Tramadol for severe pain
Monday, November 26th, 2007 Tramadol is a centrally acting analgesic which possesses opioid agonist properties and activates monoaminergic spinal inhibition of pain. It may be administered orally, rectally, intravenously or intramuscularly. In patients with moderate to severe postoperative pain, intravenous or intramuscular tramadol has generally proved to be of equivalent potency to pethidine (meperidine) and one-fifth as potent as nalbuphine. Intravenous tramadol 50 to 150mg was equivalent in analgesic efficacy to morphine 5 to 15mg in patients with moderate pain following surgery; however, when administered epidurally tramadol was one-thirtieth as potent as morphine. Tramadol has demonstrated efficacy in a few studies in the short term treatment of chronic pain of various origins. Orally administered tramadol was found to be an effective analgesic in step 2 of the World Health Organization’s guidelines for the treatment of patients with cancer pain. Tramadol is well tolerated in short term use with dizziness, nausea, sedation, dry mouth and sweating being the principal adverse effects. Respiratory depression has been observed in only a few patients after tramadol infusion anaesthesia. When used for pain relief during childbirth, intravenously administered tramadol did not cause respiratory depression in neonates. The tolerance and dependence potential of tramadol during treatment for up to 6 months appears to be low, although the possibility of dependence with long term use cannot be entirely excluded. Thus, evidence to date of the analgesic effectiveness of tramadol combined with a low respiratory depressant effect and low dependence potential in short term use, suggests that the drug may become a useful alternative to the opioid analgesics currently available for the treatment of patients with moderately severe acute or chronic pain.
With the same dose of drug postsurgical patients had more pain relief than those having dental surgery. Tramadol showed a dose-response for analgesia in both postsurgical and dental pain patients. With the same dose of drug postsurgical pain patients had fewer adverse events than those having dental surgery. Adverse events (headache, nausea, vomiting, dizziness, somnolence) with tramadol 50 mg and 100 mg had a similar incidence to comparator drugs. There was a dose response with tramadol, tending towards higher incidences at higher doses. Single-patient meta-analysis using more than half pain relief provides a sensitive description of the analgesic properties of a drug, and NNT calculations allow comparisons to be made with standard analgesics. Absolute ranking of analgesic performance should be done separately for postsurgical and dental pain.
Everyone’s response to any given medication is going to be different. Is ultram, tramadol addictive?…. not in the sense that one would typically suffer from withdrawls when ceasing it. But as with any medication, even aspirin, for those that use it regularly, there could be psychological dependency issues.
It is possible, if one were to be on very large doses of tramadol hcl, way above recommended doses, for long periods of time, to have some minor withdrawl symptoms I would imagine, but likely they would be psychological withdrawl symptoms more than physical ones. There are some physicians I work with that have indicated that patients have exhibited drug seeking behavior to mild degrees with tramadol, however not often and not with those one would think typical of drug seeking patients , usually long term elderly patients with perhaps osteoarthritis.
So while I am willing to concede that ultram may have some abuse potential, I would not at all charactize it as “Highly Addictive” as previous posters have described.
My comments above are anecdotal, so to back it up, lets look at some research. There have been no instances reported to the DEA suggesting it should be scheduled as a controlled substance. Additionally, tramadol’s chemical affinity for the mu1 receptor is mild at best with no affinity found for mu2, kappa1 or kappa2. So there really are not many opiate receptors in the nervous system for tramadol to bind with and thus have any strong effect.
Where tramadol has been found to be abused is when someone has a substance abuse problem with a controlled substance like hydrocodone or oxycodone and their supply of that particular drug has become unavailable. In an attempt to stave off withdrawl, with this population who has an opiate habit, there have been reports of this group trying to use tramadol. It may indeed help to a small degree when one is in withdrawl from a true opiate, however only to a minimal degree. This population of abuser often will take much more than the recommended dose of tramadol, reducing the bodies natural seizure threshold resulting in convulsions.
Having said all this, it is my opinion that ultram is a much safer medication, used for mild to moderate somatic pain, than opiates. In double blind control group studies, it has been shown to be nearly as effective as synthetic opiods like propoxyphene, ie. darvon, darvocet, wygesic, and somewhat less effective than codeine phosphate ie. tylenol3 etc.
I trust I have not been too long winded so that I bored anyone that read this far, I do think that ultram and ultracet are good medications to have in our arsenal of pain prepartions. In this day and age when public policy is discouraging the prescribing of DEA controlled medications for pain management, tramadol may be a good choice for those that tolerate it well and that it is effective for.
Again, as with any medication, everyone is different and everyone’s response to any given medication may vary. For some, ultram may be more effective than hydrocodone. for some it may not work well at all. These are things one needs to discuss with their personal physician.Wishing all a wonderful holiday season.
