Tramadol for osteoarthritis

April, Karine Toupin; Bisaillon, Jacinthe; Welch, Vivian; Maxwell, Lara; Jüni, Peter; Rutjes, Anne W S; Husni, M. Elaine; Vincent, Jennifer; Hindi, Tania El; Wells, George A.; Tugwell, Peter

doi:10.1002/14651858.cd005522.pub3

Cited by 46 publications

(50 citation statements)

References 64 publications

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“…5 The prevalence of knee OA among elderly in China is nearly 30%. 6 Conventional treatment of knee OA mainly aims at alleviation of pain including pharmacological, such as non-steroidal antiinflammatory drugs (NSAIDs) [7][8][9][10][11][12][13][14][15] and non-pharmacological managements 11,13 . NSAIDs are associated with a moderate effect on pain relief.…”

Section: Introductionmentioning

confidence: 99%

“…NSAIDs are associated with a moderate effect on pain relief. 9,10 However, evidence on their effectiveness is limited, 9-12, 14,15 and often associated with undesirable side effects. 11,14,15 Recent review showed that appropriate treatments for knee OA included biomechanical interventions, intra-articular corticosteroids, exercise (land-based and water-based), self-management and education, strength training, and weight management.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Laser Moxibustion for Knee Osteoarthritis: A Multisite, Double-blind Randomized Controlled Trial

Zhao

Cheng

et al. 2020

J Rheumatol

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Objective To examine the effects of laser moxibustion on pain and function in patients with knee osteoarthritis. Methods A double-blind randomized clinical trial (4-week treatment, 20-week follow-up) was conducted. A total of 392 symptomatic knee osteoarthritis patients with moderate or greater clinically significant knee pain were randomly assigned to laser treatment or sham laser control group (1:1). Twelve sessions of laser moxibustion treatments or sham on the acupuncture points at the affected knee(s) were performed three times a week for 4 weeks. The primary outcome measurement was change in WOMAC pain score from baseline to week 4. Results Among the 392 randomized participants, 364 (92.86%) completed the trial. The median WOMAC pain score significantly decreased at week 4 in the active group than in the sham group (2.1; 95% CI, 1.6 to 2.6; P < .01). At week 24, compared to the sham laser, active laser treatment resulted in significant pain reduction and function improvement (3.0; 95% CI, 2.5 to 3.6; P < 0.01, and 14.8; 95% CI, 11.9 to 17.6; P < .01, respectively). The physical component of the quality of life significantly improved in the active group than in the sham control at week 4 (3.2; 95% CI, 1.3 to 5.0; P = 0.001) up to week 24 (5.1; 95% CI, 3.3 to 7.0; P < .001). No serious adverse effects were reported. Conclusion Laser moxibustion resulted in statistically and clinically significant pain reduction and function improvement following a 4-week treatment in patients with knee osteoarthritis. Keywords: 10.6μm laser moxibustion, knee osteoarthritis, pain, traditional Chinese medicine, phototherapy

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of Laser Moxibustion for Knee Osteoarthritis: A Multisite, Double-blind Randomized Controlled Trial

Zhao

Cheng

et al. 2020

J Rheumatol

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show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…9,10 However, evidence on their effectiveness is limited, 9-12, 14,15 and often associated with undesirable side effects. 11,14,15 Recent review showed that appropriate treatments for knee OA included biomechanical interventions, intra-articular corticosteroids, exercise (land-based and water-based), self-management and education, strength training, and weight management. 13 As many as 41% 16 people with OA seek out complementary and alternative medicine therapies, including traditional Chinese medicine (TCM), acupuncture, moxibustion, and laser irradiation.…”

Section: Introductionmentioning

confidence: 99%

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Effect of laser moxibustion for knee osteoarthritis: a multi-site double-blind randomized controlled trial

