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1.
Ceska Slov Farm ; 71(2): 67-77, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35728971

RESUMO

The aim of the present study is the development and validation of a simple method based on capillary zone electrophoresis coupled with UV detection for simultaneous determination of tramadol and paracetamol in pharmaceutical and biological samples. The background electrolyte was composed of 50 mM ammonium carbonate, which is a type of a non-conventional electrolyte system. The developed method was characterized by suitable validation parameters, such as linearity (coefficient of determination r2 0,995), selectivity or the limit of detection at the level of 0.25 - 0.5 μg/ml. Acceptable values of accuracy and precision were obtained, which were in good agreement with the recommended validation guidelines for analysis of pharmaceutical and biological samples. Detection was performed at a wavelength of 200 nm. The developed method was successfully applied to determine tramadol and paracetamol in various dosage forms and in urine biological samples. Achieved results indicate a potential of the method to be integrated in the common quality control processes of drugs and/or in bioanalysis.


Assuntos
Tramadol , Acetaminofen , Eletroforese Capilar/métodos , Preparações Farmacêuticas , Tramadol/análise
2.
Int J Clin Pract ; 2022: 7387600, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35685538

RESUMO

Purpose: Investigating the effect of ondansetron on the efficacy of tramadol in patients undergoing laparoscopic cholecystectomy. Methods: Sixty American Society of Anesthesiologists (ASA) I-II patients over the age of 18 who underwent laparoscopic cholecystectomy were included in this study. All patients were given 1 mg/kg tramadol intravenously (iv) during the intraoperative period. Patients were randomly assigned to receive either 4 mg ondansetron (Group O) or 2 mL saline (Group S). Postoperative tramadol consumption, pain score (NRS), intensity of nausea (NRS), presence of vomiting, consumption of rescue analgesics and antiemetics, and patient satisfaction were recorded. Results: A total of 60 patients were enrolled in the study; five patients were excluded due to deviation from the protocol. Data from 55 patients (Group O: 28 patients, Group S: 27 patients) were evaluated in the study. No differences between the two groups were detected for postoperative consumption of tramadol, pain score (NRS), intensity of nausea (NRS), presence of vomiting, consumption of rescue analgesics and antiemetics, and patient satisfaction. Conclusions: The results showed that coadministration of tramadol and ondansetron did not change tramadol consumption during the postoperative 24 hours after laparoscopic cholecystectomy. Clinical trial registration number is as follows: https://clinicaltrials.gov/ct2/show/NCT04745273-01/31/2021.


Assuntos
Antieméticos , Colecistectomia Laparoscópica , Tramadol , Adulto , Analgésicos/uso terapêutico , Antieméticos/uso terapêutico , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/métodos , Método Duplo-Cego , Humanos , Pessoa de Meia-Idade , Ondansetron/uso terapêutico , Dor/tratamento farmacológico , Náusea e Vômito Pós-Operatórios/tratamento farmacológico , Náusea e Vômito Pós-Operatórios/prevenção & controle , Tramadol/uso terapêutico
3.
Int J Clin Pract ; 2022: 2668215, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35685608

RESUMO

Background: Transversus abdominis plane (TAP) block is used for postoperative analgesia in laparoscopic cholecystectomy. In laparoscopic cholecystectomy, the incisions are located mainly on the upper right side of the abdomen. Aims: We aim to determine the efficacy of less-invasive ultrasound-guided right unilateral oblique subcostal TAP block in laparoscopic cholecystectomy on postoperative analgesia by comparing patients undergoing bilateral TAP block and a control group. Methods: Ninety patients were equally divided into control, unilateral, and bilateral TAP block groups. TAP blocks were conducted before anesthesia. No block was applied to the control group. Patients' demographics and postoperative pain, satisfaction, and nausea-vomiting scores and tramadol/ondansetron doses were evaluated. Results: There was no significant difference in the verbal numerical rating scale for pain scores at rest and during coughing (VNRS-R and VNRS-C) between unilateral and bilateral TAP block groups at postoperative 1 hour, 2 hour, 4 hour, 8 hour, 12 hour, and 24 hours. In addition, VNRS-R and VNRS-C scores were significantly higher in the control group than in the other two groups. Tramadol consumption in the control group was significantly higher than in the unilateral and bilateral TAP block groups (p ≤ 0.01), while no significant difference was identified between unilateral and bilateral TAP block groups (p=0.303). Nausea-vomiting scores and ondansetron consumption did not differ significantly between all the groups. Patient satisfaction was significantly higher in unilateral and bilateral groups (p < 0.01, p < 0.01) than in the control group, while there was no significant difference between unilateral and bilateral TAP block groups (p=0.793). Conclusions: Right unilateral TAP block provides postoperative analgesia as effective as bilateral TAP block in laparoscopic cholecystectomy.


