Maintenance of the long-term effectiveness of tramadol in treatment of the pain of diabetic neuropathy

Diabetic Neuropathy: A Position Statement by the American Diabetes Association

“…It is an effective agent in the treatment of painful diabetic peripheral neuropathy compared with placebo as demonstrated by two large multicenter trials (129,130), and it appears to have long-term effects (131). Although tramadol has a lower potential for abuse compared with other opioids, given these safety concerns, it is not recommended for use as first-or second-line agent.…”

Opioids in chronic noncancer pain

“…Noble et al showed that oral opioids reduced pain long-term in the relatively small proportion of individuals with chronic noncancer pain who continued treatment [37]. However, for oral opioids they evaluated morphine in three studies [44][45][46], tramadol in one study [47], methadone in one study [48], extended-release oxymorphone in one study [49], controlled-release oxycodone in one study [50], as well as dihydrocodeine and buprenorphine [46]. For evaluation of effectiveness of transdermal fentanyl they included three studies [44,51,52]; however, only two studies utilized pain relief of 50% or greater as their significant criteria [44,46].…”

“…Consequently, patients who experienced long-term pain outcomes represented only a subset of the patients initially enrolled in the studies. Multiple randomized controlled trials also included open-label extension trials [45,47,49,50]. In summary, among individuals with chronic noncancer pain taking oral opioids, approximately a third did not continue long-term treatment with a follow-up time ranging from 6 to 18 months because of the intolerable adverse effects.…”

A Comparison of Long- and Short-Acting Opioids for the Treatment of Chronic Noncancer Pain: Tailoring Therapy to Meet Patient Needs

“…In a randomized, placebocontrolled study of tramadol in patients with DN, tramadol provided significant reductions in pain intensity (P<.001) and increases in pain relief (P<.001) compared with placebo during the 6-week treatment period. 74 Maintenance of pain relief was continued through a 6-month open-label extension 75 ; patients who were randomized to placebo in the original trial and subsequently given tramadol titrated to a maximum of 400 mg in the extension had improved pain scores relative to baseline; they reported scores of pain intensity and relief matching those of patients initially randomized to tramadol in the double-blind portion of the study. 75 No studies have compared directly the effectiveness of LAOs and SAOs in patients with neuropathic pain.…”