Chronic Use of Tramadol

Jun 12, 2019 | Christy Hunt | @christinehuntmd | Comments (93)

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Dr. Cornelius Thiels and colleagues including Dr. W. Michael Hooten recently published an article, “Chronic use of tramadol after acute pain episode: cohort study” in the British Medical Journal. The key conclusion of this study is that the medication tramadol, which although an opioid medication is considered by the FDA to have less addictive potential than opioids such as oxycodone or hydrocodone, had just as much potential for prolonged use after surgery as other opioids. These findings highlight an important opportunity for patients and their doctors to have thoughtful and informed discussions about acute pain management in the post-operative period.

As a fellow in the Pain Division at Mayo Clinic, I have many conversations with patients regarding management of acute and chronic pain. In the hospital, I often am working with patients and their surgical teams to help manage pain after surgery. In the clinic, I often see patients to develop plans to manage chronic pain including pain that persists weeks and months after surgery. Opioids are almost always a part of this discussion, and our conversations are very individualized according to the patient. Some patients going into surgery have been using opioid medications for many years; some are opioid naïve or have only taken opioids sporadically and for short periods in the past. Some of my patients have a history of addiction and require a pain management strategy that minimizes the use of opioids or avoids them altogether. It is very important that every plan designed for effective post-surgical pain management takes into consideration the history, values and goals of each patient and is tailored to the needs of each individual patient. The culture of Mayo Clinic and within our division is to prioritize the needs of each patient, and this is always the focus of each pain management recommendation.

Most of my patients share the goal to avoid starting or increasing long-term opioid medication use after surgery, as we discuss long-term consequences including the potential for addiction, tolerance, and worsening chronic pain. Strategies for managing post-operative pain include maximizing our use of non-opioid medications and strategies while using the minimal effective dose of opioid medication for the shortest period of time. This is less than or equal to 3 days for most patients, and for nearly all patients and surgeries at most a period of 7 days. If I happen to have the opportunity to meet with a patient before surgery to discuss their upcoming surgery, I find it very helpful to discuss the patient’s hopes and expectations regarding their pain management plan. Many patients understandably have some fear or anxiety regarding post-operative pain, especially if they have had negative experiences in the past or if this is their first surgery. Most patients do very well with post-operative pain management, but our division of pain management specialists is available to help if there are any questions or concerns.

Dr. Thiels’ article will impact my practice and conversations with patients by having good evidence around which to have a conversation about opioid medicines. Many patients do hold the belief, as do non-pain medicine specialist physicians, that tramadol is a completely safe alternative to more traditional opioids such as oxycodone or hydrocodone. We know from research and the experiences of our patients that this is not true, and the use of tramadol carries similar risks in terms of addiction, dependence, tolerance and prolonged use as traditional opioids. One of my most important jobs is to make sure that my patients have a good understanding of the risks and benefits of various management plans, including medications. Our communities and our nation continues to cope with the so-called opioid crisis, and while a better understanding of the profound risks of the use of opioid medications in chronic pain is long overdue, there is a lot of misinformation out there as well. The more evidence-based information that we have available to us to discuss with our patients, the better, and I am grateful to Dr. Thiels and his colleagues including the Pain Division’s own Dr. Hooten to having investigated the important question of the risks of prolonged use of opioids after surgery. Interestingly, fewer than 10% of the nearly 445,000 patients in this nationwide sample developed additional or persistent opioid use after surgery, as defined by filling of opioid prescriptions 90 days or more following surgery. This does align with our clinical experience of most patients not developing problematic use of opioid medicines after surgery. Whenever possible we identify patients at increased risk prior to surgery and design our plan accordingly. It is important to understand that tramadol carries similar risks as oxycodone or hydrocodone in this regard, and we should make sure to counsel our patients appropriately.

 

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@techi

I agree with everyone. When l was first given tramdol l was told by doctors, nurses and other healthcare specialists it wasn't an opiod. And then l did my own research and when l saw some states saying it was l asked again even the pharmacist and again they said no. One day l was watching the doctors on TV and the doctor had just had surgery and he said they put him on tramadol and he talked about how he felt on it and he did his research. And found out lots of people in Virginia who were on it were committing suicide. So again l told my doctors about my finding. Now our state is saying it's an opiod. And they won't prescribe more than 20. We have the highest opiod addiction rate in the US. We rate number 1. And my doctors knew l wouldn't abuse it because l like to know my surroundings. But we even had doctors who over prescribed and they were incarcerated for maybe a day. And just last year this happened and the doctor is practicing at another hospital in the city. So how about that and they want to sue the pharmaceuticals. And no one forces a doctor to prescribe all those opioids. So yes people who really need it can't get it because not only drug dealers but also sometimes doctors. And they had an employee who was acting as a pharmacist and she was prescribing all kinds of opiods but not officially licensed as a pharmacist. So sometimes it greed also and that for law makers, states and so forth. We need more caring and compassionate people who care about others. And l saw that at the mayo clinic. And there are other wonderful hospitals we just have to get the bad out. And l like some of these different hospital because they have doctors from all over the world. And in different countries not all the sick they are taught to care for like they would for themselves. We need to get back to that wake up USA we are suppose to be the number one country in a lot of things but healthcare we are falling flat. Very good article.

