Letter to the Editor
Don't Throw Tramadol on the Junk Heap Yet
Dr. Justin Morgenstern's article argues that tramadol is an awful and terrible medication that should never be used. (“No Reason to Choose Tramadol over Morphine,” EMN. 2019;41:1; http://bit.ly/2qZXkcQ.) In my extensive experience, tramadol is a pretty good pain medication with some occasional side effects, and its potential for contributing to abuse is pretty low. Tramadol enables me to prescribe something other than NSAIDs or acetaminophen for pain that has some utility in combination with those other pain medications and is not a strong opioid.
When Justin and I worked together over a year in New Zealand, he said he saw hundreds of problems related to tramadol use and abuse, and I saw almost none. To resolve this dispute, we need a large amount of information that is currently not available: How often do people abuse tramadol compared with other opioids such as hydrocodone and oxycodone? How efficacious is tramadol for pain, particularly in combination with NSAIDs and acetaminophen? How often do people have side effects, such as seizures and serotonin syndrome, after taking tramadol? What proportion of patients who were prescribed other opioids become long-term opioid users or abusers?
Some studies were done on the last question, but they include an incorporation bias that people who take tramadol long-term are considered long-term opioid users, while those who consider this a benign medication would not be concerned about this. Let's not allow this pretty good though imperfect pain medication to be discarded onto the junk heap like nitrous oxide and droperidol.
Mark J. Sagarin, MD
New Plymouth, New ZealandCopyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.