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

Our back is a complex structure of joints, bones, ligaments, and muscles. A person can strain muscles, sprain ligaments, irritate joints, and rupture disks, which can lead to back pain. In addition, obesity, poor posture, arthritis, and psychological stress can cause or complicate back pain. 

Back pain is the leading factor of disability worldwide, preventing many people from engaging in work and other everyday activities. It affects people of all ages, from adolescents to the elderly. Experts estimate that up to 80% of the population will sometimes experience back pain. People living with disability caused by low back pain worldwide increased by 54% between 1990 and 2015.

Low back pain costs Americans at least $50 billion in health care costs each year.
Majorly people suffering from low back pain recover, however, its relapse is usual, and for a smaller percentage of people, the condition will become chronic and disabling.

Tapentadol Definition And Use

Tapentadol is a novel opioid analgesic belonging to the class of centrally acting drugs. The analgesic effect of the medication is from its combined effects of agonistic activity. Also, research has supported the role of Tapentadol as one of the most versatile pain medications to help manage moderate-to-severe pain in users.

The unique dual mechanism of the opioid analgesic (i.e., noradrenaline reuptake inhibitor and opioid agonist activity) contributes to reducing both acute and chronic pain. It also reduces the risk of drug interaction and side effects, and its multimodal functioning makes Tapentadol one of the most sought-after opioid medications on the market.

Tapentadol poses a risk of addiction, medicinal misuse and potential illegal diversion. On 22 June 2009, the Drug Enforcement Agency (DEA) in the United States approved the proposal to make Tapentadol a schedule II drug under the Controlled Substance Act.

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What Are The Causes of Back Pain?

Back pain is the most common medical problem worldwide and can range from a dull, constant ache to severe pain. Walking, sleeping, working, or doing other activities might be difficult. It can be diagnosed through CT, MRI, spine X-ray, or electromyography (EMG). 

The factors affecting the severity of back pain include age, weight, overall health, occupation, lifestyle, disease, or mental disorder. Back pain can occur from different injuries or conditions, often due to damage to tendons or muscles in the back.

  1. Fractures
  2. Stress and sprains
  3. Structural problem
  4. Disk problems
  5. Arthritis
  6. Spondylolisthesis

Diseases such as spine tumors, kidney stones, and abdominal aortic aneurysm, sleep disorder, shingles
Usually, lower back pain gets better with pain relievers, rest, and physical therapy (PT). Also, Back pain that does not respond well to OTC painkillers may require a prescription NSAID. cortisone injections and hands-on treatments (like osteopathic or chiropractic manipulation) can relieve pain and help to heal.

Can Tapentadol Treat Back Pain?

Tapentadol has a multimodal function system and is characterized by a unique mechanism of action that makes it the first representative of a class of central solid analgesics, which is referred to as mu-opioid agonist receptor and noradrenaline reuptake inhibitor (MOR-NRI). 

Worldwide, back pain (including lower back and neck pain) is the leading cause of disability. This pain is challenging to treat since it presents both a nociceptive and a neuropathic component. Selection of treatment should therefore consider the ability to prevent this event. 

The molecule tapentadol acts on both nociceptive and neuropathic components of pain, and it can therefore be effective in treating a mixed pain condition such as back pain. (Wild, J.E., Grond, S., Kuperwasser, B., Gilbert, J., McCann, B., Lange, B., Steup, A., Häufel, T., Etropolski, M.S., Rauschkolb, C. and Lange, R., 2010)

Tapentadol Dosages for Back Pain 

Usual Adult Dose for Acute Pain

Individualise therapy by considering the severity of pain, response to therapy, prior analgesic treatment experience, and risk factors for Abuse, misuse, and addiction:

Initial dose: 50 to 100 mg oral every 4 to 6 hours as required 
Its second dose (if needed) can be administered within an hour after the first dose. The maximum amount is 700mg on day 1.

  • Consume its lowest dose for the shortest duration or take the drug as the healthcare practitioner recommends.
  • Monitor regularly for respiratory depression, especially within the first 24 - 72 hours after the start of therapy and with an increase in each dose.
  • Due to addiction, Abuse, and misuse risks, even at recommended doses, reserve use for patients for whom alternative treatment options (e.g., non-opioid analgesics or opioid combination products) have not been tolerated or have not been provided are not expected to provide adequate analgesia.

Usual Adult Dose for Chronic Pain
Individualise therapy by taking into consideration severity of pain, response to therapy, medical history, and risk factors for addiction, Abuse, and Misuse:

  • Discontinue all other Tapentadol and tramadol products before starting Tapentadol extended-release tablets

Precautions Before taking Tapentadol

The new FDA Opioid Analgesic REMS has been designed to communicate the severe risks associated with opioid pain medications to patients and healthcare professionals. It involves a medication guide and elements to assure safe use. 

  • Drug Abuse, Misuse, and Addiction: Addiction to, Abuse, or misuse of this drug can lead to overdose and death. Assess each patient's risk before prescribing and regularly monitor for these behaviors or conditions.
  • Life-Threatening Respiratory Depression: Close monitoring is required after the initiation or following dose increase. The fatal outcome can occur with respiratory depression. 
  • Swallow tablets as a whole as chewing, crushing, or dissolving the pills can cause rapid absorption and release of a potentially fatal dose.
  • Accidental Ingestion: Accidental ingestion of the drug, especially in children, can be fatal.
  • Interaction with Alcohol: Do not consume alcoholic beverages or use products containing alcohol while on this drug, as it may result in fatal plasma Tapentadol levels.
  • Risks from Concomitant Use of Benzodiazepines or other CNS Depressants: Concomitant use of tapentadol with CNS depressants or benzodiazepines may result in extreme sedation, coma, respiratory depression, and death. 
  • Neonatal Opioid Withdrawal Syndrome: According to neonatal experts, prolonged use of any opioid during pregnancy can result in this life-threatening syndrome if not recognized and treated adequately.

Other Uses of Tapentadol

Tapentadol is an oral opioid analgesic that acts as an agonist of µ-opioid receptor and a norepinephrine reuptake inhibitor for treating moderate to severe acute pain.
Tapentadol is highly effective in the following conditions-

  1. Neuropathic pain is associated with diabetic peripheral neuropathy, which treats pain due to nerve damage in diabetic patients.
  2. Moderate to severe acute pain that is severe enough to take opioid analgesic 
  3. Chronic pain
  4. Cancer Pain
  5. Musculoskeletal pain
  6. Medical conditions such as osteoarthritis, arthritis

In patients with chronic pain from Fibromyalgia, the increase in inhibition of endogenous pain by tapentadol was translated into analgesia in patients with a normal CNFS.
This medicine is unsafe for pregnant or breastfeeding women and should inform the healthcare practitioner. 


Back pain is the most common medical problem worldwide and can range from a dull, constant ache to severe pain. It can occur from different injuries or conditions, often due to damage to tendons or muscles in the back. It can be treated with rest, physical therapy (PT), and pain relievers.

Tapentadol has a multimodal function system characterized by a unique mechanism of mu-opioid agonist receptor and noradrenaline reuptake inhibitor (MOR-NRI). The molecule tapentadol acts on both nociceptive and neuropathic components of pain, and it can therefore be effective in treating a mixed pain condition such as back pain. 

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