The role of opioids in the management of chronic neck pain is still poorly investigated and there no literature available on Tapentadol extended release (ER).

Domenico Billeci and colleagues conducted an observational study to evaluate the efficacy and tolerability of Tapentadol ER in patients with moderate to severe chronic neck pain. The study included 54 patients suffering from chronic neck pain. The patients were selected based on pre-defined inclusion and exclusion criteria. Inclusion criteria were 1) men, non-pregnant and non-lactating women ≥18 years old; 2) clinically diagnosed with moderate-severe chronic neck pain 3) cervical degenerative disease, causing axial neck pain or radiculopathy.

Each patient received a dose of Tapentadol ER 100 mg/day, and this dosage was then adjusted according to clinical needs. The parameters recorded were changed in average pain intensity; Douleur Neuropathique 4 score; Neck Disability Index score (0-5), Neck range of motion; Pain-associated sleep interference; Quality of life (Short Form [36] Health Survey); Patient Global Impression of Change (PGIC) and Clinician GIC to evaluate patient's global health status; opioid-related adverse events; and need for other analgesics. The daily dosage of Tapentadol ER was raised from 100 mg/day to a mean dosage of 204.5 mg/day at the final assessment.

Of all, 44 patients completed the 12-week observation. The significant decrease in the mean pain intensity at the movement from baseline to 12 weeks (8.1 [1.1]) to all time points (p<0.01). At baseline, 70% of patients showed a positive neuropathic component, which dropped to 23% after 12 weeks.  Significant improvement in Neck Disability Index scores from baseline to final evaluation [55.6 (18.6) to 19.7 (20.9)] (p<0.01). Significant improvement was seen in neck range of motion in all three planes of motion, especially in lateral flexion. Quality of life considerably improved in all Short Form (36) Health Survey subscales (p<0.01) and in both physical and mental status (p<0.01). Based on PGIC results, nearly 90% of patients rated their overall condition as much/very much improved and based on CGIC evaluation, 93.1% reported much/very much improved.  Tapentadol was well tolerated, and no patients discontinued due to side effects. The use of other analgesics was reduced during the observed period.

The results indicated that Tapentadol ER started at 100 mg/day, was efficient and well tolerated in patients with chronic neck pain, including opioid-naïve patients. Patients can expect a decrease in pain, an improvement in neck function, and a decrease in neuropathic symptoms.