The role of tramadol in current treatment strategies for musculoskeletal pain

Figures & data

Figure 1 Synergistic effects of tramadol at the dorsal horn (Collart et al 1993; Raffa and Friderichs 1996).

Table 1 Effects of traditional opioids in comparison with tramadol

	Tramadol in comparison with typical strong opioids
Analgesic efficacy
– in nociceptive pain	effective
– in neuropathic pain	first line option
– in mixed pain	effective
Abuse potential	less
Side effects
– respiratory depression	less
– constipation	less
– sedation	less
– dizziness	equal
– nausea	equal
– vomiting	equal
– sweating	equal

Table 2 Controlled trials of oral tramadol in patients with chronic musculoskeletal pain

Study	Type of pain	Study design	N	Duration	Analgesic drug	Dosage (mg/day)	Analgesic efficacy	Adverse events
Adler et al 2002	Osteoarthritis	db	279	1 mo	SR tramadol	150-400	SR-T = IR-T	SR-T = IR-T
					IR tramadol	150-400
Bird et al 1995	Osteoarthritis	db, co	40	2 × 2 wk	IR tramadol	200	T >PE	T < PE
Gorol 1983	Chronic	db	94	1 wk	IR tramadol	prn	T >TI/N	NR
					Tilidine/naloxone	prn
Jensen and Ginsberg 1994	Osteoarthritis	db, co	264	2 wk	IR tramadol	300	T >D	T > D
Pavelka et al 1998	Osteoarthritis	db	60	2 × 4 wk	IR tramadol	164	T = DI	T = DI
					Diclofenac	97
Rauck et al 1994	Chronic	db	990	4 wk	IR tramadol	244
					Paracetamol/codeine	1407/140	T = P/C	T = P/C
Roth 1998	Osteoarthritis	db	63	13 d	IR tramadol + NSAID	250	T >PL	NR
					Placebo + NSAID
Schnitzer et al 2000	Low back	db	254	4 wk	IR tramadol	200-400	T >PL	T > PL
					Placebo
Silverfield et al 2002	Osteoarthritis	db	308	10 d	IR tramadol/paracetamol + NSAID	150-300/1300-2600	T/P >PL	T/P > PL
Sorge and Stadler 1997	Low back	db	205	3 wk	SR tramadol	200	SR-T = IR-T	SR-T = IR-T
Wilder-Smith et al 2001	Osteoarthritis	db	60	1 mo	SR tramadol	200	T >DC	T >DC
					IR tramadol	200
					SR dihydrocodeine	200

Abbreviations C, codeine; co, crossover; d, days; D, dextropropoxyphene; db, double-blind; DC, dihydrocodeine; DI, diclofenac; IR, immediate release; mo, months; N, naloxone; NR, not reported; P, paracetamol; PE, pentazocine; PL, placebo; prn, as needed; SR, sustained-release; T, tramadol; TI, tilidine; wk,weeks; > indicates superior to; = indicates equivalent to; < indicates inferior to.

Figure 2 Recommendations of the working group on pain management for patients with osteoarthritis.

Figure 3 Recommendations of the working group on pain management for patients with low back pain.

CollartLLuthyCDayerPPartial inhibition of tramadol antinociceptive effect by naloxone in manBr J Clin Pharmacol19933573

 Google Scholar

RothSHEfficacy and safety of tramadol HCl in breakthrough musculoskeletal pain attributed to osteoarthritisJ Rheumatol1998251358639676769

 PubMed Web of Science ®Google Scholar

AdlerLMcDonaldCO’BrienCA comparison of once-daily tramadol with normal release tramadol in the treatment of pain in osteoarthritisJ Rheumatol2002292196912375333

 PubMed Web of Science ®Google Scholar

BirdHAHillJStratfordMA double blind cross-over study comparing the analgesic efficacy of tramadol with pentazocine in patients with arthritisJ Drug Dev Clin Pract19957818

 Google Scholar

GorolDTropfenform eines stark wirksamen Analgetikums in der DoppelblindprüfungMed Klin1983781735

 Google Scholar

PavelkaKPeliskovaZStelikovaHIntraindividual differences in pain relief and functional improvement in osteoarthritis with diclofenac or tramadolClin Drug Invest19981619

 PubMed Web of Science ®Google Scholar

RauckRLRuoffGEMcMillenJIComparison of tramadol and acetaminophen with codeine for long-term pain management in elderly patientsCurr Ther Res Clin Exp199455141731

 Web of Science ®Google Scholar

SchnitzerTJGrayWLPasterRZEfficacy of tramadol in treatment of chronic low back painJ Rheumatol200027772810743823

 PubMed Web of Science ®Google Scholar

SilverfieldJCKaminMWuSCTramadol/acetaminophen combination tablets for the treatment of osteoarthritis flare pain: a multicenter, outpatient, randomized, double-blind, placebo-controlled, parallel-group, add-on studyClin Ther2002242829711911558

 PubMed Web of Science ®Google Scholar

SorgeJStadlerThComparison of the analgesic efficacy and tolerability of tramadol 100 mg sustained-release tablets and tramadol 50 mg capsules for the treatment of chronic low back painClin Drug Invest19971415764

 Web of Science ®Google Scholar

Wilder-SmithCHHillLSpargoKTreatment of severe pain from osteoarthritis with slow-release tramadol or dihydrocodeine in combination with NSAIDs: a randomised study comparing analgesia, antinociception and gastrointestinal effectsPain200191233111240075

 PubMed Web of Science ®Google Scholar