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

Chronic low back pain (CLBP) is one of the most common chronic pain conditions in pain practice. In the current study, we describe phenotypes of patients with CLBP based on the status of their endogenous pain modulatory system. 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. 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, 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.

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Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain.

Déclaration de conflit d'intérêts

The authors have no conflicts of interest to declare. This investigator initiated trial study was sponsored in part by Grünenthal GmbH, Aachen, Germany. Grünenthal had no influence on the design of the study and was not involved in the study execution, data analysis, or writing of the manuscript. T. van de Donk and A. Dahan received speakers fee from Grünenthal BV (the Netherlands).Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.