SUMAYYA
31 August 2022
Medically reviewed by
Kajal Jain
M. Pharm
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Table of Contents

Neuropathic pain, caused by disease or injury to the nervous system, includes various chronic conditions that affect up to 8% of the population. It may result from causes that affect the brain, spinal cord, and peripheral nerves.

Neuropathic pain shows unpleasant symptoms, such as shooting or burning pain, altered sensation (e.g., pins and needles) that are very difficult to describe, or numbness. It is especially problematic because of its severity and resistance to simple analgesics.

Some non-pharmacological treatments are out of there, like regular exercise, which improves your muscles' vital and helps relieve pain and control your blood sugar level. This is not suitable in all cases. Some chronic condition needs medical attention the person. Like the drug, tapentadol is an analgesic that helps in relieving pain.

Let us see in detail, 

What Is Tapentadol (Nucynta)?

Tapentadol is a centrally-acting opioid analgesic that has a dual mechanism. It acts as an agonist of the opioid receptor and as a norepinephrine reuptake inhibitor. It relieves moderate to severe acute pain in patients 18 years and older.  

Tapentadol is an alternative for patients who do not respond quickly to commonly prescribed opioid analgesics because it does not mediate its therapeutic effects via metabolism. 

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What Is Diabetic Peripheral Neuropathic Pain?

Diabetic neuropathies are the most common chronic complication of diabetes. It has an estimated lifetime prevalence exceeding 50% in people with diabetes. Among various forms of neuropathy, diabetic peripheral neuropathy (DPN) is the most common and causes considerable morbidity, impairs quality of life, and increases mortality.

  • Diabetic neuropathic pain (DNP) is characterized by tingling, burning, sharp, shooting, and lancinating or even electric shock sensations.
  • The pain is moderate to severe and often worse at night, causing sleeping disturbances.
  • DPN usually affects the toes and distal foot but gradually progresses proximally to involve the feet and legs. 
  • There is also progressive loss of nerve fibers resulting in diabetic retinopathy and nephropathy.
  • Foot ulceration and painful neuropathy are the main clinical consequences of diabetic peripheral neuropathy.
About 10% To 20% Of persons suffering from diabetic neuropathy, FDA approved some other drugs to treat this condition. Still, recently Food and drug administration approved Tapentadol via extended release for painful chronic conditions.
At first, adults should take only 50 mg two times a day; depending upon your severity, your doctor may adjust the dosage. You should not take more than 500 mg per day.
Some of the non-pharmacological treatments like cleaning your foot, maintaining the blood sugar level, Do exercise, having a balanced diet, sleeping well etc.

What Causes Diabetic Peripheral Neuropathic Pain?

Uncontrolled blood sugar damages nerves and impairs the transmission of signals, leading to diabetic neuropathy. 
High blood sugar also weakens the walls of the small vessels that nourish the nerves with oxygen and nutrients.

Risk factors

  • Poor blood sugar control
  • Diabetes history
  • Kidney disease- Diabetes can damage the kidneys. Kidney damage sends toxins into the blood and can lead to nerve damage.
  • Being overweight- A body mass Index (BMI) of 25 or more may increase the risk of diabetic neuropathy.
  • Smoking- Smoking narrows the arteries, reducing blood flow to the legs and feet. Consequently, it increases the difficulty of healing wounds and damages the peripheral nerves. 
  • Regularly drinking alcohol
  • People over 40 years old

Does Tapentadol Treat Diabetic Peripheral Neuropathic Pain?

FDA approved Tapentadol ER for both the treatment of moderate to severe chronic pain and for the management of neuropathic pain associated with diabetic peripheral neuropathy.

Tapentadol is similar to tramadol in its mechanism of action. Tapentadol ER provides adequate pain relief with twice-daily dosing. 

Tapentadol Dosing in Diabetic Peripheral Neuropathic Pain

  • Tapentadol Extended Release

  1. Initial Dose: 50–100 mg 4–6 times per day (Can take 700 mg on the first day)
  2. Maintenance dose: 600 mg daily 
  • The starting dose for opioid-naïve patients is 50mg twice daily and can be titrated to 100mg to 250mg twice daily. 
  • The daily dose is 250mg twice daily. 

Treatment For Diabetic Peripheral Neuropathic Pain

Treatment is centered initially around pain control. Effective pharmacological therapies for painful DPN include opioids, anti-epileptic agents and antidepressants 

Nonpharmacological therapies:

  • Health behavior interventions
  • Foot care-
  1. Keep your feet clean and dry. 
  2. Moisturize your feet. 
  3. Trim your toenails carefully. 
  4. Wear clean, dry socks.
  5. Wear cushioned shoes that fit well
  • Exercise
  • Blood sugar management
  • Reduced sedentary behavior
  • Dietary modification
  • Energy or nerve stimulation- High-frequency (10-kHz) spinal cord stimulation
  • Surgical Treatment-
  1. Debridement or amputation may be necessary if there are signs of necrosis or infection.
  2. Patients with intractable gastroparesis (severe nausea and vomiting, weight loss) undergo jejunostomy. Patients can take food enterally, bypassing the paralytic stomach.

Pharmacological therapies:

  • Opioids
  1. Tramadol- Initial dose: 50 mg QID 
  2. Maintenance dose: 200– 400 mg QID

Anticonvulsants- For symptomatic pain relief.

  • Pregabalin
  1. Initial dose: 25–75 mg TID
  2. Maintenance dose: 300–600 mg daily
  • Gabapentin
  1. Initial dose: 100–300 mg TID
  2. Maintenance dose:900– 3600 mg daily

SSRI

  • Duloxetine
  1. Initial dose: 20–30 mg once daily
  2. Maintenance dose: 60–120 mg once daily

Tricyclic anti-depressants

  • Amitriptyline
  1. Initial dose:10–25 mg once daily                             
  2. Maintenance dose: 25–100 mg once daily

Topical treatment:

  • Capsaicin 8% patch
  1. This alkaloid, found in red pepper, depletes tissue of substance P and reduces chemically induced pain.

Dietary Supplements

E.g., Alpha-lipoic acid, Actovegin 

Bottom Line From Practical Anxiety Solutions

Diabetic neuropathies are a common source of morbidity. It is necessary to control blood sugar, manage symptoms, and pay careful attention to foot care at this time to ensure optimal treatment.

  • Singh, Dewan Roshan, et al. "Tapentadol hydrochloride: A novel analgesic." Saudi journal of anaesthesia 7.3 (2013): 322. From https://doi.org/10.4103/1658-354X.115319  Obtain on 29/08/2022
  • Argoff, C. E., Cole, B. E., Fishbain, D. A., & Irving, G. A. (2006). Diabetic Peripheral Neuropathic Pain: Clinical and Quality-of-Life Issues. Mayo Clinic Proceedings, 81(4), S3-S11. From https://doi.org/10.1016/S0025-6196(11)61474-2  Obtain on 29/08/2022
  • Schwartz, Sherwyn, et al. "Safety and efficacy of tapentadol ER in patients with painful diabetic peripheral neuropathy: results of a randomized-withdrawal, placebo-controlled trial." Current medical research and opinion 27.1 (2011): 151-162. From https://doi.org/10.1185/03007995.2010.537589 Obtain on 29/08/2022
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