Neurológia pre prax 3/2014

Chronické bolesti zad a využití nového opioidního analgetika tapentadolu

MUDr. Jan Lejčko

Chronicke bolesti v lumbosakralni oblasti s radikularni komponentou jsou .asto obti.n. le.itelne. Usp..nost le.by se zvy.uje p.i sou.asnem pou.iti vice le.ebnych modalit. Je-li bolest intenzivni, titrace opioid. k ov..eni opioid-senzitivity je indikovana. Kombinace opioid. s gabapentinoidy byva u.inn.j.i, jeliko. t..i ze vzajemne kombinace odli.nych mechanizm. u.inku. Individualni tolerabilita k t.mto le.iv.m v.ak podmi.uje nale.ite vyu.iti jejich davkovaciho spektra. Opioid tapentadol je molekulou s dualnim efektem spo.ivajicim jak ve schopnosti aktivovat ƒĘ receptor, tak zarove. blokovat zp.tnou resorbci noradrenalinu, a proto je dnes .azen do nove, tzv. MOR- -NRI t.idy opioidnich analgetik. Kombinace t.chto dvou mechanizm. u.inku vytva.i p.edpoklad pro dosa.eni nale.ite analgezie i v p.ipadech chronickych bolesti zad s radikularni slo.kou. Kazuistika pacientky s chronickymi bolestmi zad s ischiasem a .irokou intoleranci k do te doby pou.itym opioid.m a antineuropatickym le.iv.m poukazuje na zlep.enou kontrolu bolesti po zahajeni titrace tapentadolu.

Kľúčové slová: bolest zad, neuropatická bolest, opioidy, tapentadol.

Chronic low back pain and use of new opiod analgesic tapentadol

Chronic low back pain with radicular component may not be adequately managed with available therapeutic options. Multi-modal approach to chronic pain treatment is more effective than monotherapy. Treatment with strong opioids is justified if pain is intractable. Combination of opioids and gabapentinoids takes advantage of various mechanisms of action and is more efficient than monotherapy. However, pharmacological tolerability of these agents is individual to a considerable extent and thus may decrease appropriate utilization their dosage potential. Opioid tapentadol is the first compound of the new pharmacological class MOR-NRI, that combines ě-opioid- -agonist and noradrenalin re-uptake inhibitor activities in one molecule. The integration of these two inherent mechanisms of action in one agent creates assumption for promising analgesic efficacy with an improved tolerability profile. Tapentadol may be an interesting option for pharmacological treatment of low back pain with radicular component. Case report of patient suffering from chronic low back pain with sciatica demonstrates satisfactory pain control when treatment with tapentadol was initiated.

Keywords: back pain, neuropathic pain, opioids, tapentadol.