The role of tramadol in pain management in Latin America: a report by the Change Pain Latin America Advisory Panel

Garcia, João Batista Santos; Lech, Osvandré; Kraychete, Durval Campos; Rico, María Antonieta; Hernández-Castro, John Jairo; Colimon, Frantz; Guerrero, C.; Gallegos, Manuel Sempértegui; Lara-Solares, Argelia; Cantisani, José Alberto Flores; Amescua-García, César; Núñez, María del Rocío Guillén; Cook, María Del Rosario Berenguel; Iskandar, Aziza Jreige; Sierra, Patricia Bonilla

doi:10.1080/03007995.2017.1354821

Cited by 11 publications

(7 citation statements)

References 49 publications

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“…Still under surveillance, in its 41st session (in 2018) the Expert Committee was concerned by the extent of abuse and evidence of public health risks associated with tramadol. However, because in many countries tramadol was the only available opioid analgesic and is included in the national essential medicine lists of 46 countries [143–146], the Committee did not recommend scheduling that would limit access to this medication [108].…”

Section: Discussionmentioning

confidence: 99%

Tramadol use and public health consequences in Iran: a systematic review and meta‐analysis

et al. 2020

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Background and Aims Misuse of tramadol, an opioid prescription analgesic, is known as a public health challenge globally. We aimed to systematically review studies on the prevalence of non‐prescribed use, regular tramadol use and dependence, tramadol‐induced poisoning and mortality in Iran. Methods Consistent with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines, international (Medline, Scopus, Web of Science) and Persian (SID) databases were systematically searched up to June 2019. Other relevant data were collected through personal contacts and review of reference lists. Pooled estimates of prevalence of tramadol use in subgroups of males and females, percentage of tramadol poisoning among admitted poisoning cases, tramadol‐associated seizures and mortality among tramadol poisonings and percentage of tramadol as a cause of death among fatal drug‐poisoning records were estimated through a random‐effects model. Results A total of 84 records were included. Pooled estimates of last 12‐month use of tramadol in the Iranian general population were 4.9% [95% confidence interval (CI) = 4.1–5.9] and 0.8% (95% CI = 0.2–1.8) among males and females, respectively. The estimates for last 12‐month use among Iranian male and female university students were 4.8% (95% CI = 1.9–8.9) and 0.7% (95% CI = 0.3–1.1), respectively. Six heterogeneous reports indicated the existence of regular use of tramadol and dependence in Iran. Sixty‐two studies provided data on tramadol‐induced poisoning, seizures and mortality. The pooled estimate of the percentage of tramadol poisoning among all drug‐poisoning patients was 13.1% (95% CI = 5.7–22.9). The overall estimates of seizures and mortality among tramadol‐poisoning patients were 34.6% (95% CI = 29.6–39.8) and 0.7% (95% CI = 0.0–1.9), respectively. The pooled percentage of tramadol‐related fatalities among drug‐poisoned cases was 5.7% (95% CI = 0.5–15.4). Conclusion Despite control policies, tramadol use is as prevalent as the use of illicit opioids in Iran. Numerous cases of tramadol abuse, dependence, poisonings, seizures and hundreds of tramadol‐related deaths have been reported in recent years.

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Section: Discussionmentioning

confidence: 99%

Tramadol use and public health consequences in Iran: a systematic review and meta‐analysis

et al. 2020

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“…One systematic review addressed the effects of combination pharmacotherapies; however, the authors only considered studies of combinations of two or more drugs . Three narrative reviews were found; however, these previous authors did not appraise the methodological quality of the included studies nor the quality of the evidence . We believe that the difficulties of designing and conducting studies in a complex disease such as fibromyalgia have contributed to this dearth of randomised clinical studies.…”

