Cochrane Briefs

Am Fam Physician. 2007 May 1;75(9):1335-1336.

Tramadol Relieves Neuropathic Pain

Clinical Question

Is tramadol (Ultram) safe and effective for the treatment of neuropathic pain?

Evidence-Based Answer

Tramadol is an effective treatment for neuropathic pain. One out of four patients who take the medication achieves at least 50 percent pain relief.

Practice Pointers

Tramadol is a unique pain reliever that is thought to work via a weak effect on opioid receptors and by limiting reuptake of serotonin and norepinephrine, an effect occurring with many antidepressants. This systematic review identified six randomized controlled trials of tramadol for the treatment of neuropathic pain. Four studies (337 total patients) compared tramadol with placebo. All four studies were double-blinded, and three of the four studies (including 302 of the patients) adequately concealed allocation from participants and accounted for patients lost to follow-up.

The review found a clinically significant benefit with tramadol (number needed to treat to achieve at least 50 percent pain relief = 3.8; 95% confidence interval [CI], 2.8 to 6.3). One small, unblinded study (21 total patients) found no difference between tramadol and clomipramine (Anafranil). Another study (40 total patients) found no clear difference between tramadol and morphine in patients with cancer-related pain. However, these studies were too small and too poorly designed (i.e., unblinded with many dropouts) to draw firm conclusions.

Between 5 and 15 percent of patients discontinued the study medication because of adverse effects. In the two studies that provided adverse effects data, the combined number needed to harm was 7.7 (95% CI, 4.6 to 20). Although no life-threatening adverse effects were reported, tramadol can lower the seizure threshold and should not be given to patients with a history of seizure. An evidence-based guideline from the Institute for Clinical Systems Improvement recommends tramadol as a treatment option for neuropathic pain,1 and an expert panel recommends it as a first-line treatment.2

Source

Hollingshead J, et al. Tramadol for neuropathic pain. Cochrane Database Syst Rev. 2006;(3):CD003726.

REFERENCES

1. Institute for Clinical Systems Improvement. Assessment and management of acute pain. March 2006. Accessed February 22, 2007, at: http://www.icsi.org/pain_acute/pain__acute__assessment_and_manage-ment_of__3.html.

2. Dworkin RH, Backonja M, Rowbotham MC, Allen RR, Argoff CR, Bennett GJ, et al. Advances in neuropathic pain: diagnosis, mechanisms, and treatment recommendations. Arch Neurol. 2003;60:524–34.


Copyright © 2007 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions


Article Tools

  • Print page
  • Share this page
  • AFP CME Quiz

Information From Industry

More in Pubmed

Navigate this Article