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

Autor:	Pujol J; MRI Research Unit, Department of Radiology, Hospital del Mar.; Department of Research, Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM G21., Martínez-Vilavella G; MRI Research Unit, Department of Radiology, Hospital del Mar., Doreste A; MRI Research Unit, Department of Radiology, Hospital del Mar.; Department of Clinical and Health Psychology, Autonomous University of Barcelona., Blanco-Hinojo L; MRI Research Unit, Department of Radiology, Hospital del Mar.; Department of Research, Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM G21., Ojeda F; Rheumatology Department, Hospital del Mar, Barcelona, Spain., Llorente-Onaindia J; Rheumatology Department, Hospital del Mar, Barcelona, Spain., Polino L; Rheumatology Department, Hospital del Mar, Barcelona, Spain., Deus J; MRI Research Unit, Department of Radiology, Hospital del Mar.; Department of Clinical and Health Psychology, Autonomous University of Barcelona., Monfort J; Rheumatology Department, Hospital del Mar, Barcelona, Spain.
Jazyk:	angličtina
Zdroj:	Rheumatology (Oxford, England) [Rheumatology (Oxford)] 2022 May 30; Vol. 61 (6), pp. 2335-2345.
DOI:	10.1093/rheumatology/keab761
Abstrakt:	Objective: 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. Methods: 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. Results: 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. Conclusion: 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. Trial Registration: EudraCT, https://eudract.ema.europa.eu, 2016-005082-31. (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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