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A preliminary prescription of tramadol for the management of pain associated with osteoarthritis (OA) in patients aged 50 or above is linked with a significantly higher risk of mortality over a year, stated a recently published paper in the Journal JAMA. The researchers drew the conclusion after comparing the outcomes to those of other commonly used non-steroidal anti-inflammatory drugs (NSAIDs). Nevertheless, the researchers warned that their findings may be confusing, and that additional research is warranted to establish if the association is fundamental.
According to Yuqing Zhang, from the Massachusetts General Hospital, the findings are critical as both the American Academy of Orthopedic Surgeons (AAOS) and the American College of Rheumatology conditionally recommend tramadol, along with some other NSAIDs, as the first line of therapy for patients afflicted with knee osteoarthritis.
All-cause mortality in tramadol treatment relatively higher
According to the study authors, the tramadol prescriptions have been on a rise around the globe, making it one of the most extensively used opioids, however, there is a lack of data pertaining to its safety profile like all-cause mortality. The researchers assessed the Health Improvement Network (THIN) which is an electronic medical record database containing information on 11.1 million patients from 580 general practices in the U.K, for analyzing the association between all-cause mortality and tramadol.
The final analysis included 88,902 patients, who were 50 years or older and had a history of hip, knee, or hand OA. Moreover, all the enrolled study population had paid a visit to their general practitioner between January 2000 and December 2015 and had at least a year of follow-up. For comparing all-cause mortality among participants at first treated with tramadol and those treated with other medications, the researchers carried out five sequential propensity score-matched cohort studies. These comprised of diclofenac, naproxen, celecoxib, codeine, and etoricoxib. Of the cohort, 44,451 participants received tramadol, 6,512 were prescribed diclofenac, 12,397 were given naproxen, 5,674 received celecoxib, 16,922 took codeine, and 2,946 got etoricoxib.
Compared to the treatment with other medications, with tramadol, the primary outcome was found to be an all-cause mortality within 1 year of use. According to the study authors, there were 278 deaths during the 1-year follow-up in the tramadol group, as opposed to 164 deaths in the naproxen group. Further, the researchers also observed a higher mortality in patients treated with tramadol when compared with the other control groups.
Tramadol is an opioid analgesic prescribed for the management of mild to moderate pain. Though it is considered as a safe alternative to methadone and hydrocodone, in 2014, the Drug Enforcement Administration (DEA) classified it as a federally controlled drug (Schedule IV) because of evidence of its abuse amongst the general public. When administered orally in high doses, tramadol can evoke euphoric effects similar to the ones produced by oxycodone. In addition to producing opioid-like effects, tramadol also raises the brain levels of norepinephrine and serotonin, causing withdrawal symptoms once a person stops using the drug.
Tramadol can cause disturbed sleeping patterns resulting in insomnia and can predispose a user to the risk of developing convulsions or seizures. Users have also reported taking higher doses with an increased frequency to keep their mood elevated. Fortunately, an addiction to tramadol can be treated by a medically supervised detoxification process, followed by inpatient and outpatient recovery programs.
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