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Medical research on tramadol
Is oral tramadol a reasonable PRN analgesic?
J Opioid Manag. 2008 Jan-Feb; 4(1): 8-10
Herndon CM, Johns A
Pain Res Manag. 2008 Mar-Apr; 13(2): 103-10
Beaulieu AD, Peloso PM, Haraoui B, Bensen W, Thomson G, Wade J, Quigley P, Eisenhoffer J, Harsanyi Z, Darke AC
OBJECTIVE: The present study was a randomized, parallel, double-blind comparison between controlled-release (CR) tramadol and sustained-release (SR) diclofenac in patients with chronic pain due to osteoarthritis of the hips and/or knees. METHODS: Patients with at least moderate pain intensity, and having received analgesics over the past three months, underwent a two- to seven-day washout of current analgesics before initiation of 200 mg CR tramadol or 75 mg SR diclofenac. During the eight-week study, patients returned to the clinic biweekly. CR tramadol doses were titrated to a maximum of 200 mg, 300 mg or 400 mg per day. SR diclofenac doses were titrated to 75 mg or 100 mg once daily, or 75 mg twice a day based on pain relief and the presence of side effects. For rescue analgesic, patients took acetaminophen as needed, up to 650 mg three times a day. RESULTS: Forty-five patients on CR tramadol and 52 patients on SR diclofenac were evaluable. Significant improvements from prestudy treatment were shown for visual analogue scale pain (P=0.0001), stiffness (P
Pain Res Manag. 2008 Mar-Apr; 13(2): 93-102
Thorne C, Beaulieu AD, Callaghan DJ, O'Mahony WF, Bartlett JM, Knight R, Kraag GR, Akhras R, Piraino PS, Eisenhoffer J, Harsanyi Z, Darke AC
OBJECTIVE: To compare the efficacy and safety of controlled-release (CR) tramadol (Zytram XL, Purdue Pharma, Canada) and placebo in patients with painful osteoarthritis. METHODS: Patients underwent analgesic washout for two to seven days before random assignment to 150 mg daily of CR tramadol or placebo, and were titrated weekly to 200 mg, 300 mg or a maximum of 400 mg once daily. After four weeks, patients crossed over to the alternate treatment for another four weeks. Plain acetaminophen was provided as a rescue analgesic. All patients who completed the crossover study were eligible to receive open label CR tramadol for six months. RESULTS: Seventy-seven of 100 randomly assigned patients were evaluable for efficacy. CR tramadol resulted in significantly lower visual analogue scale pain intensity scores (37.4+/-23.9 versus 45.1+/-24.3, P=0.0009). Western Ontario and McMaster Universities osteoarthritis index subscale scores for pain (189.0+/-105.0 versus 230.0+/-115.4; P=0.0001) and physical function (632.4+/-361.3 versus 727.4+/-383.4; P=0.0205) were significantly better with CR tramadol. Total pain and disability (22.8+/-14.5 versus 27.2+/-14.8; P=0.0004), and overall pain and sleep (104.7+/-98.0 versus 141.0+/-108.2; P=0.0005) scores in the Pain and Sleep Questionnaire were significantly lower for CR tramadol. Short-form 36 Health Survey scores were significantly better during CR tramadol treatment for the pain index (38.8+/-10.8 versus 35.6+/-9.0; P=0.0100), general health perception (46.5+/-11.2 versus 44.4+/-11.6; P=0.0262), vitality (43.1+/-13.2 versus 40.2+/-13.7; P=0.0255) and overall physical components (40.8+/-8.9 versus 37.8+/-7.7; P=0.0002). CR tramadol treatment was preferred by 55.8% of patients (P=0.0005) versus 20.8% and 23.4% of patients who chose placebo or had no preference, respectively. These improvements were sustained for up to six months, and 86.5% of patients reported at least moderate benefit from CR tramadol during long-term treatment. CONCLUSION: CR tramadol is effective for the management of painful osteoarthritis.
Premature ejaculation: current medical treatment and new directions (CME).
