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The Addition of Tramadol as a Second Opioid May Improve Pain Relief in Severe Osteoarthritis: A Prospective Study
Author(s) -
Di Lorenzo Luigi,
Foti Calogero,
Forte Alfonso Maria,
Palmieri Enzo,
Formisano Rita,
Vatakencherry Abraham,
Pappagallo Marco
Publication year - 2010
Publication title -
pain practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 58
eISSN - 1533-2500
pISSN - 1530-7085
DOI - 10.1111/j.1533-2500.2010.00384.x
Subject(s) - tramadol , medicine , opioid , anesthesia , osteoarthritis , morphine , adverse effect , pain relief , prospective cohort study , analgesic , receptor , alternative medicine , pathology
Abstract Background: Opioid combination has been shown to reduce the need for escalating doses for the treatment of cancer pain. A prospective study was planned to evaluate the addition of tramadol to a stronger opioid for the treatment of severe pain as a result of osteoarthritis, previously uncontrolled by non‐opioid analgesics or weak opioids. Methods: All subjects received tramadol 200 mg and tizanidine 2 mg. At 2 weeks, tramadol was discontinued for patients still reporting poor pain relief (effectiveness ≤50%), and a stronger opioid was titrated to a morphine equivalent amount (MEA) of 40–60 mg orally. After two additional weeks, patients were then divided into two groups: the Strong Opioid Group (SO) and the Tramadol plus the Strong Opioid Group (TSO). The SO group was allowed to escalate opioid dose for lack of effectiveness; the TSO group received tramadol 150 mg daily, thereafter additional strong opioid titration was allowed. Results: A total of 74 patients were studied: SO ( n = 40) and TSOG ( n = 34). All patients eventually achieved pain relief quality, with both groups reporting similar Karnofsky Performance Scale effectiveness. The SO group achieved satisfactory pain relief (>50%) at an average daily oral MEA of 120 mg. TSO subjects achieved satisfactory pain relief (>50%) at an average daily oral MEA of 95 mg. Discussion: The addition of tramadol provided a synergistic effect resulting in a 30‐mg decrease in necessary morphine equivalents with fewer opioid‐related adverse effects.