Tramadol: a valuable treatment for pain in Southeast Asian countries

Figures & data

Figure 1 Tramadol consumption in Asia compared to controlled opioids.

Notes: Consumption data from Quintiles IMS Kilochem 2015 (Bangladesh Retail, China, Hong Kong, India, Indonesia, Japan, Jordan Retail, Kazakhstan, Kuwait Retail, Lebanon Retail, Malaysia, Pakistan Retail, Philippines, Saudi Arabia Retail, Singapore, South Korea, Sri Lanka Retail, Taiwan, Thailand, Turkey, UAE Retail, Vietnam); estimated PTD calculation based on WHO ATC DDD of the respective substance, except for buprenorphine and fentanyl transdermal patches (units sold multiplied by wearing time).
Abbreviations: ATC, Anatomical Therapeutic Chemical classification system; DDD, defined daily dosage; IMS, Intercontinental Marketing Services; PTD, patient treatment days; WHO, World Health Organization.

Table 1 Questionnaire on the role of tramadol in pain management

	With regards to your personal experiences with tramadol
1.	In which indications do you use tramadol? Click here to enter text.
2.	What is the main reason for you to prescribe tramadol? Click here to enter text.
3.	In your opinion, what are the main advantages/benefits of tramadol (in general, in comparison to other analgesics, eg, other opioids, or NSAIDs)? Click here to enter text.
4.	With regards to its safety and tolerability, how do you see tramadol compared to other opioids available in your country? Click here to enter text.
5.	Based on your experiences, do you consider the abuse potential of tramadol lower than the abuse potential of other opioids? Click here to enter text.
	With regards to the use of tramadol in your country
6.	How do you rate the significance of tramadol for the treatment of the following pain indications/special patient groups in your country? Please indicate for all listed indications/special patient groups: not significant (NS)/moderately significant (MS)/significant (S)/highly significant (HS) For indications/special patient groups, you rated tramadol as “significant” or “highly significant”: What are the main reasons for the high significance of tramadol in those indications/special patient groups?
	Indication	Significance rating (NS, MS, S, or HS)	If rating is significant or highly significant, what are the main reasons?
	Cancer pain	NS MS S HS	Click here to enter text.
	Non-cancer pain	NS MS S HS	Click here to enter text.
	Acute post-op pain	NS MS S HS	Click here to enter text.
	Acute musculoskeletal pain	NS MS S HS	Click here to enter text.
	Chronic low back pain	NS MS S HS	Click here to enter text.
	Osteoarthritis	NS MS S HS	Click here to enter text.
	Neuropathic pain	NS MS S HS	Click here to enter text.
	Any other	NS MS S HS	Click here to enter text.
	Special patient groups
	Pain treatment in adult patients	NS MS S HS	Click here to enter text.
	Pain treatment in children	NS MS S HS	Click here to enter text.
	Pain treatment in elderly patients	NS MS S HS	Click here to enter text.
7.	Is tramadol used as an alternative to strong opioids in your country? Click here to enter text.
8.	Are you aware of any official reports of misuse or abuse of tramadol in patients with chronic pain in your country? Click here to enter text.
9.	If strong regulations (further controls/higher scheduling) regarding tramadol would be implemented in your country, which consequences do you foresee in regard to: • impact on medical availability of tramadol  ○ in the hospital  ○ in the outpatient setting Click here to enter text. • the treatment of patients with moderate to severe pain.  ○ Which treatment alternatives would you substitute for tramadol? Click here to enter text.  ○ What would be the impact of this substitution in terms of efficacy, safety and convenience of the alternative treatment? Click here to enter text. • The quality of pain management in your country? Click here to enter text.
10.	Is tramadol included in national guidelines? Please specify Click here to enter text.
11.	Any other comments Click here to enter text.

Abbreviation: NSAID, non-steroidal anti-inflammatory drugs.

Figure 2 Significance of tramadol in various acute and chronic pain indications.

Table 2 Reasons for the high significance of tramadol in pain management

• Efficacy in moderate to severe nociceptive and neuropathic pain

• Good tolerability and safety profile compared to NSAIDs and strong opioids, especially in elderly patients requiring long-term treatment

• Ready availability

• Multimodal mechanism of action, giving “opioid-sparing” effect

• Possibility of combination with other analgesics

• Availability of multiple formulations

• Lower risk of addiction than strong opioids

• Non-controlled prescription

• Easy to use

• Good patient compliance

Abbreviation: NSAIDs, non-steroidal anti-inflammatory drugs.