J Sex Med. 2008 May; 5(5): 1037-50; quiz 1051-2
Sadeghi-Nejad H, Watson R
INTRODUCTION: Premature ejaculation (PE) is the most common form of male sexual dysfunction. Until very recently, scientific investigation of PE has been hampered by a lack of standardized definitions and objective, validated questionnaires. Small numbers of randomized controlled studies evaluating various treatment options have also added to the challenges facing the clinicians who manage PE. AIM: This article provides a summary of some of the more relevant the peer-reviewed literature pertaining to the medical therapy of premature ejaculation. METHODS: A retrospective review of peer reviewed publications relevant to the field of premature ejaculation and related medical therapies. MAIN OUTCOME MEASURES: Review of safety and efficacy of various medical therapies for premature ejaculation. RESULTS: Selective serotonin release inhibitors have been the most promising agents to date. The on-demand "PRN" use of these agents is more convenient, but its efficacy is less well established. Chronic use of this class of medications has been associated with minor, but bothersome side effects. More recently, concern over the risk of an increased suicide rate in young men upon initiation of SSRIs has dampened enthusiasm. Recent experience with the use of Tramadol raises the hope that this might prove to be an agent as effective as SSRIs with less worrisome risk of side-effects. New trials on novel formulations of topical solutions are currently underway in the United States. CONCLUSIONS: Interest in medical therapy for PE is rapidly increasing and reflected in a disproportionate number of publications in this field in the past few years. Clinical research in this field is hampered by the complexity, variability among different men and cultures, and subjectivity of PE. Reliable, appropriately controlled and assessed studies are generally lacking and carefully devised, methodically conducted research is much needed.
The preemptive analgesic effect of lornoxicam in patients undergoing major abdominal surgery.
Int J Surg. 2008 Mar 10;
Karaman Y, Kebapcı E, Gurkan A
INTRODUCTION: The aim of this study was to examine the effect of lornoxicam used in preemptive analgesia on the intensity of pain and requirement for analgesics in the perioperative period for major abdominal surgery. METHODS: Sixty patients scheduled for elective major abdominal surgery were randomly assigned to three groups after ethics committee approval. Patients in Group PRE (n=20) received lornoxicam i.v. 8mg 20min before incision and saline i.v. after skin closure; patients in Group POST (n=20) received saline i.v. 20mins before incision and lornoxicam i.v. 8mg after skin closure; patients in Group C (n=20) received saline i.v. 5min before incision and after skin closure. A standardized general anesthetic was used. All patients were started on i.v. tramadol patient-controlled analgesia during the postoperative period. Pain intensity was measured using the visual analog scale (VAS), and tramadol consumption. In addition, the incidences of side effects were recorded at the end of the study period. RESULTS: There were no significant differences among the three groups of the demographic data. Groups PRE and POST demonstrated significantly reduced pain scores compared to Group C at various points in time. Group PRE also demonstrated a weakly significant reduction in analgesic consumption of tramadol postoperatively compared to Groups POST and C. CONCLUSION: Lornoxicam administered preemptively appears to improve the quality of postoperative analgesia and leads to reduced consumption of tramadol postoperatively in patients undergoing major abdominal operations.
Orthopade. 2008 Apr 23;
Krocker D, Ullrich H, Buttgereit F, Perka C
AIM OF THE STUDY: Chronic pain is the main symptom of postmenopausal osteoporosis. This can decrease mobility and quality of life of the patients. The hypothesis of this study was that administration of an adjuvant pain medication is essential additionally to the basic therapy. The second question was if a recommendation can be formulated whether a peripheral or a central acting pain medication is more effective to prevent osteoporosis induced chronic pain. METHODS: Three pseudorandomised patient groups were prospectively compared. Group 1 was treated with alendronate, vitamin D, and calcium. Group 2 also received ibuprofen, and group 3 also received tramadol. In 117 women suffering from postmenopausal osteoporosis, quality of life was measured before and 26 weeks after therapy using the International Osteoporosis Foundation Qualeffo-41 score, and pain intensity was measured using a visual analogue scale. RESULTS: No therapy-associated complications were observed during the study. After 26 weeks, quality of life significantly increased in groups 2 and 3 compared with group 1 (p
Involvement of serotonin 2A receptors in the analgesic effect of tramadol in mono-arthritic rats.
