There was good news for patients suffering from chronic pain in Scotland after cost regulators waved through a novel analgesic, Gruenenthal's Palexia SR, for use on the National Health Service.

The Scottish Medicines Consortium has concluded that Palexia (tapentadol prolonged release) is a cost-effective option for the NHS when used in patients with severe chronic pain in whom standard treatment with morphine sulphate modified release has failed or is not tolerated.

Palexia SR is a new centrally acting opioid analgesic known as MOR-NRI that works through two mechanisms of action in one molecule - mu-opioid receptor (MOR) agonism and noradrenaline reuptake inhibition (NRI).

The new treatment seems to bring certain advantages to the table, as clinical research suggests that it comes with fewer side effects than those commonly experienced with strong opioid painkillers like morphine.

According to Gruenenthal, a Phase III trial with nearly 3,000 patients not only showed that Palexia SR provided clinically significant pain relief, but with the added benefit of a significant reduction in side effects including nausea (21% versus 36%), vomiting (8% vs 21%), constipation (17% vs 33%), drowsiness (12% vs 17%), headache (15% vs 13%) and dizziness (17% vs 21%) versus oxycodone CR, respectively.

Decision welcomed

Heather Wallace, chair of Pain Concern, said she is "delighted" by the SMC's decision. "Frequently medicines come with a catch 22, where the pain is treated but the side effects cause problems of their own, so to have another option is good news for doctors and patients alike". 

Palexia SR 200mg costs around £1.78 per day, which is is cost-equivalent to oxycodone CR at equianalgesic daily doses, but given that healthcare resources, including inpatient, outpatient and pharmacy services, increases significantly when patients need to be treated for opioid-related GI side effects, it could generate cost savings for the NHS.

The National Institute for Health and Clinical Excellence will not be assessing Palexia for use in England and Scotland, which means that prescribing decisions must be made by health trusts at a local level.