How Chronic Pain Affects Your Mind – and Why Tapentadol 100mg May Offer Relief

What is chronic pain 

Chronic pain, ( that lasts above three to six months ), impacts a large portion of the Australian population and interferes with their day-to-day activities. A journal published in the AIOHW (Australian Institute Of Health and Welfare ) has shown that 1 out of every 5 Australian adults aged 45 and over are affected by chronic pain, with females and individuals with comorbid disorders bearing the brunt of the problem.

Chronic pain can stem from various sources like trauma, surgery, or musculoskeletal conditions. A cross-sectional survey of Australian general practice showed a 19.2% prevalence of chronic pain, with osteoarthritis and back pain being the most common causative agents. 37.1% and 28.3%  of the subjects reported moderate to severe algesic problems. The study concluded that chronic pain is a significant public health burden impacting the patient's quality of life physically while having a lasting impact on their psychological well-being.

link between physical pain and mental health

Pain and mental health are closely interrelated, with chronic pain significantly increasing the risk of developing or worsening mental health conditions. Living with chronic pain can cause a range of unpleasant emotions like frustration, anger, anxiety and shame. Also referred to as secondary suffering and encompassing the additional challenges and negative impacts arising from living with long-term chronic pain, it encompasses social and emotional consequences, including difficulty doing day-to-day tasks or inability to complete certain tasks on time.

The result is loss of work or loss of social status, impacting self-esteem and financial security and accelerating isolation, loneliness and financial insecurity.

Let us understand the process in a better manner.

Mental Health Impact 

How chronic pain affects mood, sleep, and emotions

While the exact correlation between pain mechanism and mood changes has not yet been identified, recent studies have demonstrated an overlap between pain and mood changes. Animal models have demonstrated a shared sensory pathway of body pains and the regions involved in mood management, including the insular cortex, prefrontal cortex, thalamus, hypothalamus and anterior cingulate regions that form a structural foundation for the coexistence of pain and emotional networking.

Additional studies have observed a slightly depressed volume of the prefrontal cortex and hippocampus with reduced prefrontal cortex synapses and identical neuroplasticity changes in pain models, suggesting a similar pattern of maladaptive plasticity changes in either model.

The sum total of the research resulted in researchers agreeing that chronic pain and depression are based on common neuroplasticity mechanism changes that impact their occurrence, intensity and development. On a secondary note, the prefrontal cortex  regulates sleep characteristics including sleep-onset, dreams and maintenance because of which disruptions or changes in the PFC result in sleep disturbances and negatively impact working memory, emotional control and attention.

The psychological burden of living with constant pain

While depression affects 5% of the general population, among patients with chronic pain, 35% to 40% experience depressive symptoms. Research has shown a bidirectional relationship between depression and pain, with chronic pain increasing the risk of developing depression and depression being a positive indicator of the development of chronic pain.

A study conducted by Swinkels et al., who conducted a study of fear of pain in 615 individuals with an acute episode of back pain, showed a pattern of findings consistent with that seen in patients with chronic pain. Patients with acute low back pain reporting a high fear of pain had a higher chance of displaying high levels of disability and avoided participating in home, work, social or leisure activities.

It is important to understand that

the regions of the brain of a healthy person work in balance with each other, and when one region is more active, the other regions are less active to maintain equilibrium. In chronic pain patients, this equilibrium changes. In chronic pain conditions, the region of the brain that regulates emotions is constantly active even when other regions are more active and wear out the brain, resulting in atrophy ( weakening ), neuropathies ( nerve malfunctioning ) or contractures ( nerve tightening ).

Studies have demonstrated that chronic pain patients can lose up to 11% of grey matter that is in charge of learning, memory, attention and motor control, resulting in cognitive challenges even in areas not directly related to pain. The loss of 11% because of chronic pain is equivalent to the grey matter that would be lost in 10 to 20 years of ageing. Keeping this in mind, it is crucial to get effective help to reverse the damage in time.

What You Can Do

Importance of seeing a doctor or pain specialist

When pain keeps you up at night and starts interfering with your day-to-day activities, it is important to see a doctor to get back your quality of life. GPs specialising in pain management are the ones who can evaluate, diagnose and treat your condition through medications, injections, neuromodulation or other procedures.

The first step while getting treatment is the correct diagnosis, which may require a thorough physical evaluation, any tests or diagnostic imaging and an assessment of your medical records. After evaluating your medical history and diagnostic imaging records, they develop a comprehensive care plan to help manage pain.

Counselling and lifestyle support options (e.g., therapy, support groups)

Pain isn't just about the body. It is about the whole self. For chronic pain, combining conventional treatment with CBT ( Cognitive Behavior Therapy ) helps individuals develop coping skills to deal with the emotional and psychological impact of the pain.

While evidence-based pharmacological methods are effective in sustainably reducing pain and restoring function, pain management programs like CBT teach the skills to attain the balance of managing pain with planning their day while understanding their limits and communicating their needs.

It is a well-established fact that medications are the mainstream of pain management that help reduce algesia and conduct day-to-day activities. Opioids are usually the most sought-after treatment option because of their impact on the pain receptors.

Tapentadol is a mu-opioid receptor that works in the same way as opioids but has a safer profile, making it a preferable option for managing long-term chronic pain.

