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Retardiertes Tapentadol bei Phantomschmerzen

Eine Fallserie

Prolonged-release tapentadol for phantom pain

A case series

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Zusammenfassung

Hintergrund

Immer noch stellt die erfolgreiche Behandlung von Phantomschmerzen aufgrund des letztlich ungeklärten Pathomechanismus eine große Herausforderung dar. Eine Therapie mit Tapentadol wurde bisher nicht beschrieben.

Patienten und Methoden

Wir berichten über die erfolgreiche orale Behandlung mit retardiertem Tapentadol in unterschiedlicher Dosierung bei 5 Patienten mit Phantomschmerzen der unteren und oberen Extremität.

Ergebnisse

Bei 4 Patienten zeigte sich eine stark verbesserte Schmerzlinderung von 4–6,5 auf einer visuellen Analogskala (VAS). Beim fünften Patienten stieg die Schlafdauer pro Nacht von 2 auf 5 h und die Phantomschmerzattacken verringerten sich um etwa 30 %. Bei 2 Patienten konnte die zusätzliche Medikation gesenkt oder zeitlich gestreckt werden. Nebenwirkungen (Schwindel, Müdigkeit) wurden nur in einem Fall beobachtet.

Schlussfolgerung

Die beschriebenen Fälle sind ein erster Hinweis darauf, dass die synergistische Kombination des µ-Opioidrezeptor(MOR)-Agonismus und der Noradrenalinwiederaufnahmehemmung (NRI) in Tapentadol einen Nutzen bei der Behandlung von Phantomschmerzen darstellen könnte.

Abstract

Objectives

The successful therapy of phantom pain remains a major challenge, because the underlying pathophysiological mechanisms are still not fully understood. A therapeutic approach with tapentadol has not been described so far.

Patients and methods

Five patients suffering upper and lower extremity phantom pain were successfully treated with tapentadol (prolonged release) with differing doses.

Results

In 4 patients, a strongly reduced pain intensity between 4 and 6.5 on the visual analog scale (VAS) was recorded. The fifth patient reported an increase in the nocturnal sleep duration from 2 to 5 h and a decrease in the number of phantom pain attacks by 30 %. In 2 patients, the additional medication could be lowered or stretched. Side effects (vertigo, fatigue) were only observed in one subject.

Conclusion

The cases described provide preliminary evidence that the synergistic combination of μ-opioid receptor agonism (MOR) and noradrenalin re-uptake inhibition (NRI) provided by tapentadol may be beneficial in the treatment of phantom pain.

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Interessenkonflikt

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin: Der Erstautor hat eine Beraterfunktion bei den Firmen Astellas, Berlin-Chemie, Boehringer Ingelheim, Betapharm, Grünenthal und Medi Bayreuth inne. Die weiteren Autoren geben an, dass kein Interessenkonflikt besteht. Die Erstellung dieser Fallstudie wurde von der Firma Grünenthal unterstützt.

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Authors and Affiliations

  1. Institut für Schmerzmedizin/Schmerzpraxis Wiesbaden, Sonnenberger Str. 68, 65193, Wiesbaden, Deutschland

    K.-U. Kern

  2. Schmerzambulanz, Universitätsklinikum Homburg (Saar), Homburg (Saar), Deutschland

    P. Bialas

  3. Praxis für Anästhesiologie und Schmerztherapie, Wallenhorst, Deutschland

    D. Fangmann

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  1. K.-U. Kern
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  2. P. Bialas
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  3. D. Fangmann
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Correspondence to K.-U. Kern.

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Kern, KU., Bialas, P. & Fangmann, D. Retardiertes Tapentadol bei Phantomschmerzen. Schmerz 27, 174–181 (2013). https://doi.org/10.1007/s00482-013-1309-y

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