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Tapentadol effects on brain response to pain in sensitized patients with knee osteoarthritis

他喷他多 医学 麻醉 骨关节炎 类阿片 痛觉过敏 伤害感受器 内科学 伤害 病理 受体 替代医学
作者
Jesús Pujol,Gerard Martínez‐Vilavella,Andrea Doreste,Laura Blanco‐Hinojo,Fabiola Ojeda,Jone Llorente‐Onaindia,L. Polino,Joan Deus,Jordi Monfort
出处
期刊:Rheumatology [Oxford University Press]
卷期号:61 (6): 2335-2345 被引量:4
标识
DOI:10.1093/rheumatology/keab761
摘要

Pain sensitization, in the form of knee tenderness and anatomically spread hyperalgesia, is notably common in patients with knee OA and is often refractory to conventional interventions. Tapentadol, as an opioid receptor agonist and noradrenaline reuptake inhibitor, has been proposed as a potentially effective symptomatic treatment for pain-sensitized OA patients. We empirically tested whether tapentadol could attenuate brain response to painful stimulation on the tender knee using functional MRI.Painful pressure stimulation was applied to the articular interline and the tibial surface, a commonly sensitized site surrounding the joint. Thirty patients completed the crossover trial designed to compare prolonged release tapentadol and placebo effects administered over 14 days.We found no effects in the direction of the prediction. Instead, patients administered with tapentadol showed stronger activation in response to pressure on the tender site in the right prefrontal cortex and somatosensory cortices. The somatosensory effect was compatible with the spread of neural activation around the knee cortical representation. Consistent with the functional MRI findings, the patients showed higher clinical ratings of pain sensitization under tapentadol and a significant positive association was identified between the number of tapentadol tablets and the evoked subjective pain.The tapentadol effect paradoxically involved both the spread of the somatosensory cortex response and a stronger activation in prefrontal areas with a recognized role in the appraisal of pain sensations. Further studies are warranted to explore how OA patients may benefit from powerful analgesic drugs without the associated risks of prolonged use.EudraCT, https://eudract.ema.europa.eu, 2016-005082-31.
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