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.

Management of peripheral neuropathic pain.

Stacey BR.

Pain Management Center, Department of Anesthesiology and Peri-Operative Medicine, Oregon Health and Sciences University, Portland, Oregon, USA.

Neuropathic pain results from a variety of medical conditions encountered in physiatric practice, including infection, trauma, metabolic abnormalities, and nerve compression. Unlike pain resulting from nociceptive or inflammatory processes, neuropathic pain is associated with primary lesion or dysfunction of the nervous system itself and is often difficult to treat. Existing treatment options include drug therapy (e.g., anticonvulsants, the lidocaine patch 5%, antidepressants, opioids, tramadol) or interventional treatments (e.g., peripheral or neuraxial nerve blockade, implanted spinal cord stimulators, implanted intrathecal catheters). The following article presents an overview of the cellular mechanisms associated with neuropathic pain, summarizes the results of randomized, controlled trials with the major classes of available drugs, and discusses treatment options that provide a rational basis for pharmacotherapy.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15722782&query_hl=2

Structural comparisons of meptazinol with opioid analgesics.

Li W, Hao JL, Tang Y, Chen Y, Qiu ZB.

Department of Medicinal Chemistry, School of Pharmacy, Fudan University, Shanghai 200032, China.

AIM: To investigate the mechanism of action of a potent analgesic, (+/-)-meptazinol. METHODS: The structures of meptazinol enantiomers were compared with opioid pharmacophore and tramadol. RESULTS: Neither enantiomer of meptazinol fitted any patterns among the opioid pharmacophore and tramadol, although they did share some structural and pharmacological similarities. However, the structure superpositions implied that both enantiomers of meptazinol might share some similar analgesic mechanisms with typical opiate analgesics. CONCLUSION: Meptazinol should have a different mechanism of action to known analgesics, which would be helpful in further investigations of meptazinol in the search for non-addictive analgesics. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15715930&query_hl=2

How to advance in treating pain with opioids: less myths--less pain

Krsiak M.

Ustav farmakologie, 3. lekarska fakulta UK v Praze.

Much progress has taken place in knowledge of actions and use of opioids in pain in the last quarter century. There would be much less unnecessary pain and suffering if this knowledge would be applied properly in clinical practice. Why is it not? The major reasons appear to be ignorance, false prejudices (myths) and exaggerated limitations in availability of opioids for medical treatment of pain. Even the strongest opioid analgesics do not need to relieve pain in everybody. Their effect should be monitored and if inadequate, proper measures should be taken (e.g. adjusting a dose or changing an opioid). Weak opioids (codeine, tramadol) alone are mostly not stronger then non-opioid analgesics. However, combinations of opioid analgesics with paracetamol often show synergistic analgesic effect (without increased toxicity). Opioids actually represent very safe analgesics. Exaggerated opiophobia is a major myth causing much unnecessary pain and suffering in patients. Undue fear of drug abuse and/or political considerations have resulted in laws and regulations, that make it unnecessarily difficult to obtain opioids for medical use. An example of this might be a recent re-scheduling of buprenorphine in the Czech Republic and Slovakia among drugs with a very high abuse potential (e.g. morphine, fentanyl, amphetamine).

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15702888&query_hl=2

Combined ilioinguinal blockade and local infiltration anaesthesia for groin hernia repair--a double-blind randomized study.

Andersen FH, Nielsen K, Kehlet H.

Surgical Clinic Charlottenlund, Copenhagen, Denmark.

BACKGROUND: Local infiltration anaesthesia for inguinal hernia repair is cost-effective, but fear of intra-operative pain may hinder its widespread use. It is unknown whether a combined ilioinguinal blockade and local infiltration anaesthesia improves intra-operative analgesia. METHODS: We performed a double-blind randomized study in 160 patients undergoing inguinal hernia mesh repair under local infiltration anaesthesia with or without additional ilioinguinal blockade. Intra-operative pain and pain at 24 and 48 h postoperatively and analgesic requirements (acetaminophen, ibuprofen, and tramadol) were assessed. RESULTS: Median intra-operative pain scores were reduced (P=0.02) from 13 to 9 with additional ilioinguinal blockade, with no differences in requirement for sedation. There were significantly (P<0.05) more patients with intra-operative visual analogue pain scale >/=30 in the placebo group vs the ilioinguinal blockade group. Postoperative pain scores and analgesic requirements were similar. CONCLUSION: Combined ilioinguinal blockade and local infiltration anaesthesia is recommended for groin hernia repair to reduce intra-operative pain.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15695545&query_hl=2

Tramadol: does it have a role in emergency medicine?

Close BR.

Emergency Department, The Townsville Hospital, PO Box 670, Townsville, Queensland 4810, Australia. benclose74@yahoo.com

Tramadol is a synthetic analgesic new to the Australasian market where its use is rapidly increasing. It is used extensively overseas, particularly in Europe where it has been popular since its introduction in Germany in the late 1970s. Tramadol has a dual mechanism of action: weak mu opioid receptor agonist and a reuptake inhibitor of serotonin and noradrenaline. Thus, it has distinct advantages and disadvantages compared to other available analgesics. Its use is advocated in a variety of acute and chronic pain states as well as some non-analgesic applications. The use of tramadol in an emergency setting is not well studied, with most published trials assessing its efficacy and tolerability in postoperative or dental models. This literature review concludes that tramadol does not offer any particular benefits over existing analgesics for the majority of emergency pain relief situations.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15675908&query_hl=2

Tramadol overdose and serotonin syndrome manifesting as acute right heart dysfunction.
Emergency and Intensive Care Department, The Tweed Hospital, New South Wales.

Acute right heart failure in a young person is an unusual presentation and drug overdose is a rare cause. A case is described where the patient presented with striking clinical signs of acute pulmonary hypertension and right heart failure, which were confirmed by transthoracic echocardiography. The precipitating event appeared to be poisoning by tramadol. There were features in keeping with tramadol toxicity and serotonin syndrome. The possible pathophysiology behind the process is discussed.  http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15675220&query_hl=2

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