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Tramadol as an Analgesic to Treat Chronic Pain  [cached]
Gaurav Solanki
International Journal of Pharmacological Research , 2013, DOI: 10.7439/ijpr.v2i4.513
Abstract: Pain is defined by the International Association for the Study of Pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Pain has now been equated to a fifth vital sign highlighting the significance of pain management in patient care. Tramadol is a centrally acting analgesic which is structurally related to codeine and morphine. It is effectively used to treat moderate to severe acute and chronic pain in diverse conditions. Tramadol is placed on the second step of WHO analgesic ladder and in contrast to traditional opioids, exerts its analgesic activity, a dual mechanism of action inhibiting transmission as well as perception of pain. Tramadol is more suitable than NSAIDa€ s and coxiba€ s for patient with GI, renal and cardiovascular problems. Combined with low dependence/abuse potential, it has proven to be of significant advantage over other agents especially in the elderly.
Comparison the Analgesic Effects of Single Dose Administration of Tramadol or Piroxicam on Postoperative Pain after Cesarean Delivery
Amir Farshchi,Golbarg Ghiasi
Acta Medica Iranica , 2010,
Abstract: "nA multimodal approach to postcesarean pain management may enhance analgesia and reduce side effects after surgery. We investigated postoperative pain in a double-blinded, randomized, single-dose comparison of the monoaminergic and μ-opioid agonist tramadol, 100 mg (Group T) and piroxicam 20 mg (Group P) given IM alone- single dose in 150 patients who had elective cesarean delivery. All patients were assessed at 0, 6, 12 and 24 hours post operation for pain degree (by Visual Analogue Score: VAS 1-10), nausea and vomiting. Pain degree was classified as: Painless: 0, Mild: 1-4, Moderate: 5-8, Severe: 9-10. There was no significant difference between the efficacy of tramadol and piroxicam injections (P>0.05). Pain intensity decreased markedly over time in both groups. Mean±SEM pain degrees were as follows: P=7.7±0.5, T=8.2±0.8 after 0 hours; P=5.4±0.6, T=6.1±0.5 after 6 hours; P=3.3±0.4, T=3.4±0.7 after 12 hours; P=1.1±0.4, T=1.3±0.5 after 24 hours of surgery. Side effects were similarly minimal with all treatments. It might be concluded that i.m. injections of 20 mg piroxicam (single dose therapy) could relieve postoperative pain after cesarean section as well as tramadol and it could reduce opioid analgesic requirements with less adverse side effects during the first postoperative 24 h.
Evaluation of analgesic effect of tapentadol, a central novel analgesic versus tramadol, a widely used opioid analgesic in treatment of low back pain: a randomized controlled trial  [cached]
Zaki Anwar Zaman,Deepak Kumar
International Journal of Basic & Clinical Pharmacology , 2013, DOI: 10.5455/2319-2003.ijbcp20130809
Abstract: Background: The objective of the study was to compare efficacy and tolerability (safety) of tapentadol with tramadol in the treatment of low back pain. Methods: The study was a prospective, randomized, single blinded, total 102 patients are recruited for study in which 44 patients are prescribed (50mgtwice daily) tapentadol and 58 patients prescribed (50mg twice daily) tramadol for 4 weeks. Follow-up was done on days 7, 14, 28 and 4 week after stoppage of treatment. Assessment of improvement were performed by Indian Health Assessment Questionnaire Disability Index (Indian HAQDI), Visual Analogue Scale (VAS), Numerical Rating Scale (NRS) and measurement of Pain Relief Rate (PRR). Adverse events were recorded. Results: Scores in Indian HAQDI, VAS and NRS improved significantly in both groups in the last visit but more so with tapentadol. PRR was reasonably higher with tapentadol [27(n=44)61.36%] patients experiencing significant to complete pain relief at the end of the study, compared to tramadol [25(n=58) 43.10%]. Adverse effects was less in tapentadol group [15(n=44)34.09%] versus 33(n=58)56.89%], p<0.05]. Conclusion: Tapentadol has better sustained efficacy and tolerability than tramadol in low back pain. [Int J Basic Clin Pharmacol 2013; 2(4.000): 392-396]
