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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The more I read about helping the patient to be comfortable, free from pain and anxiety in this country , the more I distrust not only the doctors but the general and all encompassing FDA totally. Let them jump inside my body after 35 years of debilitating physical and anxiety ridden lyme that attacks the neurological system with late stage infectious disease of Lyme disease, and “they” will be the first to beg for relief. It’s the doctor and patient who agree upon a plan and if that doesn’t work move on to a pain relief doctor with all your documentation you have to show character analysis of non abuse and the need for reasonable and continued treatment with low dose pain control and anti anxiety meds. We are not stupid and abusive people - we are patients in pain for whatever reason the origin is.

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@sueborfl

The more I read about helping the patient to be comfortable, free from pain and anxiety in this country , the more I distrust not only the doctors but the general and all encompassing FDA totally. Let them jump inside my body after 35 years of debilitating physical and anxiety ridden lyme that attacks the neurological system with late stage infectious disease of Lyme disease, and “they” will be the first to beg for relief. It’s the doctor and patient who agree upon a plan and if that doesn’t work move on to a pain relief doctor with all your documentation you have to show character analysis of non abuse and the need for reasonable and continued treatment with low dose pain control and anti anxiety meds. We are not stupid and abusive people - we are patients in pain for whatever reason the origin is.

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Agreed. I have been on Tramadol for years and am not addicted. I only it as I need it. Some days only at night, sometimes my neuropathy is bad from the time I wake up and I need Tramadol all day, some days not at all. Let any of these guys live with my neuropathy then say that they want to take away the Tramadol.

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@26sabrina

Agreed. I have been on Tramadol for years and am not addicted. I only it as I need it. Some days only at night, sometimes my neuropathy is bad from the time I wake up and I need Tramadol all day, some days not at all. Let any of these guys live with my neuropathy then say that they want to take away the Tramadol.

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Thank you for the reply. We are having more pro responses than negative. I had one reply that he managed without and could ride a bicycle for two miles each day.
Very pleased for him. Did he need tramadol at all?

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This commentary although thoughtfully and professionally written is mostly related to post surgical pain. Those affected citizens with unrelated situations and experiencing non post surgical situations as described are looking and searching desperately for medical help for their consistent and ongoing pain situations. Again, this has nothing to do with post surgical complications and are asking for competent and understanding help on an ongoing basis for debilitating pain or anxiety ridden complications related to diseases that produce these unrelenting pain SYNDROMES and many times naturally neurological produced anxiety situations.

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WOW! I’m surprised at the number of respondents who are down on big pharma, the government, etc. Like me I’m sure there are more than a few of you who have investments in big pharma companies in your 401K plans. So when they make money it bodes well for my retirement funds. On the other hand my needing to pay my co-insurance for my buprenorphine patch around $450.00 every quarter makes me scream. But I chose to use this drug and formulation of the drug for my pain relief. Many respondents complain about the cost but the drugs work to keep us healthy and it costs large dollars to R&D new drugs. I have no idea but I wonder how much money is wasted on unsuccessful drug research? We live in a capitalist society and it will never change and we should be used to it by now. I’m glad Medicare is finally going to begin to negotiate for lower drug prices.
My spinal OA with chronic pain is continuing to invade the rest of my body and I’m not expecting it to improve but worsen. I know no surgery or drugs will eventually work to keep me free of pain so I hope something else does me in. Living to the end in pain is not what I wish for myself and having been a nurse for so many years I have a good idea what that is like.

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Have you heard of ketamine treatments for pain management for neuropathy? I have excruciating pain after a2 month hospitalization this year from severe sepsis i got after a colonoscopy and's take gabapentin and tramadol, both low dosesas my dr has to jump through so many hoops, but it's all that had worked even a little bit. Im nearly out of ideas, thought maybe you had heard of this? Im only 50 and's can't even stand OR sit longer than maybe fifteen minutes ast a time, most days i just cry . Ive lost the ability to work, finish school, really dip anything, and it's just getting worse every day.
Thank you.

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@jamiemartini

Have you heard of ketamine treatments for pain management for neuropathy? I have excruciating pain after a2 month hospitalization this year from severe sepsis i got after a colonoscopy and's take gabapentin and tramadol, both low dosesas my dr has to jump through so many hoops, but it's all that had worked even a little bit. Im nearly out of ideas, thought maybe you had heard of this? Im only 50 and's can't even stand OR sit longer than maybe fifteen minutes ast a time, most days i just cry . Ive lost the ability to work, finish school, really dip anything, and it's just getting worse every day.
Thank you.

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Yes, there is some work being done using Ketamine for refractory neuropathic pain. So far it is not widely used or accepted. It may be a possibility for us down the line but will need to be administered by a physician who has been certified and has proper facilities to monitor.

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@jamiemartini

Have you heard of ketamine treatments for pain management for neuropathy? I have excruciating pain after a2 month hospitalization this year from severe sepsis i got after a colonoscopy and's take gabapentin and tramadol, both low dosesas my dr has to jump through so many hoops, but it's all that had worked even a little bit. Im nearly out of ideas, thought maybe you had heard of this? Im only 50 and's can't even stand OR sit longer than maybe fifteen minutes ast a time, most days i just cry . Ive lost the ability to work, finish school, really dip anything, and it's just getting worse every day.
Thank you.

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Why are you on low doses when you are in the upper scales of pain? The (doctors) are in constant fear of dosing higher and even getting an ok to prescribe is addiction. It’s a clinical observation between patient and doctor to dispense and push gif the patient. A visit us in order. Or a pain specialist.

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@jenatsky

WOW! I’m surprised at the number of respondents who are down on big pharma, the government, etc. Like me I’m sure there are more than a few of you who have investments in big pharma companies in your 401K plans. So when they make money it bodes well for my retirement funds. On the other hand my needing to pay my co-insurance for my buprenorphine patch around $450.00 every quarter makes me scream. But I chose to use this drug and formulation of the drug for my pain relief. Many respondents complain about the cost but the drugs work to keep us healthy and it costs large dollars to R&D new drugs. I have no idea but I wonder how much money is wasted on unsuccessful drug research? We live in a capitalist society and it will never change and we should be used to it by now. I’m glad Medicare is finally going to begin to negotiate for lower drug prices.
My spinal OA with chronic pain is continuing to invade the rest of my body and I’m not expecting it to improve but worsen. I know no surgery or drugs will eventually work to keep me free of pain so I hope something else does me in. Living to the end in pain is not what I wish for myself and having been a nurse for so many years I have a good idea what that is like.

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I will continue use of tramadol for my chronic pain. I’m thankful to whoever invented it to relive us of pain and help to live a fairly decent life

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@ruthblaze

I will continue use of tramadol for my chronic pain. I’m thankful to whoever invented it to relive us of pain and help to live a fairly decent life

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Me too. I'm going to use my Tramadol as much as I need for my severe neuropathic pain for as long as I need it. So I am praying that someone finds a better way to treat or a cure. I support the NEUROPATHY FOUNDATION.

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