Tapentadol treatment results in long-term pain relief in patients with chronic low back pain and associates with reduced segmental sensitization

Tine van de Donk; Jurjan van Cosburgh; Tom van Dasselaar; Monique van Velzen; Asbjørn Mohr Drewes; Albert Dahan; Marieke Niesters

doi:10.1097/PR9.0000000000000877

Tapentadol treatment results in long-term pain relief in patients with chronic low back pain and associates with reduced segmental sensitization

Pain Rep. 2020 Dec 17;5(6):e877. doi: 10.1097/PR9.0000000000000877. eCollection 2020 Nov-Dec.

Authors

Tine van de Donk¹, Jurjan van Cosburgh², Tom van Dasselaar¹, Monique van Velzen¹, Asbjørn Mohr Drewes¹, Albert Dahan¹, Marieke Niesters¹

Affiliations

¹ Department of Anesthesiology, Leiden University Medical Center, Leiden, the Netherlands.
² Department of Anesthesiology, Reinier de Graaf Gasthuis, Leiden, the Netherlands.

Abstract

Introduction: Chronic low back pain (CLBP) is one of the most common chronic pain conditions in pain practice.

Objectives: In the current study, we describe phenotypes of patients with CLBP based on the status of their endogenous pain modulatory system.

Methods: Conditioned pain modulation (a measure of central pain inhibition), temporal summation (TS, a measure of pain facilitation), and offset analgesia (a measure of temporal filtering of nociception) were evaluated in 53 patients with CLBP at painful and nonpainful sites. Next, in a double-blind, randomized, placebo-controlled trial, 40 patients with defective conditioned pain modulation responses received treatment with tapentadol prolonged-release or placebo for 3 months.

Results: The majority of patients (87%) demonstrated loss of central pain inhibition combined with segmentally increased TS and reduced offset analgesia at the lower back region. During treatment, tapentadol reduced pain intensity more than placebo (tapentadol -19.5 ± 2.1 mm versus placebo -7.1 ± 1.8 mm, P = 0.025). Furthermore, tapentadol significantly decreased pain facilitation by reduction of TS responses at the lower back (tapentadol -0.94 ± 1.9 versus placebo 0.01 ± 1.5, P = 0.020), which correlated with pain reduction (P < 0.001).

Conclusion: Patients with CLBP demonstrated different phenotypes of endogenous pain modulation. In patients with reduced conditioned pain modulation, tapentadol produced long-term pain relief that coincided with reduction of signs of pain facilitation. These data indicate that the endogenous pain system may be used as a biomarker in the pharmacological treatment of CLBP, enabling an individualized, mechanism-based treatment approach.

Keywords: Chronic low back pian; Conditioned pain modulation; Endogenous pain modulation; Offset analgesia; Temporal summation.