The Comparison of Preemptive Oral Tramadol, Gabapentin Tramadol and Parasetamol Tramadol Combination on the Efficacy of Postoperative Pain Control in Breast Reduction Surgery  [cached]
Muge Can,Zehra Hatipoglu,Cengiz Eser,Yasemin Gunes
Cukurova Medical Journal , 2013,
Abstract: Purpose: Application of tramadol by intravenous patient controlled analgesia (PCA) is a routine method for controlling postoperative pain in the breast reduction operations. It was aimed to compare the efficacy of preemptive oral gabapentin/tramadol and parasetamol/tramadol combination usage on the postoperatif tramadol consumption in patients undergoing breast reduction operation. Material and Methods: Our study was held on 54 patients (ASA I-III, aged between 18-65 yr) undergoing breast reduction operation. Patients randomly divided into three groups. Group I were received 600mg tablet gabapentin and 35mg drop tramadol one hour before the operation. Group II were received 500mg tablet parasetamol and 35mg drop tramadol one hour before the operation. Group III (Control group) were received 35mg drop tramadol one hour before the operation. 30 minutes before the end of operation, 1mg/kg i.v. tramadol and 10mg metoklopramid HCL three groups were administred. After the end of operation, three groups were started to receive tramadol infusion and intravenous patient controlled analgesia (PCA) application (300 mg diluated with 0,09% 100cc SF, 0,2 mg/kg PCA, 15 min locked in time). Peroperative SpO2, KH, SKB, DKB, extubation, disillusion, response time to the verbal stimuli, postoperative pain scores (VRS, VAS), total tramadol consumption, additional analgesic need and side effects (nausea and vomiting, diplopia, dizziness) were recorded and evaluated. Results: Peroperative SpO2, KH, SKB, DKB, extubation, disillusion, response time to the verbal stimuli, postoperative pain scores (VRS, VAS), total tramadol consumption, additional analgesic need and side effects of groups were similar to each other. Peroperative second hour DKB values and postoperative twelfth hour additional analgesic need of second group was found higher compared to other groups. There were no significantly differences in the groups except diplopia. It was found higher in favour of the first group. Conclusion: Application of tramadol/gabapentin, tramadol/parasetamol and low dose tramadol (35mg) in patients undergoing breast reduction operation did not affect intraoperative hemodinami. The tramadol combined with postoperatif HKA also does not cause any differences among postoperative pain scores, 24 hours total tramadol consumption and additional analgesia need except twelfth hour. It was concluded that the side effects in group applied gabapentin were similar except diplopia. [Cukurova Med J 2013; 38(3.000): 417-425]
Comparación de la Eficacia Analgésica de Codeína más paracetamol vs Tramadol en el Tratamiento del Dolor por Cáncer Comparison of the analgesic effectiveness of codeine plus paracetamol vs Tramadol in the Treatment of Cáncer Pain  [cached]
R. F. Rodríguez,Luís E. Bravo,A. M. ángel,M. F. Rodríguez
Revista de la Sociedad Espa?ola del Dolor , 2008,
Abstract: El dolor es el síntoma más importante en 70% de pacientes que padecen cáncer avanzado. La terapia con analgésicos utilizada en forma adecuada, controla el dolor en 80-90% de los pacientes. Objetivos. Comparar la eficacia analgésica y seguridad de la codeína más acetaminofén (CA) y Clorhidrato de Tramadol (T) en el alivio del dolor por cáncer. Método. Se realizó un ensayo clínico controlado doble ciego, en pacientes con dolor por cáncer de intensidad moderada o severa. En forma aleatoria se asignó un grupo de pacientes para ser tratados con la combinación de Codeína más paracetamol, mientras que el otro grupo recibió Clorhidrato de Tramadol por un periodo de tres semanas. La intensidad del dolor fue medida con una escala numérica de cero a diez, considerándose como dolor de intensidad moderada el marcado en la escala entre 5-7 y de intensidad severa de 8-10. El tratamiento analgésico se consideró eficaz cuando el dolor desapareció o disminuyó a una intensidad leve, comprendida entre 1-4. Resultados. Se incluyeron 115 pacientes: 59 recibieron CA y 56 recibieron T. En el grupo de pacientes que recibió CA 58% aliviaron con una dosis inicial de codeína de 150 mg/día y 8% con la dosis doblada; 34% no