Assuntos
Analgesia , Colecistectomia Laparoscópica , Tramadol , Músculos Abdominais , Analgésicos Opioides/uso terapêutico , Colecistectomia Laparoscópica/efeitos adversos , Método Duplo-Cego , Humanos , Náusea , Ondansetron , Medição da Dor , Tramadol/uso terapêutico , Ultrassonografia de Intervenção , Vômito
4.
J Opioid Manag ; 18(3): 265-271, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35666483

RESUMO

BACKGROUND: Seizure and electrocardiographic (ECG) abnormalities are of the most common complications of tramadol toxicity. OBJECTIVE: This study aimed to show the prevalence and predictive value of various factors for ECG findings in patients with tramadol-induced seizures. METHOD: In a descriptive cross-sectional study, 146 patients with tramadol-induced seizures referred to Poursina Hospital, Guilan, Iran, between June and November 2018 were enrolled. The clinical manifestations, such as blood pressure, respiratory rate, and pulse rate (PR), and ECG parameters, including PR interval, QRS duration, R wave in aVR lead, and corrected QT interval, were assessed. Appropriate statistical tests were used to analyze the data. RESULTS: We showed that tramadol dose was significantly higher in patients with abnormal ECG findings compared with those with normal ECG pattern both upon admission (p = 0.001) and after 6 hours of admission (p = 0.001). The results found the predictive value of tramadol dose for abnormal ECG patterns upon admission (odds ratio (OR) 1.014, 95 percent CI 1.008 to 1.020) and 6 hours later (OR 1.008, 95 percent CI 1.003 to 1.013) in these patients. In addition, it was revealed that PR was a strong predictor of abnormal ECG findings in patients with tramadol-induced seizures upon admission (OR 1.085, 95 percent CI 1.038 to 1.134). Nevertheless, age only predicted abnormal findings 6 hours later (OR 1.104, 95 percent CI 1.019 to 1.195). CONCLUSION: Tramadol dose, age, PR, and seizures frequency could be used as indicators of abnormal ECG findings in patients with tramadol-induced seizures. KEY POINTS: The results of our study showed a high prevalence of sinus tachycardia, terminal S and R waves in aVR lead terminal S wave, and the combination of these abnormalities in this subset of patients.


Assuntos
Tramadol , Analgésicos Opioides/efeitos adversos , Arritmias Cardíacas , Estudos Transversais , Eletrocardiografia/métodos , Humanos , Convulsões/induzido quimicamente , Convulsões/diagnóstico , Convulsões/epidemiologia , Tramadol/efeitos adversos
5.
Clin Drug Investig ; 42(5): 439-446, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35499818