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Tramadol was an over the counter drug also known as ultram until a few years ago. It is easily obtained over the counter in many countries in 50 or 100 mg tablets. The United States is the only country with very rigid rules

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@ruthblaze

Tramadol was an over the counter drug also known as ultram until a few years ago. It is easily obtained over the counter in many countries in 50 or 100 mg tablets. The United States is the only country with very rigid rules

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What country are you living in? Tramadol/Ultram was never an OTC medication in the US. I'm a nurse and I remember when it first appeared in the 90's, (Rx only) but it wasn't until the 2000's that it was classified as an opioid.

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I have chronic back problems, lamenectomy, fusion L5-S1, now hardware removal after bone infection. I have been having more pain than before surgery and don’t know if the dr will refill script. How am I going to function.
I don’t see why anyone should have to live in pain. We’re not part of the opioid crisis.

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Chronic pain is no way to live out the retirement years you have surely earned. Mayo pain management doctors can do wonders. They understand pain issues and were willing to refill my Tramadol RX. I am functioning again with this medication and carefully monitored. Agree we are not part of the opioid crisis. We are trying to live our best life in an aging body whatever it takes.

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@lilypaws

After a shoulder replacement I can't get Tramodol. I did but can only take one a day. They are so strict about giving any pain med, but Tramodol really helped me before my surgery. I don't know why I can't take 3 a day???

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Because if anything happens to you (OD, Addiction, etc.) the doctor has to answer for it. That is why the doctors don't even want to take the chance. Also, their malpractice insurance goes up for each patient on controlled substance and who can afford that?

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@mhanson60

Because if anything happens to you (OD, Addiction, etc.) the doctor has to answer for it. That is why the doctors don't even want to take the chance. Also, their malpractice insurance goes up for each patient on controlled substance and who can afford that?

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I f a patient takes the medication the way it prescribed there is no OD. All opiates will make one dependent if taken long enough. In Mexico they sell tramadol over the counter at all stores. The reason you’re not being taken care of is heroin, fentanyl, people shooting up oxycontin and so on. Those deaths were counted with all others , suicide included. one has to be careful taking opiates but to suffer with chronic pain is barbaric.

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@dkappel

I f a patient takes the medication the way it prescribed there is no OD. All opiates will make one dependent if taken long enough. In Mexico they sell tramadol over the counter at all stores. The reason you’re not being taken care of is heroin, fentanyl, people shooting up oxycontin and so on. Those deaths were counted with all others , suicide included. one has to be careful taking opiates but to suffer with chronic pain is barbaric.

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Yes, I totally agree.

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Doctor, this is a very comprehensive and astutely written article on pain control. I’m on and have been a vigilant user of tramadol. One is overlooking ongoing situations such as lyme disease (yes, a very debatable disease ) but one which I have dealt with for over 30 years. Having been bitten by s lyme tick in Scarsdale. NY in 1979 and going undiagnosed by over 20 some doctors, I have been left with an ongoing case of systemic or intracellular Lyme disease and approximately 3/4 coninfections. This had been s nightmare for my family to live with, child rearing and working to my full capacity. I take various herbal supplements, a varying degree of antibiotics according to what my latest bloods show and at the moment and for the past 5 yrs, a timed and conscientious regimen of Klonopin and tramadol to calm down the neurological problems of my own case of LD. I would be huddled in a cold shivering trembling mass in my bed if I did not have these controlled substances. My visits to my pain control specialist is vital to control intake and symptoms.
I urge most friends and even doctors to open up and look outside the box at TBDiseases. It will and should astonish not only the medical profession but should give some answers to the still sick and suffering in their homes with families at their wit’s end on what to do next. Pain control meds have a purpose for those of us plagued by ongoing incurable disease. It’s not to be confused only to post operative discussions.

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@sueborfl

Doctor, this is a very comprehensive and astutely written article on pain control. I’m on and have been a vigilant user of tramadol. One is overlooking ongoing situations such as lyme disease (yes, a very debatable disease ) but one which I have dealt with for over 30 years. Having been bitten by s lyme tick in Scarsdale. NY in 1979 and going undiagnosed by over 20 some doctors, I have been left with an ongoing case of systemic or intracellular Lyme disease and approximately 3/4 coninfections. This had been s nightmare for my family to live with, child rearing and working to my full capacity. I take various herbal supplements, a varying degree of antibiotics according to what my latest bloods show and at the moment and for the past 5 yrs, a timed and conscientious regimen of Klonopin and tramadol to calm down the neurological problems of my own case of LD. I would be huddled in a cold shivering trembling mass in my bed if I did not have these controlled substances. My visits to my pain control specialist is vital to control intake and symptoms.
I urge most friends and even doctors to open up and look outside the box at TBDiseases. It will and should astonish not only the medical profession but should give some answers to the still sick and suffering in their homes with families at their wit’s end on what to do next. Pain control meds have a purpose for those of us plagued by ongoing incurable disease. It’s not to be confused only to post operative discussions.

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Thank you for your message. I have been taking Tramadol for 5 years with no ill effects. I have worked with pain control clinics to alleviate my neurological pain and none have been able to offer any other help. So I will continue to take Tramadol.

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I have had chronic pain for three year’s following a knee replacement where all scans and X-rays have been negative. I’m 78 years old and I take tramadol 50 mg every day it helps me tremendously and at my age I am not concerned about developing a tolerance. I exercise three time weekly and some days I don’t take it if I have less pain. I’m thankful to my primary doctor who orders it. I have a decent quality of life

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