Tramadol drug is used for pain relief
Tramadol (generic for Ultram) is a prescription medication used for the management of moderate to moderately severe pain. Tramadol® has been prescribed to more than 55 million patients worldwide; Ultram® has been prescribed to more than 21 million patients in the U.S.

Tramadol as adjunct to psoas compartment block with levobupivacaine 0.5%: a randomized double-blinded study.

Mannion S, O'Callaghan S, Murphy DB, Shorten GD.

Department of Anaesthesia and Intensive Care, Cork University Hospital, University College Cork, Cork, Ireland. mannionstephen@hotmail.com

BACKGROUND: Tramadol has been administered peripherally to prolong analgesia after brachial plexus and neuraxial blocks. Our aim was to evaluate the systemic and perineural effects of tramadol as an analgesic adjunct to psoas compartment block (PCB) with levobupivacaine. METHODS: In a randomized, prospective, double-blinded trial, 60 patients (ASA I-III), aged 49-88 yr, undergoing primary total hip or knee arthroplasty underwent PCB and subsequent bupivacaine spinal anaesthesia. Patients were randomized into three groups. Each patient received PCB with levobupivacaine 0.5%, 0.4 ml kg(-1). The control group (group L, n=21) received i.v. saline, the systemic tramadol group (group IT, n=19) received i.v. tramadol 1.5 mg kg(-1) and the perineural tramadol group (group T, n=20) received i.v. saline and PCB with tramadol 1.5 mg kg(-1). Postoperatively patients received regular paracetamol 6-hourly and diclofenac sodium 12-hourly. Time to first morphine analgesia, 24-hour morphine consumption, sensory block, pain and sedation scores and haemodynamic parameters were recorded. RESULTS: Time (h) to first morphine analgesia was similar in the three groups [mean (SD)]: group L, 11.2 (6.6); group T, 14.5 (8.0); group IT, 14.6 (6.8); P=0.35. Twenty-four-hour cumulative morphine (mg) consumption was also similar in the three groups [group L, 21.9 (10.1); group T, 19.8 (6.7), group IT, 16.5 (9.5)], as were durations of sensory and motor block. There were no differences in the incidence of adverse effects except that patients in group IT were more sedated at 14 h than group L (P=0.02). CONCLUSION: We conclude that our data do not support a clinically important local anaesthetic or peripheral analgesic effect of tramadol as adjunct to PCB with levobupivacaine 0.5%.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15608044&query_hl=2

Meeting the challenges in cancer pain management.

Fine PG, Miaskowski C, Paice JA.

Pain Management Center at the University of Utah in Salt Lake City, USA.

Improved life expectancy among patients with cancer has unfortunately resulted in significant increases in the number of patients experiencing chronic, intractable pain-neuropathic pain syndromes, in particular. Yet treatment for this pain is frequently suboptimal.This is due, at least partially, to the generalized nature of available therapeutics, which are often aimed toward symptom management and temporal pain properties rather than targeted directly toward the multiple mechanisms underlying the generation and propagation of pain. Although the future of pain medicine undoubtedly lies with improved formulations, kinetics, and metabolic characteristics, the current armamentarium nevertheless has proven effective in promoting beneficial outcomes and improved life quality in cancer patients with neuropathic pain. Novel, evidence-based guidelines recommend several agents for first-line consideration, including gabapentin, the lidocaine (5%) patch, tramadol hydrochloride, tricyclic antidepressants, and opioid analgesics. However, in oncology perhaps more than in any other field, pain is dynamic and ever-changing in response to a variety of factors, including chemotherapeutic, radiation, or surgical interventions. For this reason, patient-specific assessment and continual monitoring are warranted when selecting a therapeutic regimen. General considerations, particularly when an opioid agent is utilized, should include pharmacoclinical, pharmacoeconomic, and pharmacogenetic variables.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15605922&query_hl=2

Treatment of pediatric chronic pain with tramadol hydrochloride: siblings with Ehlers-Danlos syndrome - Hypermobility type.

Brown SC, Stinson J.

Department of Anaesthesia, The Hospital for Sick Children, Toronto, Ontario. stephen.brown@sickkids.ca

OBJECTIVE: To evaluate the effectiveness of tramadol hydrochloride for the treatment of chronic pain refractory to previous treatment in two pediatric patients. METHODS: Tramadol hydrochloride was administered (50 mg/day to 150 mg/day) to two siblings with Ehlers-Danlos syndrome - Hypermobility type refractory to previous pharmacological treatments, and changes in pain intensity and physical activity were assessed. RESULTS: Pain intensity decreased and physical activity improved within days of starting therapy. Positive results have been maintained for 30 months. CONCLUSIONS: Tramadol hydrochloride was a safe and effective treatment for relieving chronic pain in two pediatric patients suffering from the hypermobility type of Ehlers-Danlos syndrome. No morbidity or side effects were noted during the 30-month follow-up.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15605135&query_hl=2

Treatment of patients with arthritis-related pain.

DeAngelo NA, Gordin V.

Director of the Pain Medicine Division, Milton S. Hershey Medical Center, 500 Univesity Dr, Hershey, PA 17033-0850, USA.

Many causes of arthritic pain are encountered in clinical practice. Osteoarthritis is the most common form of arthritis in the United States, afflicting tens of millions of people. The authors review current literature on the treatment of patients with osteoarthritis. They discuss nonpharmacologic therapy such as physical therapy, weight reduction, and osteopathic manipulative treatment. Pharmacologic treatment of patients with osteoarthritis includes acetaminophen, nonsteroidal anti-inflammatory drugs, tramadol hydrochloride, and opiate analgesics in patients who failed all other treatment modalities. Patients who failed medical management should be referred for consideration for surgery.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15602034&query_hl=2

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