Tramadol (Ultram) Focus on musculoskeletal and neuropathic pain

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Minerva Anestesiol. 2005 Oct;71(10):565-84.

Tramadol. Focus on musculoskeletal and neuropathic pain.

Mattia C, Coluzzi F.

Department of Anaesthesiology, Intensive Care Medicine and Pain

Therapy, University of Rome La Sapienza, Rome, Italy.

In the light of the most recent acquisitions published in the

international literature, this review analyzes the pharmacologic

features and modes of use of tramadol, one of the most widely used,

on a worldwide scale, analgesic agents in acute and chronic pain of

moderate to severe intensity. The action of the 2 enantiomers of

tramadol - which exert different pharmacologic effects - and of

metabolite M1, is differentiated. The global activity of tramadol

results from the sum of their specific actions. Data of kinetics show

a very high oral bioavailability and the sustained-release (SR)

formulations assure a 24-h coverage through the constant blood

levels. Data reported in the relevant literature show that tramadol

is effective in the treatment of arthrosic and neuropathic pain, with

a value of Number Needed to Treat (NNT) of 3.4, and in the mixed

nociceptive-neuropathic pain, especially in persistent or chronic

pain. Moreover, tramadol maintains a good tolerability profile in the

elderly subjects and a good analgesic efficacy in the long-term

treatments with reduced pharmacological interactions and a low

incidence of constipation. These global features assured its

inclusion into the most recent guidelines on the management of

chronic pain. Furthermore, data from literature showed that tramadol

is devoid of immunosuppressive activity, has a poor tendency to

tolerance and a minimum risk of addiction and abuse.