The role of tramadol in cancer pain treatment—a review

Abstract

In most cancer patients pain can be successfully treated with pharmacological measures using opioid analgesics alone or in combination with adjuvant analgesics (coanalgesics). Weak opioids are usually recommended in the treatment of moderate cancer pain. There is still a debate as to whether the second step of the WHO analgesic ladder comprising opioid analgesics such as tramadol, codeine, dihydrocodeine, and dextropropoxyphene is still needed for the treatment of cancer pain. On the basis of our experience and review of the literature we think that there is definitely a place for weak opioids in the treatment of moderate cancer pain. One of the most interesting and useful weak opioids is tramadol (Adolonta, Contramal, Nobligan, Top-Algic, Tramal, Tramal Long, Tramal Retard, Tramundin, Trodon, Ultram, Zydol). Its unique mechanism of action, analgesic efficacy and profile of adverse reactions have been the reason of performing many experimental and clinical studies with tramadol. In this article we summarize data on pharmacology, mechanisms of action, pharmacokinetics, side effects and clinical experience assessing analgesic efficacy, adverse reactions and safety of tramadol in cancer pain.

A Study on Epidural Tramadol Compared with Epidural Fentanyl Combined with Low Dose Bupivacaine for the Control of Metastatic Cancer Pain

“…In another recent study, on the basis of their experience and review of the literature it was decided that there is definitely a place for weak opioids in the treatment of moderate cancer pain 19 . One of the most interesting and useful weak opioids is tramadol.…”

“…One of the most interesting and useful weak opioids is tramadol. Its unique mechanism of action, analgesic efficacy and profile of adverse reactions have been the reason of performing many experimental and clinical studies with tramadol in this study 19 .…”

Diagnóstico y tratamiento del dolor oncológico

“…De ellos destacan por su extendido uso la codeína, la dihidrocodeína y el tramadol. El tramadol es más eficaz que los otros y produce menos estreñimiento, pero tiene mayor incidencia de vómitos entre las personas mayores 11 . El tramadol es un agonista opiáceo débil, que modifica la actividad serotoninérgica y noradrenérgica de las vías nerviosas descendentes moduladoras del dolor.…”

“…En la insuficiencia renal se debe reducir las dosis o evitar usarlo. Puede interaccionar con los inhibidores selectivos de la recaptación de serotonina (IRSS), por inhibición de su metabolismo hepático 11 . Se puede usar por vía oral, subcutánea o intravenosa, con una relación entre las dosis 11 de 1:1.…”

Pharmacological Management of Cancer-Related Pain

“…Tramadol has opioid-agonist properties and prevents the uptake of norepinephrine and serotonin, making it useful for neuropathic pain. 30 Tramadol possesses low affinity for opioid receptors, with an affinity to μ receptors 10 times weaker than codeine, 60 times weaker than dextropropoxyphene, and 6,000 times weaker than morphine. 31 Tramadol requires conversion to an active metabolite by CYP2D6.…”