Tapentadol vs Oxycodone: Which Painkiller Works Best in the UK?

Introduction

Tapentadol and Oxycodone are two important opioid analgesic medications used for moderate to severe pain management that, despite the similarity in use, vastly differ in mechanism of action, safety, and effectiveness.

Tapentadol is a safer option than Oxycodone with similar effectiveness. Literature has demonstrated improved gastronomical tolerability in Tapentadol users, coupled with a lower chance of abuse potential at minimal doses. Further, it is more effective for neuropathic pain. That said, it is important to delve deeper into each medication before arriving at a conclusion.

Tapentadol and Oxycodone - An Overview

Tapentadol is a synthetic centrally acting analgesic that targets MOR ( Mu Opioid Receptors ) and NE ( Norepinephrine Reuptake ) to alleviate pain. A paper by the Korean Journal of Pain has demonstrated Tapentadol’s affinity for mu-opioid receptors to be 50 times less than that of Morphine.

Tapentadol was introduced by the United States Food and Drug Administration ( FDA ) in 2008 and approved by the UK in 2011 for severe chronic pain managed only with opioid analgesics.

Oxycodone, available under the brand names Roxycodone and OxyContin, is a semi-synthetic opioid that targets the mu, kappa, and delta opioid receptors to work on pain. It has been FDA-approved to manage acute or chronic moderate to severe pain when opioid medication is considered suitable and alternative pain management strategies are ineffective.

Similarities between Tapentadol and Oxycodone

Let us have a quick review of the similarities between Tapentadol and Oxycodone.

Drug Class

Both Tapentadol and Oxycodone are opioid analgesics that work on target mu-opioid receptors to block pain signals from traveling to the brain, along with impacting the emotional aspects of pain perception.

FDA Approved

FDA has approved Tapentadol in 2008 and Oxycodone in 1976; Both medications are available in immediate-release and extended-release versions for pain management.

Classification and Labelling

Tapentadol and Oxycodone are classified as Schedule II controlled substances In the US.

In the UK, they are classified as Class A Controlled Drugs.

Tapentadol vs Oxycodone - Key Differences

To make the correct choice while selecting Tapentadol and Oxycodone, it is equally important to understand their key differences.

Mechanism of Action :- While Tapentadol and Oxycodone target the mu-opioid receptors to block pain signals, Tapentadol exerts additional impact on norepinephrine reuptake, increasing its effectiveness for neuropathic pain.

Potency :- Tapentadol has a weaker mu-opioid potency than Oxycodone, significantly decreasing its abuse potential.

Best For :- Tapentadol is a better option for mixed nociceptive pain ( pain from injury and inflammation ) and neuropathic pain ( from nerve damage or malfunction ) Oxycodone works very well for nociceptive pain and has even been effective to some extent for cancer-related pain while showing a poor response for neuropathic pain.

Safety Profile :- Tapentadol has a greater gastrointestinal tolerability than Oxycodone with lower rates of nausea. Additionally, histamine release is less in Tapentadol in comparison to Oxycodone.

Tapentadol vs Oxycodone - A comparison of their Uses

Oxycodone is a pure mu-opioid receptor agonist whose strongest effect is in the cortex and limbic system of the brain, where it reduces the perception of pain. Additionally, it alters the emotional response to pain, changing how pain is perceived once the signal has reached the brain, resulting in less distress and the ability to cope with pain better.

This makes Oxycodone a welcome option for nociceptive pain, especially post-surgical pain, trauma, or fracture-related pain, and even in arthritic pain.

Tapentadol, along with activating mu-opioid receptors in the cortical region of the brain, works in the norepinephrine receptors in the spinal cord, helping lower the intensity of incoming pain signals, reducing the emotional response to pain. The result is an increased response to neuropathic or mixed pain, especially chronic back pain with nerve compression or cancer pain with neuropathic components.

A Comparison of Tapentadol and Oxycodone Benefits

In a study conducted on 114,410 patients undergoing surgery, out of which 2775 received Oxycodone and 153o, Oxycodone demonstrated better results than Tapentadol, with Oxycodone patients demonstrating decreased length of stay and fewer adverse reactions.

In a study conducted on 343 patients with moderate to severe cancer pain, Tapentadol showed comparative or even better results in reducing the intensity of pain. The Patient Global Impression of Change recorded 58.7% of the Tapentadol group reported much improved pain than 50.4% in the Oxycodone group. Patients were very satisfied with Tapentadol treatment of their cancer-related pain and reported much improvement in their general condition after switching to Tapentadol.

Tapentadol vs Oxycodone - A Comparison of Their Effectiveness

There can be no denying the fact that Tapentadol has a similar effectiveness to Oxycodone while having a safer profile.

Literature searches using Medline and Cochrane Databases have shown that the prolonged-release form of Tapentadol and Oxycodone offers a fast onset of analgesia, and controls pain for 12 hours, providing clinically meaningful relief of moderate to severe pain and improving quality of life across a broad spectrum of pain types.

Data has shown that for the same pain-relieving effect, 25 mg of oral Tapentadol is equivalent to 5 mg of Oxycodone. Even then, Tapentadol 50 mg is associated with lower rates of nausea, dizziness, and constipation than Oxycodone 10 mg, making it a safer option for cancer patients. Most importantly, breast cancer patients with neuropathic pain reported a higher response rate to Tapentadol.

Tapentadol vs Oxycodone - Side Effects and Safety Concerns

Tapentadol and Oxycodone have different safety profiles and side-effect considerations despite their opioid connection.

Tapentadol use is associated with a lower incidence of gastrointestinal effects and results in less colonic dysmotility than Oxycodone in equianalgesic doses.

That said, Tapentadol use is associated with other side effects like nausea, vomiting, and dizziness. At times, it can even cause confusion and headaches.

Oxycodone use is associated with constipation and itchiness. Most importantly, Oxycodone use has a greater abuse and dependence potential along with lethal respiratory depression in selective cases.

For safe usage, it is important to discuss your systemic history with the health care provider before starting either medication and get urgent help in case your adverse reactions suddenly increase in intensity or persist.

Conclusion

Pain is highly prevalent among the UK population, impacting 42% of its citizens. Research has proved that UK women have a higher prevalence of musculoskeletal pain, while men report persistent pain.

Overall, they pose a significant healthcare problem impacting the quality of life and day-to-day activities to a significant extent.

It is important to determine the intensity and causative factor behind your pain condition to decide which of the two would suit you best.

For safe use, limit the intake to a maximum of 3-4 weeks and taper their use before discontinuing them.