Tramadol May Have Slight Effect on Reducing Chronic Pain

In continuation of my update on Tramadol..

Tramadol may slightly reduce chronic pain but seems to increase the risk for serious and nonserious adverse events, according to a review published online Oct. 7 in BMJ Evidence-Based Medicine.

Jehad Ahmad Barakji, M.D., from the Centre for Clinical Intervention Research in Copenhagen, Denmark, and colleagues conducted a systematic review to examine the benefits and harms of tramadol versus placebo in chronic pain. Data were included from 19 randomized placebo-controlled trials, with 6,506 participants.

The researchers observed evidence of a beneficial effect of tramadol on chronic pain (mean difference numerical rating scale [NRS], −0.93 points) in a meta-analysis and trial sequential analysis, with the effect size below the predefined minimal important difference of 1.0 point on the NRS. There was evidence of a harmful effect of tramadol on serious adverse events (odds ratio, 2.13), which was mainly due to a higher proportion of cardiac events and neoplasms. Due to a lack of data, it was not possible to conduct a meta-analysis on quality of life. The risk for several nonserious adverse events, including nausea, dizziness, constipation, and somnolence, was increased with tramadol (number needed to harm: seven, eight, nine, and 13, respectively).

"In the United States, the number of opioid-related overdose deaths increased from 49,860 in 2019 to 81,806 in 2022," the authors write. "Given these trends and the present findings, the use of tramadol and other opioids should be minimized to the greatest extent possible."

Abstract/Full Text

Tramadol May Have Slight Effect on Reducing Chronic Pain - Drugs.com MedNews

Tramadol Linked to Increased Hip Fracture Risk in Adults Aged ≥50

In continuation of my update on Tramadol

For older adults, initiation of tramadol is associated with an increased risk for hip fracture compared with initiation of codeine, ibuprofen, and other commonly used nonsteroidal anti-inflammatory drugs, according to a study published online Feb. 5 in the Journal of Bone and Mineral Research.

Jie Wei, Ph.D., from Central South University in Changsha, China, and colleagues examined the association between tramadol and the risk for hip fracture among individuals aged 50 years or older without a history of hip fracture, cancer, or opioid use disorder. Five sequential propensity score-matched cohort studies were assembled, including participants initiating tramadol (146,956 participants) or one of the following: codeine (146,956 participants), naproxen (115,109 participants), ibuprofen (107,438 participants), celecoxib (43,130 participants), or etoricoxib (27,689 participants).

The researchers identified 518 hip fractures in the tramadol cohort and 401 in the codeine cohort (3.7 versus 2.9/1,000 person-years) during one-year follow-up (hazard ratio, 1.28 for tramadol versus codeine). Hip fracture risk was higher in the tramadol cohort compared with the naproxen (2.9 versus 1.7/1,000 person-years; hazard ratio, 1.69), ibuprofen (3.4 versus 2.0/1,000 person-years; hazard ratio, 1.65), celecoxib (3.4 versus 1.8/1,000 person-years; hazard ratio, 1.85), and etoricoxib (2.9 versus 1.5/1,000 person-years; hazard ratio, 1.96) cohorts.

"Considering the significant impact of hip fracture on morbidity, mortality, and health care cost, our results point to the need to consider tramadol's associated risk of fracture in clinical practice and treatment guidelines," the authors write.

https://asbmr.onlinelibrary.wiley.com/doi/10.1002/jbmr.3933

https://en.wikipedia.org/wiki/Tramadol












Tramadol Linked to Increased Hip Fracture Risk in Adults Aged ≥50 

Etoricoxib better than tramadol for postoperative pain.....

In continuation of my update on Etoricoxib...

Researchers lead by Dr. Metha Brattwall of University Hospital Möndal in Gothenburg, Sweden, have come up with an  interesting finding, i.e., for patients with moderate pain after foot surgery, the cyclo-oxygenase 2 (COX-2) inhibitor drug etoricoxib provides better pain relief with fewer side effects than the opioid drug tramadol. The study also helps to alleviate concerns that COX-2 inhibitors and other nonsteroidal anti-inflammatory drugs (NSAIDs) may interfere with bone healing after surgery.  The researchers compared two different pain-relieving drugs in 100 women undergoing surgery for bunions (hallux valgus). One group received the COX-2 inhibitor etoricoxib, while the other group received tramadol, an opioid (narcotic-like) drug similar to codeine.

Although both drugs were effective in controlling pain in the week after surgery, pain scores were significantly lower in the etoricoxib group. Women assigned to etoricoxib had an average pain score of 12.5 (on a 100-point scale), compared to 17 in those receiving tramadol.  As per the claim by  the researchers, patients in the etoricoxib group had lower maximum pain scores throughout the week after surgery. They also had better pain relief on the second and third days after surgery, when pain scores were highest.

"Etoricoxib was also associated with fewer side effects and thus overall patient satisfaction with pain medication," the researchers write...

Interesting results from this study are that, no evidence of impaired healing in patients taking NSAIDs, at least after a relatively minor operation like bunion surgery. Etoricoxib is not currently approved for use in the United States, but is available in other countries. NSAIDs are generally considered much safer than opioid drugs.And this research further substantiate this.

"The results suggest that NSAIDs can provide superior analgesia for patients with moderate pain after bone surgery, with reduced risk," Dr. Shafer adds...

Ref : Metha Brattwall,  Ibrahim Turan, and Jan Jakobsson, Anesthesia & Analgesia

New Drug Application for Tramadol....

About Tramadol :

Tramadol is a centrally acting analgesic, used for treating moderate to severe pain. Tramadol was developed by the German pharmaceutical company Grünenthal GmbH in the late 1970.

Tramadol possesses agonist actions at the μ-opioid receptor and affects reuptake at the noradrenergic and serotonergic systems. Tramadol is a compound with mild and delayed μ-agonist activity.

Tramadol is a synthetic stripped-down analog of Codeine and, as such, is an opioid. The opioid agonistic effect of tramadol and its major metabolite(s) almost exclusively effects the μ-opioid receptor. This characteristic is notable, because even morphine is not exclusive to the μ-receptor, although it manifests the preponderance of its opioid agonistic effects here. Tramadol is used to treat moderate to moderately severe pain and most types of neuralgia, including trigeminal neuralgia.

Recently, Par Pharmaceutical Companies, Inc received FDA approval for the abbreviated New Drug Application for the 100mg and 200mg strengths of tramadol ER.....

Source : http://www.parpharm.com/media/NR_20091116.jsp