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- Title
The Addition of Tramadol as a Second Opioid May Improve Pain Relief in Severe Osteoarthritis: A Prospective Study . Tramadol Plus Strong Opioid in Osteoarthritis.
- Authors
Di Lorenzo, Luigi; Foti, Calogero; Forte, Alfonso Maria; Palmieri, Enzo; Formisano, Rita; Vatakencherry, Abraham; Pappagallo, Marco
- Abstract
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. 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. 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. The addition of tramadol provided a synergistic effect resulting in a 30-mg decrease in necessary morphine equivalents with fewer opioid-related adverse effects.
- Subjects
BUPRENORPHINE; OXYCODONE; FENTANYL; DRUG therapy; MORPHINE; THERAPEUTIC use of transdermal medication; ANALGESICS; COMBINATION drug therapy; CHRONIC pain; LONGITUDINAL method; NARCOTICS; NURSING assessment; OSTEOARTHRITIS; HEALTH outcome assessment; QUESTIONNAIRES; PERFORMANCE evaluation; TREATMENT effectiveness; SEVERITY of illness index; DRUG dosage; TRAMADOL; PHARMACODYNAMICS; THERAPEUTICS
- Publication
Pain Practice, 2010, Vol 10, Issue 6, p540
- ISSN
1530-7085
- Publication type
Article
- DOI
10.1111/j.1533-2500.2010.00384.x