Journal des rapports de cas cliniques

Switching From High Doses of Opioids to Tapentandol PR: Two Cases of Neuropathic Pain–Cancer and Non-Cancer

Abstract

Vincenzo Pota, Maria Caterina Pace, Maria Beatrice Passavanti, Pasquale Sansone, Manlio Barbarisi and Caterina Aurilio

Opioids represent the main treatment for moderate to severe chronic pain both oncological than neuropathic one. They are assuredly effective drugs to relieve the pain symptoms but are burdened in chronic use by adverse events that may limit their use (tolerance, nausea, vomiting, itching, sleepiness). The strategy of switching opioids is a response to this. Rotation from one opioid to another, regulated by conversion tables, is useful to ensure a better balance of analgesia and toxicity. Tapentadol is a novel, centrally acting analgesic with dual mechanism of action, combining mu-opioid receptor agonism with noradrenaline reuptake inhibition in the same molecule. It has an improved side effect profile when compared to opioids and nonsteroidal anti-inflammatory drugs. The dual mechanism of action makes Tapentadol a useful analgesic to treat acute, chronic, and neuropathic pain. As the Pain Treatment Service of the Second University of Naples, we present two clinical cases of patients being treated with high dose opioids who we rotated to tapentadol.