Brain Res. 2008 Feb 29;
Xie H, Dong ZQ, Ma F, Bauer WR, Wang X, Wu GC
The analgesic effects of tramadol are considered to be mediated by both the opioid system and the serotonergic system. This study investigated the involvement of a subtype of serotonin receptors, 5-hydroxytryptamine (5-HT)(2A) receptor, in the analgesic effect of tramadol. The intraperitoneal (i.p.) injection of tramadol reduced the paw withdrawal latency (PWL) to radiant heat testing in mono-arthritic rats. The antagonistic effect of i.p. ketanserin (a 5-HT(2A) receptor antagonist) on tramadol analgesia was observed. The expression of the 5-HT(2A) receptor mRNA in the nucleus of raphe magnus (NRM), ventrolateral periaqueductal gray (vlPAG) and spinal dorsal horn of mono-arthritic rats after a ten-day treatment with tramadol was measured with in situ hybridization. Either single injections or 10 days of tramadol treatment dose-dependently elevated PWL of arthritic rats while ketanserin could partially antagonize the tramadol analgesic effect. Expression of the 5-HT(2A) receptor mRNA in NRM, ipsilateral vlPAG, and the ipsilateral spinal dorsal horn of arthritic rats was significantly increased after tramadol treatment. These results suggest that 5-HT(2A) receptors are involved in the analgesic effect of tramadol. This study provides evidence for involvement of 5-HT(2A) receptors in the tramadol analgesia of inflammatory pain. The increase in this receptor mRNA in the chronic study may contribute to the sustaining effect of tramadol long-term treatments in clinical practice.
Anaesthesist. 2008 Apr 15;
Jage J, Laufenberg-Feldmann R, Heid F
In part 1 of this review, perioperative aspects of the use of non-opioids (acetaminophene, dipyrone, traditional NSAR, coxibs) were discussed. In part 2 the perioperative aspects of opioids (weak opioids: tramadol, tilidine with naloxone, strong opioids: morphine, piritramide, oxycodone, hydromorphone, fentanyl, methadone, buprenorphine) and coanalgesics (gabapentinoids; ketamine) will now be presented. The main aim of the review is to describe the use, risks and cost of some substances to facilitate the differential indication. New aspects concerning the use of gabapentinoids and ketamine are discussed.
Pediatr Surg Int. 2008 Apr 12;
Ekemen S, Yelken B, Ilhan H, Tokar B
Prevention of postoperative pain in children is one of the most important objectives of the anesthesiologist. Opioids have been used as an analgesic for postoperative pain in children for many years. Tramadol has both opioid and monoaminergic agonist actions. The aim of the study was to determine if the analgesic potency and occurence of adverse effects of tramadol differ from pethidine when administered to children. A total of 110 healthy children, aged 2-12 years, scheduled for elective lower abdominal surgery were randomized to receive either pethidine 1 mg/kg (Group I, n = 60) or tramadol 2 mg/kg (Group II, n = 50) for postoperative pain after anesthesia induction. Pain intensity, adverse effects, heart rate, and systolic and diastolic blood pressure were recorded at regular intervals. The mean pain scores on postoperative 24 h were significantly greater with tramadol than with pethidine. Sedation scores, heart rate and systolic and diastolic blood pressure showed no significant differences betweeen the groups. We conclude that pethidine and tramadol are effective in providing analgesia in pediatric patients, but pethidine provided better postoperative analgesia than tramadol. Changes in blood pressure, heart rate and arterial oxygen saturation were minimal and were similar in both drugs.
The effect of repeated daily measurements on paw withdrawal latencies in Hargreaves test.
Coll Antropol. 2008 Jan; 32 Suppl 1: 93-7
Kocevski D, Tvrdeić A
The hypothesis that repeated measurements during 4 subsequent days affect withdrawal latencies in Hargreaves test was investigated. Paw withdrawal latencies to radiant heat were determined in the control, tramadol or saline group of male Wistar rats. The control group (N=10) had no treatment. Tramadol group (N=7) and saline group (N=7) received one daily intraperitoneal injection of tramadol (15 mg/kg) or saline (0.9% NaCl), respectively. A significant decline in withdrawal latencies was observed in the control group on the day 2 to day 4, when compared to day 1 (p < 0.05 Bonferroni test). In the saline and tramadol groups, latencies remained stable from day 1 to day 4. During the entire testing period withdrawal latencies were 27-50% longer in tramadol group (p < 0.05 ANOVA) compared with the saline group. When compared to the control group, the effect of tramadol, was noted from the second to forth day (p < 0.01 Bonferroni test), but not on the first day. Finally, a tendency to decrement in withdrawal latencies existed on day 1 in the saline group compared with control group, but this difference does not reach significance. We conclude that one day of training affect withdrawal latencies in the Hargreaves test.