Analgesic efficacy in Head and neck cancer patients using tapentadol vs. tramadol plus paracetamol

Date 24 November 2018
Event ESMO Asia 2018 Congress
Session Poster display - Cocktail
Topics Palliative Care
Head and Neck Cancers
Presenter Rajesh Narayanasamy
Citation Annals of Oncology (2018) 29 (suppl_9): ix94-ix104. 10.1093/annonc/mdy438
Authors R.K. Narayanasamy1, S. Thiagarajan1, K. Perumal2
  • 1Radiation Oncology, Rai CBCC Cancer Center, 600095 - Chennai/IN
  • 2Radiation Oncology, Apollo Speciality Hospital, 600018 - Chennai/IN



We aimed to assess the pain control and tolerance to drug induced emesis in Head and Neck Squamous cell carcinoma (HNSCC) with progressive disease post-concurrent Chemoradiation using single agent tapentadol vs. oral tramadol plus paracetamol.


HNSCC patients with progressive disease post concurrent chemoradiation experiencing severe pain were randomised to three groups (20 patients in each group). Group-A received tapentadol 50mg twice daily; dose was increased up 200mg with 6 hours interval, if pain persisted. Group-B received tramadol plus paracetamol with antiemetics. Group-C received tramadol plus paracetamol without antiemetics. Patients were evaluated on 3rd and 4th weeks of treatment for pain using Visual Analogue Scale.


In Group-A, 18 (90%) patients had good pain relief with pain score0-1 of which 31 patients showed pain relief with 50mg twice daily and 4 had dose escalation of 50mg four times daily, 1 patient showed skin allergy with good pain control, 4 patients were switched to morphine 10gm 4th hourly. In group-B, 17 (85%) patients had good pain relief with pain score 0-1, but 5 patients did not tolerate due to emesis and sedation, in spite of good pain relief; these 5 patients were switched to morphine 10mg 4th hourly. In group-C only 4 (20%) patients had pain relief; others did not tolerate emesis and sedation and were given symptomatic care.


Single agent Tapentadol provided statistically superior pain control than combined tramadol with paracetamol, and was tolerated better by the patients without emesis.

Editorial acknowledgement

Clinical trial identification

Legal entity responsible for the study

CBCC-Chennai, Saveetha University, Chennai.


Has not received any funding.


All authors have declared no conflicts of interest.