RESUMO

BACKGROUND: Clinical practice guidelines (CPGs) and health system policies to mitigate inappropriate opioid prescribing practices may have an extended impact on low-dose opioid (e.g., tramadol) and non-opioid (e.g., gabapentinoid) pain medication prescribing practices. OBJECTIVE: To evaluate changes in opioid, tramadol, and gabapentinoid prescribing rates from January 2016 to February 2020 within the Military Health System, including the degree to which prescribing rates changed after release of a US Defense Health Agency Procedural Instruction. METHODS: In this observational health services research study, opioid, tramadol, and gabapentin prescription dispense events of US Military Health System beneficiaries enrolled in care at military treatment facilities prior to US Defense Health Agency Procedural Instruction release (January 2016-May 2018) were used to forecast values from the post-intervention period (June 2018-February 2020). RESULTS: The median opioid and tramadol prescribing rates decreased from January 2016 to February 2020, aside from tramadol prescribing in Surgery Clinics, which increased. Gabapentinoid prescribing rate changes were mixed. In Bayesian time series models, the forecasted proportion of patients receiving each of the three medications, regardless of age group or clinic type, did not significantly vary from the actual prescribing rates in the post-intervention period. CONCLUSION: Overall, CPGs and policies targeting opioid prescribing practices may have provided the maximal impetus for providers to re-evaluate their prescribing practices, as the policy did not appear to change the slope in prescribing rates. However, it is unclear whether the policies mitigated the likelihood of plateaus in prescribing rates. Further work is needed to assess the degree to which providers simultaneously altered other non-opioid pain medication prescribing practices, self-management recommendations, and non-pharmacological therapy referrals.


Assuntos
Serviços de Saúde Militar , Tramadol , Analgésicos Opioides/uso terapêutico , Teorema de Bayes , Prescrições de Medicamentos , Humanos , Dor/tratamento farmacológico , Políticas , Padrões de Prática Médica , Tramadol/uso terapêutico
6.
Drug Des Devel Ther ; 16: 1289-1300, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35531319

RESUMO

Purpose: This study aimed to explore the effects of intravenous analgesia using tramadol on postoperative depression, anxiety, and sleep in women undergoing abdominal endoscopic surgery. Patients and Methods: Two hundred female patients (100 in each group) who underwent abdominal endoscopic surgery were recruited to randomly receive intravenous analgesia with sufentanil combined with tramadol (tramadol group) or sufentanil (control group). The primary outcome was the incidence of postoperative depression, which was assessed at 1, 2, and 3 days after surgery using the 13-item Beck Depression Inventory. The secondary outcomes were the incidence of anxiety and sleep quality, which were assessed using the 20-item Self-Rating Anxiety Scale and Richards-Campbell Sleep Questionnaire. Results: The incidence of depression (Beck depression scale≥4) during the 3-day follow-up in the control group was 51%, which was significantly higher than that in the tramadol group of 28% (relative risk [RR]=0.55; 95% confidence interval [CI], 0.38-0.79; P=0.001). No difference was found in the incidence of anxiety state (Self-Rating Anxiety Scale≥40) between the tramadol and control groups (7%vs 5%; RR=1.40; 95% CI, 0.46-4.25; P=0.552). All of the Richards-Campbell sleep scales of patients in the tramadol group at 1 (77.4±15.2 vs 64.2±20.1, P<0.001), 2 (84.1±14.9 vs 71.8±18.8, P<0.001), and 3 days (87.0±12.2 vs 70.3±21.0, P<0.001) after surgery were higher than those in the control group. Conclusion: Intravenous analgesia using tramadol can effectively improve the postoperative depression and sleep status of women undergoing abdominal endoscopic surgery. Tramadol is recommended for use in postoperative analgesia when improving postoperative mood, and sleep is needed in clinical practice.


Assuntos
Analgesia , Tramadol , Analgesia Controlada pelo Paciente , Analgésicos Opioides/uso terapêutico , Depressão/tratamento farmacológico , Método Duplo-Cego , Feminino , Humanos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Complicações Pós-Operatórias/tratamento farmacológico , Sufentanil/uso terapêutico , Tramadol/uso terapêutico
7.
Croat Med J ; 63(2): 110-116, 2022 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-35505644

