Does Tramadol Have a Role in Pain Control in Palliative Care?

Abstract

Background:

The effectiveness of the step II of the World Health Organization analgesic ladder including tramadol has been questioned recently.

Methods:

Retrospective study of patients treated with tramadol admitted as inpatients to one palliative care unit between November 1, 2009, and October 30, 2012.

Results:

In the study period, 730 patients were admitted and 66 (9%) of them met the criteria for inclusion; 45 (68%) continued medication with tramadol until discharge from the unit, while 21 (32%) had to switch to an opioid for moderate to severe pain. The reason for switching was uncontrolled pain in 16 (76%) patients, and for 5 (24%) patients, the switch was made for other reasons.

Conclusion:

The data suggest that tramadol may have a role to play in the treatment of pain in palliative care.

Keywords

palliative care pain pain control tramadol analgesic ladder opioids for mild to moderate pain

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References

Gibson

, Pharmacokinetics, efficacy, and safety of analgesia with a focus on tramadol HCl. Am J Med. 1996;101 (suppl 1A):47S–53S.

Leppert

. Tramadol as an analgesic for mild to moderate cancer pain. Pharmacol Rep. 2009;61 (6):978–992.

Duthie

DJR

. Remifentanil and tramadol. Br J Anaesth. 1998;81(1):51–57.

Leppert

. CYP2D6 in the metabolism of opioids for mild to moderate pain. Pharmacology. 2011;87 (5–6):274–285.

Frank

. Recognition and treatment of serotonin syndrome. Cam Fam Physician. 2008;54 (7):988–992.

Jadad

Browman

. The WHO analgesic ladder for cancer pain management. JAMA. 1995;274 (23):1870–1873.

Marinangeli

Ciccozzi

Leonardis

. Use of strong opioids in advanced cancer pain: a randomized trial. J Pain Symptom Manage. 2004;27 (5):409–416.

Maltoni

Scarpi

Modonesi

. A validation study of the WHO analgesic ladder: a two-step vs three-step strategy. Support Care Cancer. 2005;13 (11):888–894.

Tassinari

Drudi

Rosari

Tombesi

Sartori

Maltoni

. The second step of the analgesic ladder and oral tramadol in the treatment of mild to moderate cancer pain: a systematic review. Palliat Med. 2011;25(5):410–423.

10.

Altman

Bland

. Absence of evidence is not evidence of absence. BMJ. 1995;311 (7003):485.

11.

Ferraz

Gonçalves

Almeida

Antunes

. A cross-sectional survey of pain in palliative care in Portugal. Support Care Cancer. 2013;21 (7):2033–2039.

12.

Leppert

Luczak

. The role of tramadol in cancer pain treatment—a review. Support Care Cancer. 2005;13 (1):5–17.

13.

Arbaiza

Vidal

. Tramadol in the treatment of neuropathic cancer pain: a double-blind, placebo-controlled study. Clin Drug Invest. 2007;27 (1):75–83.

14.

Grond

Radbruch

Meuser

Loick

Sabatowski

Lehmann

. High-dose tramadol in comparison to low-dose morphine for cancer pain relief. J Pain Symptom Manage. 1999;18 (3):174–179.

15.

Petzke

Radbruch

Sabatowski

Karthaus

Mertens

. Slow-release tramadol for treatment of chronic malignant pain – an open multicenter trial. Support Care Cancer. 2001;9 (1):48–54.

16.

Leppert

Majkowicz

. The impact of tramadol and dihydrocodeine treatment on quality of life of patients with cancer pain. Int J Clin Pract. 2010;64 (12):1681–1687.