A risk-benefit assessment of tramadol
in the management of pain

Desmeules JA.
Clinical Pharmacology & Multidisciplinary Pain Centre,
University Hospital,
Geneva, Switzerland.
Eur J Pain 2000; 4 Suppl A:15-21


Tramadol is an option for the treatment of rheumatological pain. Its mode of action and safety profile distinguishes it from other opioids. Tramadol differs from other opioids by combining a weak opioid and a monoaminergic mode of action. It is effective in different types of moderate-to-severe pain, including neuropathic pain. Moreover, as the mode of action of tramadol does not overlap with that of NSAIDs, it is a useful agent to be combined with these drugs. Tramadol induces fewer opioid adverse reactions for a given level of analgesia compared with traditional opioids. Common adverse reactions of tramadol such as nausea and dizziness, which usually occur only at the beginning of therapy and attenuate over time, can be further minimized by up-titrating the drug over several days. Dose adjustment is only necessary in patients over 75 years of age, or in those with either hepatic or renal insufficiency. Tramadol should be avoided or used with caution in epileptics, or in individuals who are receiving seizure-threshold lowering drugs. Finally, tramadol has a low risk of abuse because it has only a weak opioid effect and its monoaminergic action could inhibit the development of dependence. The low abuse potential of tramadol has been demonstrated by postmarketing surveillance data.
Poppy tea
Ultram abuse?
Tramadol (Ultram)
Tramadol: seizures
Tramadol: metabolites
Tramadol and analgesia
Tramadol: pharmacology
Tramadol and acute pain
Tramadol and osteoarthritis
Tramadol versus venlafaxine
Tramadol as an antidepressant
Tramadol versus buprenorphine
Tramadol : morning or evening?
Tramadol and perioperative pain
Pharmacokinetics and pharmacodynamics
Tramadol, depression and Parkinson's disease
Serotonin, norepinephrine (noradrenaline) and pain

and further reading

Future Opioids
BLTC Research
Utopian Surgery?
The Abolitionist Project
The Hedonistic Imperative
The Reproductive Revolution
Critique of Huxley's Brave New World

The Good Drug Guide
The Good Drug Guide

The Responsible Parent's Guide
To Healthy Mood Boosters For All The Family