Tramadol osteoarthritis

Silverfield, J.C., Kamin, M., Wu, S.C., Rosenthal, N. Tramadol/acetaminophen comination tablets for the reatment of osteoarthritis flare pain a multicenter, outpatient, randomized, double-blind, placebo-controlled, parallel-group, ad-on study, Clin. Ther. 2002, 24, 282-297. 

Lornoxicam has demonstrated clinical efficacy in relieving chronic pain associated with osteoarthritis [3], rheumatoid arthritis, and ankylosing spondylitis [4]. In the treatment of postoperative pain, lornoxicam has been shown to be as effective as morphine [5]. An in vitro study suggested that lornoxicam is 100 times more potent than tenoxicam as a COX inhibitor and its analgesic potency is 12 and 10 times greater than that of piroxicam and tenoxicam, respectively. Lornoxicam analgesic potency of 16 mg (i.m.) is comparable with that of 20 mg morphine (i.m.) or 50 mg tramadol (i.v.) [6,7]. 

In a 4-week, double-bhnd, multicenter, randomized study, tramadol plus paracetamol (37.5/325 mg) was as effective as codeine plus paracetamol (co-codamol 30/300 mg) in chronic non-mahgnant low back pain and osteoarthritis pain, with acceptable tolerability (6). 

Tramadol and non-steroidal anti-inflammatory drugs have been compared in two studies of patients with joint pain associated with osteoarthritis (8,9). In an open, randomized study 60 patients with osteoarthritis taking NSAIDs were given either modified-release tramadol 100 mg 8-hourly or modified-release dihydrocodeine 60 mg 8-hourly for 4 days the controls were 30 patients who took an NSAID alone (8). Both opioids provided adequate analgesic adjuncts to NSAIDs, but tramadol caused significantly more minor initial adverse effects. 

In 129 patients with severe joint pain associated with osteoarthritis, tramadol was significantly more effective than placebo, but 26 patients taking tramadol and 43 taking placebo withdrew because of ineffectiveness or adverse effects the main adverse effects of tramadol were nausea and constipation (9). 

Wilder-Smith CH, Hill L, Spargo K, Kalla A. Treatment of severe pain from osteoarthritis with slow-release tramadol or dihydrocodeine in combination with NSAID s. A randomised study comparing analgesia, antinociception and gastrointestinal effects. Pain 2001 91(l-2) 23-31. 

Fleischmann RM, Caldwell JR, Roth SH, Tesser JRP, Olson W, Kamin M. Tramadol for the treatment of joint pain associated with osteoarthritis a randomised double-... 

Pavelka K, Peliskova Z, Stehlikova H, Ratcliffe S, Repas C. Intraindividual differences in pain relief and functional improvement in osteoarthritis with diclofenac or tramadol. Clin Drug Invest 1998 16 421-9. 

Tramadol ER was administered to a total of 3108 patients during studies conducted in the USA. These included four double-blind studies in patients with osteoarthritis and/or chronic low back pain and one open-label study in patients with chronic non-malig-nant pain. A total of 901 patients were 65 years or older. Adverse events increased with dose from 100 mg to 400 mg in the two pooled, 12-week, randomized, double-blind, placebo-controlled studies in patients with chronic non-malignant pain [4) (see Table 30.1)... 

Canal T, Pascual MG. Extended-release tramadol in the treatment of osteoarthritis a multicenter, randomized, double-blind, placebo-controUed clinical trial. Curr Med Res Opin 2006 22 ... 

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