SUMAYYA
28 August 2022
Medically reviewed by
Kajal Jain
M. Pharm
tapentadol-for-ostrearthritis
Table of Contents

Osteoarthritis (OA) is the most common joint disorder, affecting 32.5 million adults in the United States. Among older adults, it is the leading cause of disability. The annual incidence of knee OA is highest between 55 and 64 years of age.

OA affects 13.9% of people over 24 and 33.6% over 64. Knee OA is the most common form. 19% of Americans over age 45 have knee OA.

62% of people with OA are women. In people younger than 45, OA is more common in men; over 45, OA is more common in women. (Matthews, G.L. and Hunter, D.J., 2011)

Tapentadol

Tapentadol is a centrally-acting opioid analgesic to relieve moderate to severe acute pain in adults. Tapentadol acts by activating mu-opioid receptors and inhibiting norepinephrine reuptake.

As it is not a pro-drug and does not mediate its therapeutic effect via metabolism, Tapentadol is an alternative for patients who do not respond quickly to commonly prescribed opioid analgesics.

Indications for use:

Moderate to severe pain, musculoskeletal pain, including neuropathic pain associated with diabetic peripheral neuropathy.

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Osteoarthritis 

Osteoarthritis is a degenerative disorder of the joint in which joint tissue breaks down over time. People with OA usually have joint pain that stiffens for a short period after rest or inactivity.

Osteoarthritis affects each person differently. In some people, osteoarthritis is moderate and does not interfere with everyday activities. In others, it causes severe pain and disability. (Perrot, S., 2015)

The most commonly affected joints in OA include:

  • Hands
  • Knees.
  • Hips.
  • Neck.
  • Lower back.

Types of Osteoarthritis

Primary OA has no known underlying cause. It is also known as idiopathic OA.
Secondary OA is due to another condition or trauma to the joint, such as a sports injury or repetitive use.

Causes of Osteoarthritis Pain

Osteoarthritis occurs when the cartilage and other tissues within the joint break down or change structure.

  • Ageing
  • Being overweight or obese
  • Overuse due to repetitive movements of the joint
  • Joints that do not form properly.
  • Family history of osteoarthritis.
  • Genetic predisposition
  • Previous history of injury or surgery for joint pain

Is Tapentadol an Effective medicine for Osteoarthritis Pain?

Proper management of pain is crucial to the management of OA. Tapentadol is an innovative, dual-acting analgesic molecule that combines two mechanisms of action, MOR agonism and NRI.

Its simultaneous reduction in adverse event burden is unprecedented and makes this drug particularly suitable for OA-associated pain, especially when a neuropathic component is present.

Tapentadol ER provided effective and well-tolerated treatment of severe chronic OA pain concerning the incidence of specific adverse events. 

The favourable tolerability profile supports Tapentadol ER as a treatment option before other opioids. For patients with severe OA pain, Tapentadol appears to hold promise as a safe, effective therapeutic option. (Lange, B., Kuperwasser, B., Okamoto, A., Steup, A., Häufel, T., Ashworth, J. and Etropolski, M., 2010)

Dosages of Tapentaol for Osteoarthritis Pain

Initial dose: 50 mg twice daily.
Administer the second dose as early as one hour after the first dose 

Acute Moderate- to-Severe Pain

Immediate-release tablet or oral solution: 50-100 mg PO every 4-6 hrs; not to exceed 700 mg on day 1 and 600 mg/day following days.

Chronic (extended-release tablet)

50-250 mg as needed every 12 hours

Opioid-naive patients: Start with 50 mg BD every 12hr as needed; not to exceed 500 mg/day.

Opioid-experienced patients: The initial dose depends on the type of the previous analgesic used.

Chronic Severe Pain

50-250 mg as needed every 12 hours; not to exceed 500 mg/day.

Opioid-naive patients: 50 mg PO every 12 hours; titrated to optimal dosage as required; not to exceed 500 mg/day.

Alternatives for Osteoarthritis Pain

Physical Activity 

Exercise is considered a treatment for OA - perhaps the most effective treatment - rather than just a way to manage the condition.

  1. Flexibility and balance exercises 
  2. Aerobic activities - Water aerobics, walking, and riding a stationary bicycle are good options.
  3. Strengthening exercises - These are important for joint stability and function.
  • Diet and weight loss - Be sure to eat a balanced diet.
  • Assistive Devices – These help to relieve your pain and improve your ability to move. These may include supports, braces, splints, shoe orthotics, grabbers, canes, and walkers.
  • Physical and Occupational Therapy - It can help you perform daily activities better and help you manage your OA by developing a specific program.

Pain Management

  • Analgesics- Analgesics are medications used to relieve pain. Acetaminophen is a non-opioid analgesic that does not reduce inflammation or swelling but is helpful when pain is the main problem.
  • NSAIDs- Nonsteroidal anti-inflammatory drugs help relieve joint pain, stiffness, and swelling. E.g., aspirin, ibuprofen, and naproxen sodium. 
  • Injectables- Corticosteroids can be injected into an affected joint to relieve pain and swelling. Hyaluronic acid therapy involves injecting the joint with a substance that occurs naturally in joint fluid and helps lubricate and cushion the joint.
  • Antidepressants- Duloxetine has been approved by the FDA for chronic musculoskeletal pain.
  • Topical Pain Relievers- Topical pain relievers are available as creams, gels, patches, rubs, or sprays. They contain salicylates, skin irritants, and local anaesthetics to relieve pain. Some NSAIDs are also available by prescription for topical use.
  • Nutritional Supplements- Glucosamine and chondroitin sulfate are supplements that many believe relieve OA pain. Be sure to talk to your doctor about potential benefits and risks before taking these - or any other- supplements.
  • Surgery- Surgery may be helpful if your joints are severely damaged, you have severe joint pain, or you are disabled because of mobility problems. Different types of surgery are available for people with OA. It includes removing or replacing damaged cartilage or restoring all or part of the joint.

Non-Medicinal Pain Relief

  • Heat and cold treatments- Heat directly applied helps in chronic pain. Cold packs provide relief for acute pain.
  • Relaxation techniques- Train your muscles to relax and slow your thoughts with deep breathing, guided imagery, and visualization.
  • Massage- Massages can help relieve arthritis pain, improve joint function and reduce stress and Anxiety.
  • Acupuncture- Acupuncture, the insertion of fine needles into the body at specific points, has been shown to relieve pain.

Conclusion

If you have osteoarthritis, it is essential to know how to manage your pain and schedule and plan your daily activities. A better understanding of the disease and active management can improve your outcomes and quality of life.

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