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Feature Article

The atypical opioids: buprenorphine, tramadol and tapentadol

STEPHAN A. SCHUG

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© SEBASTIAN KAULITZKI/ SHUTTERSTOCK
© SEBASTIAN KAULITZKI/ SHUTTERSTOCK

Abstract

There are many differences between conventional and atypical opioids, including different efficacies, adverse effects and toxicities, as well as risk of abuse. These factors should be considered when prescribing opioids for chronic pain conditions.

Note
This article was first published in the the Medicine Today supplement Conventional and atypical opioids in September 2018.

Key Points

  • Atypical opioids differ from conventional opioids as they do not rely exclusively on mu-receptor agonism for their analgesic effect.
  • The atypical opioids, buprenorphine, tramadol and tapentadol, have different effects and different adverse effects including toxicity and abuse potential compared with conventional opioids.
  • These differences result in improved outcomes and reduced risks with the use of atypical opioids for individual patients and society as a whole.
  • Atypical opioids are the preferred strong analgesics for chronic pain that requires pharmacological treatment.
  • Tapentadol in particular seems to offer the best risk-benefit ratio in the pharmacological management of chronic pain with proven efficacy in nociceptive, neuropathic and mixed pain conditions, best tolerability and good safety data.

Figures

© SEBASTIAN KAULITZKI/ SHUTTERSTOCK
© SEBASTIAN KAULITZKI/ SHUTTERSTOCK