aliviaron. En el grupo de pacientes tratado con T el dolor alivió en 62% de los pacientes con la dosis inicial de 200mg/día y 11% con la dosis doblada, mientras que 27% no experimentó alivio. Las diferencias entre los dos grupos no fueron significativas en cuanto a su eficacia analgésica. El grupo que recibió Tramadol presentó en forma significativa, mayor incidencia de efectos colaterales de intensidad leve: náusea (p: 0.05, RR: 0.62; IC95%: 0.38-1.01), mareo (p: 0.04; RR: 0.58; IC95%: 0.33-1.01) y pérdida de apetito (p: 0.001; RR: 0.08; IC95%: 0.01-0.59). Conclusión. No existen diferencias en cuanto a la eficacia analgésica de CA y T en el tratamiento del dolor por cáncer. Con el uso de T se presentó una mayor incidencia de efectos colaterales de intensidad leve. Pain is the principal symptom in 70% of patients with severe cáncer. Analgesics therapy with a proper management controls pain in 80-90% of patients. Objective. Compare the analgesic efficacy and tolerability of codeine plus acetaminophen (CA) and tramadol clorhydrate (T) in the relief of cáncer pain. Method. A double blind, randomize controlled clinical trial was perform in patients with modérate to severe pain intensity. Randomly patients were assigned in a group for receiving codeine plus acetaminophen and in other group for receiving tramadol chlorhydrate for a three weeks period. Pain intensity was
Tramadol/paracetamol fixed-dose combination in the treatment of moderate to severe pain
Pergolizzi Jr JV, van de Laar M, Langford R, Mellinghoff H-U, Morón Merchante I, Nalamachu S, O'Brien J, Perrot S, Raffa RB
Journal of Pain Research , 2012, DOI: http://dx.doi.org/10.2147/JPR.S33112
Abstract: amadol/paracetamol fixed-dose combination in the treatment of moderate to severe pain Expert Opinion (2516) Total Article Views Authors: Pergolizzi Jr JV, van de Laar M, Langford R, Mellinghoff H-U, Morón Merchante I, Nalamachu S, O'Brien J, Perrot S, Raffa RB Published Date August 2012 Volume 2012:5 Pages 327 - 346 DOI: http://dx.doi.org/10.2147/JPR.S33112 Received: 19 April 2012 Accepted: 01 June 2012 Published: 29 August 2012 Joseph V Pergolizzi Jr,1,2 Mart van de Laar,3 Richard Langford,4 Hans-Ulrich Mellinghoff,5 Ignacio Morón Merchante,6 Srinivas Nalamachu,7,8 Joanne O'Brien,9 Serge Perrot,10 Robert B Raffa11 1Department of Medicine, Johns Hopkins University, Baltimore, MD, USA; 2Association of Chronic Pain Patients, Houston, TX, USA; 3Arthritis Center Twente (MST and UT), Enschede, The Netherlands; 4Anaesthetics Laboratory, St Bartholomew's Hospital, London, UK; 5Department of Endocrinology, Diabetology and Osteology, Kantonsspital St Gallen, St Gallen, Switzerland; 6Centro de Salud Universitario Goya, Madrid, Spain; 7Kansas University Medical Center, Kansas City, KS, USA; 8International Clinic Research, Leawood, KS, USA; 9Department of Pain Management, Beaumont Hospital, Beaumont, Dublin, Ireland; 10Service de Médecine Interne et Consultation de la Douleur, H pital Dieu, Paris, France; 11Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia, PA, USA Abstract: Pain is the most common reason patients seek medical attention and pain relief has been put forward as an ethical obligation of clinicians and a fundamental human right. However, pain management is challenging because the pathophysiology of pain is complex and not completely understood. Widely used analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol (acetaminophen) have been associated with adverse events. Adverse event rates are of concern, especially in long-term treatment or at high doses. Paracetamol and NSAIDs are available by prescription, over the counter, and in combination preparations. Patients may be unaware of the risk associated with high dosages or long-term use of paracetamol and NSAIDs. Clinicians should encourage patients to disclose all medications they take in a "do ask, do tell" approach that includes patient education about the risks and benefits of common pain relievers. The ideal pain reliever would have few risks and enhanced analgesic efficacy. Fixed-dose combination analgesics with two or more agents may offer additive or synergistic benefits to treat the multiple mechanisms of pain. Therefore, pain may be effectively treated while toxicity is reduced due to lower doses. One recent fixed-dose combination analgesic product combines tramadol, a centrally acting weak opioid analgesic, with low-dose paracetamol. Evidence-based guidelines recognize the potential value of combination analgesics in specific situations. The current guideline-based paradigm for pain treatment recommends NSAIDs for ongoi
