Focus on tapentadol: Role in the treatment of neuropathic pain

Neuropathic pain is a difficult-to-treat condition; pathologic changes in neuronal pathways may result in suboptimal analgesic control with opioid agents alone. Polypharmacy is employed often to simultaneously target multiple levels of the pain pathway, at the expense of escalated complexity of drug regimens and risk for drug-drug interactions and adverse effects. Tapentadol combines 2 mechanisms of action within a single molecule, allowing for mu-receptor activation and norepinephrine reuptake inhibition without the aforementioned drawbacks of multiple agent regimens. Recently approved in its extended-release formulation with favorable pharmacokinetics and improved gastrointestinal tolerance over pure opioids, tapentadol may prove cost effective when productivity and indirect costs are considered.