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Am Fam Physician. 1998;58(9):2148-2150

Tramadol hydrochloride is a centrally acting analgesic with minor opioid agonist properties that make it suitable for the treatment of acute pain. It also inhibits monoamine reup-take, which may make it suitable for the treatment of chronic pain. It has a lower potential for abuse than other opioids and no antiprostaglandin activity. Comparative studies have shown that tramadol hydrochloride has efficacy comparable to that of propoxyphene or pentazocine in the management of postoperative pain, and comparable to that of codeine after dental extraction. Turturro and associates conducted a randomized, double-blind, prospective study to evaluate the analgesic effect of oral tramadol hydrochloride versus oral hydrocodone with acetaminophen in patients with acute musculoskeletal pain after minor trauma.

Patients with suspected substance abuse, a history of hypersensitivity to any of the analgesics used in this study, or known pregnancy or lactation were excluded from the study. Study participants received an unlabeled capsule that contained either 100 mg of tramadol hydrochloride or 5 mg of hydrocodone with 500 mg of acetaminophen. Pain was evaluated at baseline and at 30-minute intervals up to 180 minutes using a visual analog scale. Mean pain scores were similar at baseline among the study participants but significantly lower in the group taking hydrocodone with acetaminophen from 30 minutes through the end of the study period. The difference in pain scores between the two groups became more pronounced with each interval that followed the initial analgesic dose.

The authors conclude that tramadol hydrochloride is less effective in the management of acute pain in patients with musculoskeletal pain following trauma than hydrocodone with acetaminophen. In addition, the manufacturer's reports of such side effects as dizziness within seven days of use, nausea, constipation, headache and somnolence may also cause problems in both short and long medication courses. The decreased analgesic effect, relatively frequent side effects and increased cost make tramadol hydrochloride a less desirable choice in the treatment of minor to moderate acute musculoskeletal pain.

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Copyright © 1998 by the American Academy of Family Physicians.

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