Tramadol for the treatment of fibromyalgia

Abstract

Tramadol is a novel, synthetic opioid receptor agonist with serotonin-norepinephrine reuptake inhibitor properties that is often prescribed acutely for painful conditions. Fibromyalgia (FM) is a chronic painful condition that is difficult to treat and until more recently has had no approved medical treatments. Currently, the only US FDA-approved medications for FM include duloxetine, milnacipran and pregabalin. No opioid is approved for use in the treatment of FM. This paper specifically reviews the literature on tramadol use in FM and concludes that there is a fair evidence base to support its use as a second-line treatment for more resistant cases.

Keywords:

• fibromyalgia
• opiates
• opioids
• tramadol

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Fibromyalgia is a condition of diffuse, widespread pain that has a bona fide diagnostic and treatment approach.

• This disorder is often associated with fatigue and cognitive dysfunction but current treatments largely focus on pain reduction as a primary measure.

• Pregabalin is an anti-epileptic that has been studied and is the first US FDA approved to improve pain in fibromyalgia.

• Duloxetine and milnacipran are selective serotonin-norepinephrine reuptake inhibitors, whose antidepressant mechanism of action may independently lower pain perception in fibromyalgia.

• Both are FDA approved.

• Tramadol is a synthetic opioid FDA approved for the treatment of acute pain.

• Tramadol has a fair evidence base to support its off-label use in treating fibromyalgia.

• Tramadol is novel compared with other opioids as it also may act as a serotonin-norepinephrine reuptake inhibitor and as a glutamate-inhibiting agent.

• Its application should be considered in more treatment-resistant or refractory cases of fibromyalgia.