Tramadol/paracetamol fixed-dose combination in the treatment of moderate to severe pain  [cached]
Pergolizzi Jr JV,van de Laar M,Langford R,Mellinghoff H-U
Journal of Pain Research , 2012,
Abstract: Joseph V Pergolizzi Jr,1,2 Mart van de Laar,3 Richard Langford,4 Hans-Ulrich Mellinghoff,5 Ignacio Morón Merchante,6 Srinivas Nalamachu,7,8 Joanne O'Brien,9 Serge Perrot,10 Robert B Raffa111Department of Medicine, Johns Hopkins University, Baltimore, MD, USA; 2Association of Chronic Pain Patients, Houston, TX, USA; 3Arthritis Center Twente (MST and UT), Enschede, The Netherlands; 4Anaesthetics Laboratory, St Bartholomew's Hospital, London, UK; 5Department of Endocrinology, Diabetology and Osteology, Kantonsspital St Gallen, St Gallen, Switzerland; 6Centro de Salud Universitario Goya, Madrid, Spain; 7Kansas University Medical Center, Kansas City, KS, USA; 8International Clinic Research, Leawood, KS, USA; 9Department of Pain Management, Beaumont Hospital, Beaumont, Dublin, Ireland; 10Service de Médecine Interne et Consultation de la Douleur, H pital Dieu, Paris, France; 11Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia, PA, USAAbstract: Pain is the most common reason patients seek medical attention and pain relief has been put forward as an ethical obligation of clinicians and a fundamental human right. However, pain management is challenging because the pathophysiology of pain is complex and not completely understood. Widely used analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol (acetaminophen) have been associated with adverse events. Adverse event rates are of concern, especially in long-term treatment or at high doses. Paracetamol and NSAIDs are available by prescription, over the counter, and in combination preparations. Patients may be unaware of the risk associated with high dosages or long-term use of paracetamol and NSAIDs. Clinicians should encourage patients to disclose all medications they take in a "do ask, do tell" approach that includes patient education about the risks and benefits of common pain relievers. The ideal pain reliever would have few risks and enhanced analgesic efficacy. Fixed-dose combination analgesics with two or more agents may offer additive or synergistic benefits to treat the multiple mechanisms of pain. Therefore, pain may be effectively treated while toxicity is reduced due to lower doses. One recent fixed-dose combination analgesic product combines tramadol, a centrally acting weak opioid analgesic, with low-dose paracetamol. Evidence-based guidelines recognize the potential value of combination analgesics in specific situations. The current guideline-based paradigm for pain treatment recommends NSAIDs for ongoing use with analgesics such as opi
The effect of local tramadol injection in post appendectomy pain  [cached]
Alireza Khazaei,Farshid Arbabi-Kalati,Soheil Borumand,Reza Rooshanravan
Zahedan Journal of Research in Medical Sciences , 2012,
Abstract: Background: It has been demonstrated that tramadol, asemisynthetic opioid, is an effective analgesic with systemic (central) and local (peripheral) anesthetic effects. The aim of this study was to compare the post-operative anesthetic effect of subcutaneous wound infiltration of tramadol with normal saline as placebo in the incision wounds after appendectomy and measuring the average need to petidine during the next 24 hours after the appendectomy. Materials and Method: This double blind study was carried out on 60 patients over 15 years old. Patients were randomly divided in two equal groups. At the end of procedure after repairing fascia 100mg of tramadol that was diluted with water for injection up to 10 cc in one syringe or 10 cc of normal saline in another syringe was infiltrated subcutaneously by surgeon before suturing the skin. The intensity of pain (NRS) was recorded in the recovery room, after 6 and 24 hours post-operation as well as total amount of administered petidine in the same period. At the end