Section: Discussionmentioning

confidence: 99%

Tramadol for management of fibromyalgia pain and symptoms: Systematic review

et al. 2019

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Summary Background Fibromyalgia is a heterogeneous condition that appears to be associated with physiological and biochemical disturbances of pain modulation, and that consequently affects numerous other facets of life. Tramadol is currently being explored as an option to manage fibromyalgia pain and other symptoms because of its inhibitory activity of reuptake of neurotransmitters, but its safety and efficacy have not yet been established in these patients. Objective To evaluate the effectiveness and safety of tramadol on the management of symptoms of the syndrome. Methods We searched CENTRAL, MEDLINE, EMBASE, LILACS, Opengrey, ClinicalTrials.gov and WHO‐ICTRP for randomised controlled trials analysing the association between tramadol used for fibromyalgia either single‐agent or in combination with other drugs. Two reviewers independently extracted data and assessed risk of bias using the Cochrane risk‐of‐bias tool for all included studies. Quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results Four RCTs comprising 459 patients were included. Tramadol—either as a single‐agent or in combination with an antidepressant or analgesic—had a positive effect on pain. Tramadol combined with analgesic showed improved quality of life over placebo as measured by the Fibromyalgia Impact Questionnaire at 91 days. However, this difference did not hold for tramadol as a single agent against placebo. The evidence in these articles was rated “low” using the GRADE approach. No serious adverse events were reported. No improvement in depression and quality of sleep were observed. Conclusions This systematic review found a dearth of clinical trials on tramadol in patients with fibromyalgia. Although the combination of monoamine and opioid mechanism of tramadol has shown positive effects for fibromyalgia, the available evidence is not sufficient to support or refute the use of tramadol in clinical practice for pain or symptom management. Protocol registration number in the PROSPERO database: CRD42017062139.

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“…The Change Pain Latin America panel agreed that tramadol is well tolerated, and without the safety issues associated with long-term NSAIDs use, has fewer opioid-like side effects than classical opioids, and a lower risk of abuse. 26 Vercauteren et al demonstrated that the combination of sufentanil with tramadol reduced the dose requirements of both components by approximately 20%. 27 In comparison with another study conducted at our institution, the consumption of tramadol in the present study was reduced by about half, even though there was no significant differences in sufentanil consumption between the two studies.…”

Section: Discussionmentioning

confidence: 99%

Comparison of different sufentanil–tramadol combinations for pain relief within the first 24 hours after cesarean section: a retrospective study

Cao

Zhang

2018

JPR

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IntroductionPostcesarean section pain management is important for both the mother and the newborn. This study compared the analgesic effects and incidence of adverse events associated with intravenous patient-controlled analgesia (iv-PCA), using different sufentanil–tramadol combinations for postoperative pain control.MethodsParturients (n=5,794) who had been scheduled for cesarean section under neuraxial anesthesia and had received iv-PCA between September 2013 and March 2017 were retrospectively analyzed. These patients were assigned to three groups, based on different sufentanil–tramadol combinations: ST1 (n=1,347), ST2 (n=2,401), and ST3 (n=2,046). The analgesic efficacy, total drug consumption, and incidence of adverse effects within 24 hours after surgery were compared among the three groups.ResultsThe ST3 group had lower visual analog scale pain scores at rest and with movement at all time points during the first 24 hours postoperatively than the other two groups (P<0.01, Bonferroni corrected). The sufentanil dosage administered to the ST3 group was lower, and the tramadol dosage was higher than those administered to the other groups within 24 hours after surgery (P<0.01, Bonferroni corrected). Moreover, all parturients scored 2 points on the Ramsay sedation scale. Adverse reactions such as pruritus and respiratory depression were not observed in any group. No significant differences were noted in the incidence of nausea/vomiting, abdominal distension, and dizziness among the three groups (P>0.05).ConclusionThe visual analog scale scores for postoperative pain decreased as the concentrations of sufentanil and tramadol administered in iv-PCA moderately increased over 24 hours after surgery. This analgesic strategy resulted in a significant reduction in the total sufentanil requirement without increasing the incidence of adverse effects.

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The role of tramadol in pain management in Latin America: a report by the Change Pain Latin America Advisory Panel

Cited by 11 publications

References 49 publications

Tramadol use and public health consequences in Iran: a systematic review and meta‐analysis

Tramadol use and public health consequences in Iran: a systematic review and meta‐analysis

Tramadol for management of fibromyalgia pain and symptoms: Systematic review

Comparison of different sufentanil–tramadol combinations for pain relief within the first 24 hours after cesarean section: a retrospective study

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The role of tramadol in pain management in Latin America: a report by the Change Pain Latin America Advisory Panel

Cited by 11 publications

References 49 publications

Tramadol use and public health consequences in Iran: a systematic review and meta‐analysis

Tramadol use and public health consequences in Iran: a systematic review and meta‐analysis

Tramadol for management of fibromyalgia pain and symptoms: Systematic review

Comparison of different sufentanil&ndash;tramadol combinations for pain relief within the first 24 hours after cesarean section: a retrospective study

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Comparison of different sufentanil–tramadol combinations for pain relief within the first 24 hours after cesarean section: a retrospective study