New pain medications increase doctors’ options

With the development of pain clinics, the treatment of chronic pain has become a specialized field of medicine that includes injections, devices, procedures and, of course, drugs.

Some of the drugs are used for acute (temporary) pain as well as chronic (long-term) pain. Other drugs should only be used for acute pain.

In the emergency department, I get lots of experience prescribing drugs for acute pain. People seem to get injured every day and come to the hospital looking for some relief from their suffering.

When they do, I must keep in mind their entire list of medical problems, allergies and current medications when prescribing something for their pain. Sometimes it is hard to think of a drug that fills the bill, especially in people who have had trouble with previous pain medicines for whatever reason.

That is why I am always happy to learn of another drug to try in these situations. In fact, the Food and Drug Administration recently approved a new drug called tapentadol (Nucynta) for treatment of moderate to severe acute pain in patients 18 years or older.

Although it has some structural similarity to tramadol (Ultram), which is not classified as a controlled substance, tapentadol has been classified as a Schedule II controlled substance. This means that it is in the same class as narcotics like morphine, demerol, dilaudid and others.

Studies show tapentadol to be as effective in treating pain as moderate doses of morphine and oxycodone. However, more than one in 10 patients reported nausea, dizziness, vomiting, headache and/or sleepiness. Seizures, which have been a problem with tramadol, are a theoretical concern but have not been reported.

Tapentadol has a high potential for abuse and discontinuing the drug without tapering the dose has led to symptoms consistent with withdrawal.

There are also some drug interactions with other pain medicines, antidepressants and migraine headache drugs that will require careful attention by the prescriber. This also means that nobody should casually take someone else’s tapentadol. It is never a good idea to take a prescription drug dispensed for another person unless instructed to do so by an appropriate and well-informed healthcare professional.

Tapentadol should be used carefully in patients with liver disease since it is mainly broken down and removed from the body by the liver. It should not be used at all in patients with severe liver or kidney impairment. Also, after the first dose, doses higher than 600 mg per day are not recommended.

With all of the above information in mind, I polled some local pharmacies and found that some of them do not have the drug on hand yet. However, one pharmacy has filled a prescription for it already.

Unless there is no alternative, I have no plans of using this drug any time soon since I have lots of prescribing experience with several older drugs that can control acute pain. It is also expensive, at nearly $2 per pill. However, I think it is very important to know about new drugs that may benefit patients who might not be able to take the older, cheaper drugs for some reason.

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