Tapentadol

INTRODUCTION

Indications

Management of moderate-to-severe acute pain in patients ≥18 yr.

Action

Acts as μ-opioid receptor agonist. Also inhibits the reuptake of norepinephrine. Therapeutic Effects: ↓ in pain severity.

Adverse Reactions/Side Effects

CNS: SEIZURES, dizziness, headache, somnolence. Resp: RESPIRATORY DEPRESSION. GI: nausea, vomiting.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess symptoms of respiratory depression, including decreased respiratory rate, confusion, bluish color of the skin and mucous membranes (cyanosis), and difficult, labored breathing (dyspnea). Monitor pulse oximetry and perform pulmonary function tests (See Appendix I) to quantify suspected changes in ventilation and respiratory function. Excessive respiratory depression requires emergency care.

• Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings immediately to the physician.

• Be alert for excessive sedation or somnolence. Notify physician or nurse immediately if patient is unconscious or extremely difficult to arouse.

• Use appropriate pain scales (visual analogue scales, others) to document whether this drug is successful in helping manage the patient's pain.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

Interventions

• Implement appropriate manual therapy techniques, physical agents, and therapeutic exercises to reduce pain and help wean patient off opioid analgesics as soon as possible.

• Because of the risk of respiratory depression, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, respiratory rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

• Help patient explore other nonpharmacologic methods to reduce chronic pain, such as relaxation techniques, exercise, counseling, and so forth.

Patient/Client-Related Instruction

• Advise patient that opioid analgesics are usually more effective if given before pain becomes severe; emphasize that adequate pain control will allow better participation in physical therapy.

• Educate patient about the dangers of opioid overdose; encourage patient to adhere to proper dosing schedule.

• Emphasize that the risk of physical addiction (tolerance and dependence) is usually minimal during short-term treatment of pain. Advise patient that addiction is more likely during excessive or inappropriate use of opioid analgesics.

• Advise patient to avoid alcohol and other CNS depressants because of the increased risk of sedation and decreased CNS function.

• Instruct patient to report other troublesome side effects such as severe or prolonged headache or GI problems (nausea, vomiting).