Emerging Drug Options: Moderate-to-Severe Pain

More than 25 million Americans experience acute pain each year as a result of injuries or surgery, and it’s the most common reason people seek medical attention. Several classes of medications—particularly opioids—have been historically used to treat moderate-to-severe pain, but the adverse effects of these medications can be difficult for patients to endure. Researchers are continuing to search for new medications and combinations of therapies that limit adverse effects while maximizing efficacy. Two Mechanisms of Action In November 2008, the FDA approved tapentadol (Nucynta, Johnson & Johnson Pharmaceutical R&D, to be marketed by PriCara, Division of Ortho-McNeil-Janssen). This new therapy, available in 50 mg, 75 mg, and 100 mg doses, is an immediate-release tablet indicated for the relief of moderate-to-severe acute pain in adults aged 18 and older. It’s a centrally acting oral analgesic that combines mu-opioid receptor agonist activity and norepinephrine reuptake inhibition. Mu-opioid agonists bind to and activate mu-opioid receptors in the central nervous system. These drugs modify sensory and affective aspects of pain and inhibit pain transmission at the spinal cord. They affect activity at parts of the brain that control how pain is perceived. Norepinephrine reuptake inhibitors, which also affect the central nervous system, are medications that increase the level of norepinephrine in the brain by inhibiting its re-absorption into nerve cells; these compounds have analgesic properties. Tapentadol provides analgesia through both of these mechanisms. Analyzing the Data The approval of tapentadol was based on data from clinical studies involving more than 2,100 patients. At the 2008 annual meeting of the American Pain Society, researchers presented multiple phase III studies demonstrating that tapentadol offered patients...