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The Addition of Tramadol as a Second Opioid May Improve Pain Relief in Severe Osteoarthritis: A Prospective Study . Tramadol Plus Strong Opioid in Osteoarthritis.

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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
Source: Pain Practice. Nov/Dec2010, Vol. 10 Issue 6, p540-547. 8p. 1 Diagram, 2 Charts, 2 Graphs.
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
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. [ABSTRACT FROM AUTHOR]
Copyright of Pain Practice is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: The Addition of Tramadol as a Second Opioid May Improve Pain Relief in Severe Osteoarthritis: A Prospective Study . Tramadol Plus Strong Opioid in Osteoarthritis.
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  Data: <searchLink fieldCode="AR" term="%22Di+Lorenzo%2C+Luigi%22">Di Lorenzo, Luigi</searchLink><br /><searchLink fieldCode="AR" term="%22Foti%2C+Calogero%22">Foti, Calogero</searchLink><br /><searchLink fieldCode="AR" term="%22Forte%2C+Alfonso+Maria%22">Forte, Alfonso Maria</searchLink><br /><searchLink fieldCode="AR" term="%22Palmieri%2C+Enzo%22">Palmieri, Enzo</searchLink><br /><searchLink fieldCode="AR" term="%22Formisano%2C+Rita%22">Formisano, Rita</searchLink><br /><searchLink fieldCode="AR" term="%22Vatakencherry%2C+Abraham%22">Vatakencherry, Abraham</searchLink><br /><searchLink fieldCode="AR" term="%22Pappagallo%2C+Marco%22">Pappagallo, Marco</searchLink>
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  Data: <searchLink fieldCode="JN" term="%22Pain+Practice%22">Pain Practice</searchLink>. Nov/Dec2010, Vol. 10 Issue 6, p540-547. 8p. 1 Diagram, 2 Charts, 2 Graphs.
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  Data: 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. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Pain Practice is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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      – Type: doi
        Value: 10.1111/j.1533-2500.2010.00384.x
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      – Code: eng
        Text: English
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      Pagination:
        PageCount: 8
        StartPage: 540
    Subjects:
      – SubjectFull: Buprenorphine
        Type: general
      – SubjectFull: Oxycodone
        Type: general
      – SubjectFull: Fentanyl
        Type: general
      – SubjectFull: Drug therapy
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      – SubjectFull: Morphine
        Type: general
      – SubjectFull: Therapeutic use of transdermal medication
        Type: general
      – SubjectFull: Analgesics
        Type: general
      – SubjectFull: Combination drug therapy
        Type: general
      – SubjectFull: Chronic pain
        Type: general
      – SubjectFull: Longitudinal method
        Type: general
      – SubjectFull: Narcotics
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      – SubjectFull: Nursing assessment
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      – SubjectFull: Osteoarthritis
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      – SubjectFull: Health outcome assessment
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      – SubjectFull: Questionnaires
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      – SubjectFull: Performance evaluation
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      – SubjectFull: Treatment effectiveness
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      – SubjectFull: Severity of illness index
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      – SubjectFull: Drug dosage
        Type: general
      – SubjectFull: Tramadol
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      – SubjectFull: Pharmacodynamics
        Type: general
      – SubjectFull: Therapeutics
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      – TitleFull: The Addition of Tramadol as a Second Opioid May Improve Pain Relief in Severe Osteoarthritis: A Prospective Study . Tramadol Plus Strong Opioid in Osteoarthritis.
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              M: 11
              Text: Nov/Dec2010
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              Y: 2010
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