Zhao

Cheng

et al. 2020

Preprint

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Background A laser device that mimics traditional moxibustion without smoke may be effective and safe for treating patients with knee osteoarthritis.Methods A double-blind randomized clinical trial was conducted. A total of 392 patients with osteoarthritis of the knee were randomly assigned to receive laser treatment or sham control three times a week for 4 weeks with 20-week follow-up. Primary outcomes were changes in the WOMAC pain scores at week 4. Results Among the 392 randomized participants, 364 (92.86%) completed the trial. The median WOMAC pain score significantly decreased at week 4 in the active group than in the sham group (2.2; 95% CI, 1.7 to 2.8; P < .01). At week 24, compared to the sham laser, active laser treatment resulted in significant pain reduction and function improvement (3.3; 95% CI, 2.7 to 3.9; P < 0.01, and 15.7; 95% CI, 12.8 to 18.8; P < .01, respectively). The physical component of the quality of life significantly improved in the active group than in the sham control at week 4 (3.0; 95% CI, 1.1 to 4.9; P = 0.002) up to week 24 (5.1; 95% CI, 3.2 to 7.0; P < .001). No serious adverse effects were reported. Conclusion Laser moxibustion resulted in statistically and clinically significant pain reduction and function improvement following a 4-week treatment in patients with knee osteoarthritis.

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Tramadol, Codeine, and Risk of Adverse Outcomes

Kim

McCarthy

Lank

2021

JAMA

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In this issue of JAMA, Xie and colleagues 1 report findings from an evaluation of adverse outcomes following initial prescriptions for tramadol or codeine among residents of Catalonia, Spain. Using 10 years of linked primary care and pharmacy claims data, the investigators used propensity score matching to assemble a cohort of 368 960 individuals who received an initial prescription for either tramadol or codeine. Initial receipt of a tramadol prescription, compared with codeine, was associated with a significantly higher 1-year cumulative incidence of all-cause mortality (absolute rate difference [ARD], 7.37 [95% CI,] per 1000 personyears), cardiovascular events (ARD, 1.36 [95% CI,] per 1000 person-years), and fractures (ARD, 4.10 [95% CI,] per 1000 person-years) but no significant difference in risk of falls, delirium, constipation, opioid abuse/dependence, or sleep disorders. The study findings were robust to several sensitivity analyses, including a dose-response analysis that demonstrated higher effect sizes with higher quantities of tramadol dispensed.These findings add to a growing body of literature that reports adverse outcomes associated with tramadol use, such as hypoglycemia, seizure, and all-cause mortality. [2][3][4] Notably, the results reported by Xie et al 1 diverge from the findings of a smaller study by Zeng et al 4 of 16 992 older adults with osteoarthritis, which found no significant difference in mortality between initial tramadol prescriptions compared with codeine but increased mortality risk with tramadol compared with nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 inhibitors. However, the study by Zeng et al used prescribing data from the UK at a time when tramadol and codeine were available over the counter.Inferring causal relationships from observational studies that compare different clinical treatments can be difficult because of the potential for underlying confounding by indication. 5 For example, administration of a specific medication in observational studies can be affected by the perceived clinical indication as determined by the prescribing physician. Individuals who received opioids for osteoarthritis, for example, might differ from those who received NSAIDs with respect to pain intensity, disability, and comorbidities. Although randomized treatment allocation is the ideal method to limit such confounding, conducting a randomized trial may not always be feasible, particularly for outcomes with very low incidence rates, such as those evaluated by Xie et al. In such cases, propensity score methods can be used to help reduce bias when estimating potential causal relationships. 6 Xie et al 1 used propensity score matching to adjust for initial dissimilarities between individuals receiving tramadol and codeine and eventually selected a propensity-matched cohort with respect to sex, age, socioeconomic status, existing medical diag-

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Tramadol for osteoarthritis

Cited by 46 publications

References 64 publications

Effect of Laser Moxibustion for Knee Osteoarthritis: A Multisite, Double-blind Randomized Controlled Trial

Effect of Laser Moxibustion for Knee Osteoarthritis: A Multisite, Double-blind Randomized Controlled Trial

Effect of laser moxibustion for knee osteoarthritis: a multi-site double-blind randomized controlled trial

Tramadol, Codeine, and Risk of Adverse Outcomes

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