Image Credit - https://en.wikipedia.org/wiki/Tapentadol

Role of Tapentadol 100mg

Efficacy

Several studies have demonstrated the effectiveness of Tapentadol in chronic pain conditions like osteoarthritis, lower back pain, neuropathic pain and even cancer pain.

Data on patients with severe chronic knee or hip osteoarthritis pain has demonstrated the efficacy of Tapentadol PR within three months of treatment. It effectively reduces pain intensity and pain-related restrictions on daily functioning and improve physical and mental quality of life in osteoarthritis patients. The medication is tolerated by the elderly age group above 65 years and has a lower incidence of adverse drug reactions.

Other studies have demonstrated the effectiveness of Tapentadol ER in lower back conditions with a comparable tolerability to Oxycodone. In a study conducted on 981 patients with moderate to severe chronic back pain, Tapentadol ER significantly reduced average pain intensity and was associated with significantly lower treatment-emergent adverse reactions. It relieved moderate to severe lower back pain over fifteen weeks and had better gastronomical tolerability than Oxycodone.

While osteoarthritis and back pain impact 7.1 % of Australian adults, Neuropathic pain impacts 1 in 20 Australians and impacts their day-to-day activities and has economic consequences.

Tapentadol comes in handy in managing various conditions of neuropathic pain, including diabetic neuropathy and cancer-related nerve pain. According to a paper by the Journal of Advances in Medicine and Medical Research, Tapentadol can help manage Diabetic polyneuropathy pain and is well tolerated in older individuals.

It has been further recognized as an adequate pharmacotherapy solution for pain relief in skeletal metastatic breast cancer patients. Australia recorded 20,640 new cases of breast cancer in 2022, making it a crucial treatment plan for pain relief among Australian medical cases.

Dual Mechanism Of Action

Tapentadol incorporates dual effects of mu-opioid receptors and noradrenaline reuptake inhibition, making it a safer pain relief option while enabling it to work over a wide range of pain actions from nociceptive to neuropathic pain. Norepinephrine is a neurotransmitter that suppresses pain by inhibiting pain signals. Serotonin or 5HT sensitizes pain nerve fibres in inflammatory and neuropathic pain conditions to help reduce pain in painful conditions.

Tapentadol, during its course of action, increases extracellular norepinephrine ( NE ) levels by more than 5HT, reducing the risk of serotonin-related side effects and treating physical and emotional aspects of chronic pain.

Comparison with other Opioids

Despite being a mu-opioid receptor, Tapentadol has a similar efficacy to Morphine and Oxycodone in pain relief. That said, it has fewer adverse reactions and a favourable gastronomical profile because of its pharmacological properties.

Data has shown Tapentadol to be two to three times more potent than Tramadol despite having a similar activity on noradrenergic receptors. It is well suited for chronic pain conditions that do not respond satisfactorily to other treatment options and has a favourable gastrointestinal profile.

An important POV while discussing mu-opioid receptors of Tapentadol is mu-load or how much it relies on the opioid system to exert its pain-relieving actions. Tapentadol's mu-load is less than 40%, meaning it uses less than half of the opioid activity of medications like Morphine and Oxycodone, and the remaining main relief comes from its norepinephrine-boosting action, reducing opioid-related side effect risk like drowsiness, respiratory depression and the risk of addiction.

Tolerability

Several studies have demonstrated the safety and efficacy of Tapentadol 100 mg in managing moderate to severe chronic pain and providing symptomatic relief to the patient. Previous Phase 3 Trials have demonstrated that Tapentadol Prolonged Release is effective and well-tolerated in managing chronic osteoarthritis and lower back pain as well as in managing pain related to peripheral diabetic neuropathy.

Open-label trials have even demonstrated Tapentadol as an effective and tolerable option for chronic pain conditions inadequately managed by WHO Step I or II analgesics, coanalgesics or that were not treated adequately with regular analgesics.

Tapentadol 100 mg can be used in patients with mild to moderate kidney disease without dosage adjustments.

Long Term Use  

Results of a one-year open-extension study, including safety data from patients who received Tapentadol 100 Mg ER for up to two years, have indicated the medication to be a well-tolerated option that is safe and effective for the management of moderate to severe chronic pain.

The study conducted on 1154 individuals from different sites in Australia, the United States, Canada, and New Zealand showed that Tapentadol 100 mg ER was an effective option for chronic osteoarthritis pain or low back pain for up to two years without any major adverse reactions. Headache, nausea and constipation were the most common treatment-emergent adverse reactions. Pain relief and improvements in quality of life were maintained throughout the study and were effective for individuals of all age groups dealing with long-term pain.

Research has even shown the tolerability of Tapentadol in musculoskeletal pain conditions with a continued benefit over up to two years of treatment. It can be a useful option in chronic pain patients exhibiting tolerance to opioids or in need of a safe opioid option.

Conclusion

Chronic pain can impact the physical health, mental well-being, job prospects and financial security of an individual. if not managed timely, the symptoms can exacerbate and even lead to mortality risks. Timely intervention and effective treatment can go a long way in helping the person regain their self-confidence and continue their day-to-day activities without any untoward problems.

Tapentadol 100 mg is an effective treatment option that can work for acute and chronic pain conditions without compromising the safety of the patient. It has an efficacy tolerable to that of conventional opioids with an added safety and efficacy profile, making it popular among GPs and patients. Even then, it is important to use it wisely, under the guidance of the physician, to obtain safe results without compromising the patient's health.