of study the intensity of pain in the mentioned times and the average use of petidine compared in two groups. Results: A significant difference was noted in the severity of pain between two groups in recovery time, 6 and 24 hours afetr operation that was lower in tramadol group (p<0.0001). Also the average use of petidine was significantly lower in tramadol group in 24 hours (p<0.05). The average severity of pain by NRS in recovery was 5.36 for control (N) and 3.08 for tramadol (T) groups; and after 6 hours it was 5.36 for (N) and 3.36 for (T) and after 24 hours reached to 3.08 for (N) and 2.08 for (T) and the average number of injected 25mg ampoules of petidine was 1.56 in (N) and 0.76 in (T).Conclusion: Local wound infiltration of tramadol is a good choice for reduction of post appendectomy pain and decreasing need for high potent opioid analgesics
Analgesic Effect of Intraarticular Tramadol with Morphine after Arthroscopic Knee Surgery  [PDF]
Hussain Faisal,Arjun Lamichhane,Deepak Mahara
Nepal Orthopaedic Association Journal , 2013, DOI: 10.3126/noaj.v3i1.9320
Abstract: Introduction: Post-operative improved pain control of patients has made arthroscopy as a day care procedure, reducing patient’s expenses and hospital staffs work load. Various analgesic drugs have been administered into the joint following Arthroscopy. Intra-articular injection of morphine has been practiced in many centres all over the world. We aimed to compare the efficacy of intra-articular tramadol and morphine. Tramadol is an opioid drug with similar analgesic properties like morphine. Tramadol unlike morphine is readily available over the counter not being abused and has more favourable side effects. Methods: It was a prospectively randomized double-blind study in which sixty patients having elective arthroscopic surgery of the knee were randomized into two groups. Group A (Tramadol Group) received intra-articular tramadol 50mg and Group B (Morphine Group) received morphine 5mg in equivalent volumes. Post-operative pain using Visual Analogue Score (VAS) between 0 and 10, (0 no pain to 10 worst pain) requirement of first analgesic, and incidence of side effects were recorded postoperatively at intervals of 3,4,5,6 and 24 hours. Results: The assessment of VAS score among the two groups in 3,4,5,6 and 24 hours of IA injection showed a p value of 0.349, 0.807, 0.676, 0.271 and 0.163 respectively, suggesting non significant difference in two groups. There was statistically significant result (p=0.005) for request of first analgesia (Ibuprofen 400mg+ Paracetalmol 500mg) at 6 hours of IA injection with tramadol group, requiring less analgesics. There are no other clinically important differences between the groups, including preoperative duration of symptoms, postoperative pain scores and side effects irrespective of the diagnosis and the procedure performed. Conclusion: 50 mg IA tramadol provides analgesia equivalent to 5 mg IA morphine. DOI: http://dx.doi.org/10.3126/noaj.v3i1.9320 Nepal Orthopedic Association Journal 2013 Vol.3(1): 14-18
Pain relief in labour: tramadol versus pentazocine  [cached]
Kavita Chandnani,H. B. Sainee
International Journal of Reproduction, Contraception, Obstetrics and Gynecology , 2013, DOI: 10.5455/2320-1770.ijrcog20130615
Abstract: Background: The present study was undertaken to compare the effect of 100 mg intramuscular tramadol to 30 mg intramuscular Pentazocine for labour analgesia. Methods: A total of 60 cases with 37-40 weeks pregnancy in labour, without any foetal or maternal complications were selected. Out of them Inj. Tramadol was given to 30 cases while rest of the 30 patients received injection Pentazocine. Results: In Tramadol group pain relief was observed in 80% cases, effect started as early as 7-8 min and continued for 2.13 hrs. While in Pentazocine group pain relief was observed in only 60% cases with delayed onset (15-16 min), effect lasted for 2.67 hrs. Maternal and foetal complications were slightly more in Pentazocine group. Conclusions: Tramadol is an effective and safe labour analgesic, producing moderate to satisfactory. Besides it also significantly shortens the duration of labour. [Int J Reprod Contracept Obstet Gynecol 2013; 2(2.000): 186-189]
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