RESUMO

AIM: To compare the effect of intermittent tramadol dosing vs tramadol administration via patient-controlled pump on pain after lumbar discectomy. METHODS: This randomized prospective study enrolled 100 patients who underwent elective LIV-LV lumbar discectomy in the neurosurgery department at Sestre Milosrdnice University Hospital Center from May 2016 to July 2017. Patients were randomized to receive either tramadol (600 mg daily) via a patient-controlled analgesia (PCA) pump or intermittently. Pain was evaluated by the Croatian version of Short-Form McGill Pain Questionnaire. RESULTS: Forty percent of patients were women. The median (interquartile range) age of the patients was 51 (40-61) years. The groups did not differ in pain at 7 pm on the day of discectomy. However, in the morning and evening on the first postoperative day and in the morning and evening of the second postoperative day, the PCA group had significantly lower pain (P=0.023, P<0.001, P<0.001, P=0.026, respectively). CONCLUSION: This is the first study that used the Short Form McGill Pain Questionnaire to compare the effect of tramadol administration via PCA pump and intermittent administration on pain after LIV-LV discectomy in a neurosurgery department. Tramadol showed a good analgesic efficacy in lumbar spine surgery; tramadol via PCA controlled pain more effectively than intermittently administered tramadol.


Assuntos
Tramadol , Analgesia Controlada pelo Paciente , Discotomia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/tratamento farmacológico , Estudos Prospectivos , Tramadol/uso terapêutico
8.
Basic Clin Pharmacol Toxicol ; 131(1): 83-92, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35538919

RESUMO

Tramadol is a commonly used opioid with a potential of addiction and abuse. Using Danish nationwide registers, we aimed to (1) characterise opioid poisonings; (2) assess the 30-day mortality following morphine, oxycodone, and mixed poisonings compared to tramadol poisonings; and (3) assess the development in tramadol poisonings during a 12-year period. Poisonings were identified from 2006 to 2017. A Cox proportional hazards regression model was used to estimate adjusted hazard ratios (aHRs) along with 95% confidence intervals (CIs) for 30-day mortality following morphine, oxycodone or mixed poisonings compared to tramadol poisonings. We identified 7718 opioid poisonings among 6365 patients. The patients with a tramadol poisoning were younger and had less comorbidities than the patients with a morphine, oxycodone or mixed poisoning. Within 30 days, a total of 205 patients died. The 30-day mortality risk was higher following morphine (aHR 3.2, 95% CI 2.0-5.1), oxycodone (aHR 2.1, 95% CI 1.2-3.6) and mixed poisonings (aHR 1.6, 95% CI 1.0-2.7) compared to tramadol poisonings. The annual number of tramadol poisonings increased from 233 in 2006 to 501 in 2013 and declined to 348 in 2017. In conclusion, despite a lower mortality risk compared to other opioid poisonings, physicians should consider the poisoning and abuse risks when prescribing tramadol.


Assuntos
Tramadol , Analgésicos Opioides , Anti-Inflamatórios não Esteroides , Dinamarca/epidemiologia , Humanos , Morfina , Oxicodona , Tramadol/efeitos adversos
9.
Arthritis Res Ther ; 24(1): 85, 2022 04 11.
Artigo em Inglês | MEDLINE | ID: mdl-35410440

RESUMO

BACKGROUND: The use of tramadol among osteoarthritis (OA) patients has been increasing rapidly around the world, but population-based studies on its safety profile among OA patients are scarce. We sought to determine if tramadol use in OA patients is associated with increased risks of all-cause mortality, cardiovascular diseases (CVD), venous thromboembolism (VTE), and hip fractures compared with commonly prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) or codeine. METHODS: Using administrative health datasets from British Columbia, Canada, we conducted a sequential propensity score-matched cohort study among all OA patients between 2005 and 2013. The tramadol cohort (i.e., tramadol initiation) was matched with four comparator cohorts (i.e., initiation of naproxen, diclofenac, cyclooxygenase-2 [Cox-2] inhibitors, or codeine). Outcomes are all-cause mortality, first-ever CVD, VTE, and hip fractures within the year after the treatment initiation. Patients were followed until they either experienced an event, left the province, or the 1-year follow-up period ended, whichever occurred first. Cox proportional hazard models were used to estimate hazard ratios after adjusting for competing risk of death. RESULTS: Overall, 100,358 OA patients were included (mean age: 68 years, 63% females). All-cause mortality was higher for tramadol compared to NSAIDs with rate differences (RDs/1000 person-years, 95% CI) ranging from 3.3 (0.0-6.7) to 8.1 (4.9-11.4) and hazard ratios (HRs, 95% CI) ranging from 1.2 (1.0-1.4) to 1.5 (1.3-1.8). For CVD, no differences were observed between tramadol and NSAIDs. Tramadol had a higher risk of VTE compared to diclofenac, with RD/1000 person-years (95% CI) of 2.2 (0.7-3.7) and HR (95% CI) of 1.7 (1.3-2.2). Tramadol also had a higher risk of hip fractures compared to diclofenac and Cox-2 inhibitors with RDs/1000 person-years (95% CI) of 1.9 (0.4-3.4) and 1.7 (0.2-3.3), respectively, and HRs (95% CI) of 1.6 (1.2-2.0) and 1.4 (1.1-1.9), respectively. No differences were observed between tramadol and NSAIDs for all events. CONCLUSIONS: OA patients initiating tramadol have an increased risk of mortality, VTE, and hip fractures within 1 year compared with commonly prescribed NSAIDs, but not with codeine.


