Tramadol Relieves Neuropathic Pain

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Tramadol Relieves Neuropathic Pain

http://www.aafp.org/afp/20070501/cochrane.html#c2

Clinical Question

Is tramadol (Ultram) safe and effective for the treatment of

neuropathic pain?

Evidence-Based Answer

Tramadol is an effective treatment for neuropathic pain. One out of

four patients who take the medication achieves at least 50 percent

pain relief.

Practice Pointers

Tramadol is a unique pain reliever that is thought to work via a

weak effect on opioid receptors and by limiting reuptake of

serotonin and norepinephrine, an effect occurring with many

antidepressants. This systematic review identified six randomized

controlled trials of tramadol for the treatment of neuropathic pain.

Four studies (337 total patients) compared tramadol with placebo.

All four studies were double-blinded, and three of the four studies

(including 302 of the patients) adequately concealed allocation from

participants and accounted for patients lost to follow-up.

The review found a clinically significant benefit with tramadol

(number needed to treat to achieve at least 50 percent pain relief =

3.8; 95% confidence interval [CI], 2.8 to 6.3). One small, unblinded

study (21 total patients) found no difference between tramadol and

clomipramine (Anafranil). Another study (40 total patients) found no

clear difference between tramadol and morphine in patients with

cancer-related pain. However, these studies were too small and too

poorly designed (i.e., unblinded with many dropouts) to draw firm

conclusions.

Between 5 and 15 percent of patients discontinued the study

medication because of adverse effects. In the two studies that

provided adverse effects data, the combined number needed to harm

was 7.7 (95% CI, 4.6 to 20). Although no life-threatening adverse

effects were reported, tramadol can lower the seizure threshold and

should not be given to patients with a history of seizure. An

evidence-based guideline from the Institute for Clinical Systems

Improvement recommends tramadol as a treatment option for

neuropathic pain,1 and an expert panel recommends it as a first-line

treatment.2

MARK EBELL, MD, MS

Source: Hollingshead J, et al. Tramadol for neuropathic pain.

Cochrane Database Syst Rev 2006;(3):CD003726.

REFERENCES

1. Institute for Clinical Systems Improvement. Assessment and

management of acute pain. March 2006. Accessed February 22, 2007,

at:

http://www.icsi.org/pain_acute/pain__acute__assessment_and_management

_of__3.html.

2. Dworkin RH, Backonja M, Rowbotham MC, RR, Argoff CR,

GJ, et al. Advances in neuropathic pain: diagnosis,

mechanisms, and treatment recommendations. Arch Neurol 2003;60:524-

34.