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Updated: Jul 18, 2025

Assessment of Morphine-induced Hyperalgesia and Analgesic Tolerance in Mice Using Thermal and Mechanical Nociceptive Modalities
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Differences in the Analgesic Effect of Opioids on Pain in Cancer Patients With Spinal Metastases

Miho Takemura1,2, Kazuyuki Niki1,2, Yoshiaki Okamoto2

  • 1Department of Clinical Pharmacy Research and Education, Osaka University Graduate School of Pharmaceutical Sciences, Suita, Japan.

Palliative Medicine Reports
|August 28, 2023
PubMed
Abstract

Insights

Tapentadol and methadone show greater effectiveness in managing spinal metastasis pain, particularly when accompanied by numbness. These opioids may offer superior relief compared to hydromorphone, oxycodone, and fentanyl for such patients.

Area of Science:

  • Oncology
  • Pain Management
  • Pharmacology

Background:

  • Spinal metastasis pain involves inflammatory and neuropathic components.
  • Opioids targeting only μ-opioid receptors are less effective for neuropathic pain.
  • Limited comparative studies exist on opioid efficacy for spinal metastasis pain.

Purpose of the Study:

  • To compare the efficacy of tapentadol and methadone against other opioids for spinal metastasis-induced back pain.

Main Methods:

  • Retrospective cohort study involving 274 patients in Japan (2013-2021).
  • Patients received tapentadol, methadone, hydromorphone, oxycodone, or fentanyl for spinal metastasis pain.
  • Pain intensity was assessed using the Numerical Rating Scale (NRS) before and seven days after opioid initiation.

Main Results:

  • In patients with numbness, tapentadol showed significantly greater NRS score reduction than hydromorphone, oxycodone, and fentanyl, and was comparable to methadone.
  • No significant differences in NRS score reduction were observed among the five opioid groups in patients without numbness.

Conclusions:

  • Tapentadol and methadone may be more effective than hydromorphone, oxycodone, and fentanyl for spinal metastasis pain, especially in patients experiencing numbness.
  • This suggests a potential benefit of dual-acting analgesics for neuropathic components of cancer pain.
Keywords:
bone metastasis paincancer pain managementmethadoneopioidsspinal metastasistapentadol

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