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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.
Helpful Links:
- Watch a video with Dr. Thiels describing the study
- Learn more about Dr. Michael Hooten
- Read more about the study via Mayo Clinic News Network
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That’s the problem, they think they know what you need. Bodies are all different. Plus tramadol is just a step above Tylenol. Must be in a really strict state to use tramadol. In FL land if crazies and that scares me. Do your research. They hate that. I was told stay off the internet including this site. Only talk to docs. Really? Get more info here. From real people not docs who preach, then drink a bottle of wine and smoke a pack at night. They don’t like we may have a brain and God forbid you saw another doc and is trying supplements. You may just die! Was told even the national Institute of health is when you do not look at. I sat there and I scratch my head.
It’s my careful opinion that after having trouble in NY and FL with my request for filling low mg Klonopin and Tramadol used specifically for pain for chronic Lyme disease that doctors cannot dispense or prescribe like they once did. They can try but the prescriptions are automatically filed with the individual state medical controls and you are or will be most certainly denied. The pharmacies are also controlling your intake too. I’ve run into that in Florida. And the doctors are alerted and drop you like a hot potato! It’s the bums who rent out space in an upper floor and try with underhanded methods to dispense illegal amounts of pain meds. I’ve seen this come and go in my own neighborhood. Especially NY. I’m having trouble in Florida and it gets to the point that one is humiliated to ask for pain - or be in extreme discomfort 24/7. The alternative is to be a very “strong” patient and just BEAR UP to pain and the doctor is so pleased. I’ve had embarrassing moments and received the doctor’s skeptical demeanor and leave sheepishly after he finally dispenses a pitiful amount that won’t take you to 30 days. Getting a little wiser, I’ve then resorted to the states ruling about coding & how to obtain the decent amt of pills so I can function from day to day.
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2 ReactionsPlease explain coding and how it is helpful. Thanks.
Completely agree!
I completely agree. My wife has scoliosis, fused vertebrae, arthritis, and degenerative disc disease and is in pain most days. Her doctor says “ I don’t prescribe pain medications” … that’s it, no explanation. Is this practicing “good” medicine? People are suffering because good intentioned politicians are riding the wave of ignorance.
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6 ReactionsSome of us have arthritis, neuropathy, and other conditions that get progressively worse and more painful as time passes. We all try otc and holistic meds, hypnosis, physical therapy, massage, acupuncture, tylenol, aspirin etc. before we resort to low level prescription pain killers. If the meds make asthma worse, cause insomnia or diahrea, or don't work, we have to keep moving up. We suffer a lot along the way. If someone is old and living with progressive pain that can't be cured, politicians, reformers, and doctors should all exercise compassion and let them take whatever helps them. There are people in these Mayo Clinic groups who live on combinations of drugs that sound like they could kill a buffalo but if that's what it takes to keep them comfortable, Medicare should give it to them and no one should try to take their medicine away - it's cruel. A nurse told me that her mother took huge amounts of morphine daily before she passed away from inoperable cancer - but she was still lucid because her body used all the morphine to kill the pain. Extra morphine might have made her mother dingy but her mom took just enough. The amount should be up to the patient. If a patient with terminal cancer likes to feel dingy - let them - who cares if they are high until they die.
Peggy
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6 ReactionsThis is pretty much BS. I had prostate surgery. Dr screwed something up and have been in horrible pain ever since. Hydrocordin really worked well. Did not make me goofy or any problems other than constipation. I quit taking a
And have been on tramadal ever since. Very little help with pain relief. And it is NOT an opioid. Period.
It also is NOT habit forming. I skip taking these on long weekends or if I am not going to be active. No big deal.
People who want to preach about pain meds need to understand how horrible it is to be in constant pain with lit or no help available.
Before my Prostate operation I was a physical specimen. Had to give up running (knees) but walked between 5 and 10 miles per day. And lifted weights.
I am 75 years old and am pretty
Much going down hill every week. And NO real help anywhere
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2 ReactionsCoding is simply how the doctor or doctors explain your situation and/or illness to the insurance company. It determines what insurance you have and how they view your medical conditions. Pain meds are the hardest to have a doctor prescribe and how they determine your need for controlled substances. Lyme disease in its chronic stages as I have experienced is a pain filled internal neurological condition. The only thing that relives it is an anti anxiety pill. If not, I get internal tremors 24/7. The tramadol is for advanced fibromyalgia which no exercise will completely eliminate.
It’s a tough unrecognized disease and yes the states where you live can control your meds.
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1 ReactionCan relate entirely as to levels of pain and what purposes we need the doctor to help. I have tramadol and can have one or two for Lyme discomfort. It’s
non addictive. It’s beyond wearisome that a patient has to beg a doctor to help relieve these syndromes for quality of life. I’ve asked a friend who visits frequently here in Florida to bring from NY(as allowed by the newly passed law of NY) the CBD products to be dispensed.
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1 ReactionI am really sorry about what is happening to you. I have been taking Tramadol for 3 or 4 years. I live in California
You need to get your doctor to strongly advocate for you. He needs to document why you still need the Tramadol. Don't just give up.
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