Tapentadol: A Novel, Centrally Acting Analgesic for Moderate-to-Severe Acute Pain

Objective: To review the role of tapentadol in the treatment of moderate-to-severe acute pain. Data Sources: Primary literature was retrieved by searching MEDLINE (1950-August Week 3, 2010), EMBASE (1980-Week 34, 2010), International Pharmaceutical Abstracts (1970-August 2010), and Google Scholar, A bibliographic review of published articles was also performed. Search terms included tapentadol, Nucynta, and acute pain. Study Selection and Data Extraction: Randomized controlled trials available in the English language that evaluated the efficacy and/or safety of tapentadol were included in this review. Data Synthesis: Tapentadol is a centrally acting analgesic that simultaneously activates mu-opioid receptors and inhibits the reuptake of norepinephrine in the central nervous system without affecting serotonin reuptake. We identified 6 randomized controlled trials that evaluated the use of tapentadol in over 3,000 adult patients in various acute pain models. Tapentadol was found to be superior to placebo for the management of moderate-to-severe acute pain and was found to be noninferior to oxycodone in the setting of post-bunionectomy pain and acute pain related to end-stage joint disease. Although the incidence of somnolence and dizziness was similar to that of oxycodone, tapentadol was less likely to cause nausea, vomiting, or constipation. Conclusions: Tapentadol is a novel analgesic with dual mechanisms of action that appears to be safe and effective for the management of moderate-to-severe acute pain. Future studies should focus on comparative efficacy as well as the role of tapentadol in chronic pain.