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ISRN Pain  2013 

Tramadol Extended-Release for the Management of Pain due to Osteoarthritis

DOI: 10.1155/2013/245346

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Current knowledge on pathogenesis of osteoarticular pain, as well as the consequent several, especially on the gastrointestinal, renal, and cardiovascular systems, side effects of NSAIDs, makes it difficult to perform an optimal management of this mixed typology of pain. This is especially observable in elderly patients, the most frequently affected by osteoarthritis (OA). Tramadol is an analgesic drug, the action of which has a twofold action. It has a weak affinity to mu opioid receptors and, at the same time, can result in inhibition of the reuptake of noradrenaline and serotonin in nociceptorial descending inhibitory control system. These two mechanisms, “opioidergic” and “nonopioidergic,” are the grounds for contrasting certain types of pain that are generally less responsive to opioids, such as neuropathic pain or mixed OA pain. The extended-release formulation of tramadol has good efficacy and tolerability and acts through a dosing schedule that allows a high level of patients compliance to therapies with a good recovery outcome for the patients' functional status. 1. Background Pain is the most common symptom of osteoarthritis (OA), and, as pain levels rise, patients experience a reduced range of motion with a consequent increase of disability [1]. Pain and function limitations substantially reduce the life quality of people affected by OA. The treatment planning for OA is designed to essentially provide pain relief, to prevent from complications such as muscle atrophy or joint deformities, and to maintain and/or improve the functional status with the final aim to produce a sensible life quality improvement [2]. The effectiveness of pain relief not only may result in a reduction of the intensity of pain itself but can also lead to an improvement of life aspects that are strictly related to pain. As has been widely documented, chronic persistent pain can sensibly reduce the health-related quality of life, causing reduced sleep, interference with social/family relationships [3], activity of daily living and productivity, and increased anxiety and depression [4]. There is, therefore, a general need for optimized pharmacologic treatment strategies in patients with chronic/persistent pain due to OA. A management strategy for such patients also should require individualized therapies that are able to ensure a positive risk/benefit profile. It should also provide analgesia outcomes covering an extended period of time. Tramadol is a centrally acting synthetic analgesic with two mechanisms of action. It involves weak -opioid receptors agonism and


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