tramadol

[stoic]

Hey what's up everyone -

I've got a few questions regarding tramadol. I'm an MS1 and have been a little perplexed by how much variability i've seen in how, when, and why different practictioners (mostly primary care) will write for tramadol. Some write for it quite often, usually when the pain from a chronic condition is not completely controlled by NSAIDS but not severe enough to warrant stronger opioids. Other practitioners I've been around seem to treat tramadol much like the stronger narcotics and prescribe it fairly rarely. From both sides i've heard a lot of varying information about the efficacy of the drug ranging from "as strong as hydrocodone" to "basically little more they tylenol"

i know there is still some controversy over the mechanism in that it's somewhat unclear just how much mu-receptor binding tramadol and it's M1 metabolite due. that said, i know PCP's who will write for it with seeking patients because "it's not really an opioid." but i also recall a paper where it was shown most of the pain-relieve comes from opioid activity....

i've rarely seen it used for acute pain; if someone is in obvious pain, they seem to always get something stronger.

As pain people, what are you're thoughts about this drug? Do you think it should be scheduled? in what sorts of situations do you write for it?

thanks,
dave

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[fab4fan]

Not a doc, but a nurse who worked a lot with chronic pain pts. We rarely used the stuff; our experience was that it wasn't much better than NSAIDs.

We tended to give it to people who were opioid naive and were geting some relief from non-narcs, but not enough. Sometimes with older pts. we'd use it because it caused less sedation.

Overall, it just wasn't used much. Usually we went right to Vicodin/Percocet, or in severe chronic pain we used methadone mostly. (Once in a while OxyContin or Duragesic, but not often.)

 

[DigableCat]

This was discussed briefly in a previous thread some months ago...when the Vioxx/Bextra fiasco happened.
COX 2 Inhibitors Taken Off The Market

Now, as more people have had to transition to other medications, I've found people are responding better to tramadol than I initially thought they would. I particularly use it in patients who
1. Could not tolerate the more sedative side effects of vicodin, percoset, etc(ie. those that actually want to continue working and elderly patients who tend to get loopy on the stronger medications).
2. Those who want to transition patients off vicodin because of liver disease or active Hep C. You can't get hydrocodone alone, although you can get oxycodone alone(but I usually don't want to go there unless I have to).
3. People with active/recent history of drug abuse with whom I'm leery of prescribing anything stronger. Tramadol has a low abuse potential(still there of course) and has almost nil street value.

 

[prettyinpink187]

Tramadol is used in a manner similar to codeine, to treat moderate to moderately severe pain. It's pharmacologically similar to levorphanol, both of which are also opioid NMDA antagonists, which also have SNRI activity other opioids to do the same are dextropropoxyphene Darvon and M1 tapentadol like molecule Nucynta which is a new synthetic opiate made to mimic the properties atypical agonist metabolite of tramadol, M1 O-desmethyltramadol. Here's a few good sources:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000960/
http://www.gossipcenter.co/blog/tramadol.php

 

[facetguy]

Is that a 5 1/2 year old thread you just revived?

 

[Bill122]

There is something important I feel compelled to tell everyone. And it's this- If you are a person with an addiction-prone personality,
I advise you not to take Tramadol. It has been shown to be addicting because it is an opiod, which means it's a synthetic opiate.
It not only relieves pain, but it sort of chills some people out, similar to opiates. Some studies are going on testing Tramadol as an
anti anxiety and anti depressant drug. Google 'tramadolportal'or go to Tramadol information for more info on that use. I hope this helped someone.