks. CPM and OA were measured before and on the last day of treatment. RESULTS:Before treatment, none of the patients had significant CPM or OA responses. At week 4 of treatment, CPM was significantly activated by tapentadol SR and coincided with significant analgesic responses. CPM increased from 9.1 (5.4)% (baseline) to 14.3 (7.2)% (placebo) and 24.2 (7.7)% (tapentadol SR, P<0.001 vs placebo); relief of DPN pain was also greater in patients treated with tapentadol than placebo (P=0.028). Neither placebo nor tapentadol SR treatment had an effect on the magnitude of the OA responses (P=0.78). CONCLUSIONS:Tapentadol's analgesic effect in chronic pain patients with DPN is dependent on activation of descending inhibitory pain pathways as observed by CPM responses. CLINICAL TRIAL REGISTRATION:The study was registered at trialregister.nl under number NTR2716.

journal_name

Br J Anaesth

journal_title

British journal of anaesthesia

authors

Niesters M,Proto PL,Aarts L,Sarton EY,Drewes AM,Dahan A

doi

10.1093/bja/aeu056

subject

Has Abstract

pub_date

2014-07-01 00:00:00

pages

148-56

issue

1

eissn

0007-0912

issn

1471-6771

pii

S0007-0912(17)31555-6

journal_volume

113

pub_type

杂志文章,随机对照试验

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