Assuntos
Doenças Cardiovasculares , Fraturas do Quadril , Osteoartrite , Tramadol , Tromboembolia Venosa , Idoso , Anti-Inflamatórios não Esteroides/efeitos adversos , Doenças Cardiovasculares/induzido quimicamente , Codeína/efeitos adversos , Estudos de Coortes , Inibidores de Ciclo-Oxigenase 2/efeitos adversos , Diclofenaco/uso terapêutico , Feminino , Fraturas do Quadril/induzido quimicamente , Fraturas do Quadril/tratamento farmacológico , Fraturas do Quadril/epidemiologia , Humanos , Masculino , Osteoartrite/induzido quimicamente , Osteoartrite/tratamento farmacológico , Tramadol/efeitos adversos , Tromboembolia Venosa/induzido quimicamente , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/epidemiologia
10.
J Opioid Manag ; 18(2): 191-197, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35476888

RESUMO

STUDY OBJECTIVE: Evaluating the time to the first request of rescue analgesic after adding either dexmedetomidine or tramadol to intraarticular bupivacaine. DESIGN: A prospective, randomized, control, double-blinded study. SETTING: Operating room at Tanta University Hospital. PATIENTS: Sixty adult patients were enrolled and scheduled for knee arthroscopic surgery. INTERVENTIONS: Post-operative intra-articular injection of dexmedetomidine 1 µg/kg or tramadol 100 mg compared with a control group receiving intra-articular bupivacaine alone. MAIN OUTCOME: The time to the first request of rescue analgesic, total consumption of analgesic, and post-operative numeric rating scale at 1, 3, 6, 9, 12, and 24 hours post-operatively. RESULTS: The time to the first request of analgesia was comparable between group D and group T with p value 0.84, but it was significantly shorter in group T and group D in comparison with group C, with p value 0.001 for both. Post-operative 24 hours morphine consumption was also comparable between group D and group T with p value 0.17, but it was significantly lower in group T and group D in comparison with group C, with p value 0.001 for both. There was also no significant difference in numeric rating scale between dexmedetomidine group and tramadol group over the 24 hours of the study, but numeric rating scale values were significantly higher in the control group. The incidence of nausea and vomiting was comparable among the three groups. All patients displayed a stable hemodynamic profile. CONCLUSIONS: Adding either dexmedetomidine or tramadol as a single dose to intra-articular bupivacaine resulted in the prolongation of the time to the first request of analgesic and reduced the incidence of post-operative pain and post-operative morphine requirement, when compared with the groups receiving intra-articular bupivacaine alone.


Assuntos
Dexmedetomidina , Tramadol , Adulto , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/efeitos adversos , Artroscopia/efeitos adversos , Bupivacaína/efeitos adversos , Dexmedetomidina/efeitos adversos , Humanos , Injeções Intra-Articulares , Morfina/efeitos adversos , Medição da Dor/métodos , Estudos Prospectivos , Tramadol/efeitos adversos
11.
J Emerg Med ; 62(5): 668-674, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35370038

RESUMO

BACKGROUND: Amidst the opioid epidemic, there has been an increasing focus on opioid utilization in U.S. emergency departments (EDs). Compared with other opioids, little is known about the use of tramadol over the past decade. Tramadol has uncertain efficacy and a concerning adverse effect profile compared with traditional opioids. OBJECTIVE: Our aim was to describe trends in tramadol use in U.S. EDs between 2007 and 2018. METHODS: We analyzed the National Hospital Ambulatory Medical Care Survey from 2007 to 2018 to examine ED visits by patients 18 years or older in which tramadol was administered or prescribed. We examined trends in demographics and resource utilization and compared these trends with those of traditional opioids. Survey-weighted analyses were conducted to provide national-level estimates. RESULTS: Between 2007 and 2018, ED visits in which tramadol was used increased 70.6%, from 1.7% of all ED visits in 2007 to 2.9% in 2018. The largest increases were noted among patients aged 55 through 64 years and 65 years and older. Diagnostic resource utilization increased across the study period. Overall opioid utilization during the study period decreased from 28.4% in 2007 to 17.9% in 2018 (p < 0.001). The use of other specific opioids declined or remained stable between 2007 and 2018. CONCLUSIONS: Although the use of traditional opioids decreased from 2007 to 2018, the use of tramadol increased. Increases were largest among older patients, who may be more susceptible to the adverse effects associated with this medication. Further research in the appropriate use of tramadol in the ED setting is warranted.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Epidemias , Tramadol , Analgésicos Opioides/efeitos adversos , Serviço Hospitalar de Emergência , Pesquisas sobre Serviços de Saúde , Humanos , Tramadol/efeitos adversos , Estados Unidos/epidemiologia
12.
Drug Des Devel Ther ; 16: 1143-1157, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35478935

RESUMO

Purpose: Gastric ulcer induced by NSAIDs is the major medical concern and researchers are utilizing several approaches to combat this medical issue. In the current study, we investigated the efficacy of thiadiazinethione derivative (2,2'(2-thioxo-1,3,5-thiadiazinane-3,5-diyl) diacetic acid, as new less ulcerogenic compound. Methods: 2,2'(2-thioxo-1,3,5-thiadiazinane-3,5-diyl) diacetic acid was evaluated using standard animal models including hot plate, writhing test and formalin induced nociceptive models. Anti-inflammatory activity was assessed via carrageenan-induced paw oedema model. Involvement of opioidergic nociceptive mechanism was confirmed via naloxone administration in hot plat assay. The gastro-ulcerogenic potential of test and standard compounds were evaluated via NSAID-induced pyloric ligation model followed by standard histopathological and biochemical analysis. Results: In acetic acid-induced writhing test, our compound significantly reduced abdominal constrictions at the tested doses of 15 (p < 0.05), 30 (p < 0.01) and 45 mg kg-1 (p < 0.001) as compared to control (p < 0.001). In hot plate test, after 30 min of administration, our test compound showed significant anti-nociceptive potential (p < 0.05 at 15 and 30 mg kg-1 and p < 0.01 at 45 mg kg-1) and tramadol (p ˂ 0.001) at 30 mg kg-1 dose. After 60 min tramadol (30 kg-1) and test sample (30, 45 mg kg-1) exhibited significant anti-nociceptive activity p < 0.001. In Formalin-induced nociceptive response, a significant decline (p ˂ 0.001) was observed for aspirin and test compound during acute and chronic phases. Decline in the anti-nociceptive potential of tramadol and test sample via administration of naloxone indicate the involvement of opioidergic mechanism. Our compound exhibited significant anti-inflammatory activity in second phase of carrageenan induced paw oedema model. Histological and biochemical parameters exhibited less ulcerogenic potential as compared to aspirin. Conclusion: Our findings suggests that our test compound has desirable anti-nociceptive and anti-inflammatory potentials with less propensity to cause gastric ulcer.


Assuntos
Úlcera Gástrica , Tramadol , Analgésicos/uso terapêutico , Animais , Anti-Inflamatórios/farmacologia , Anti-Inflamatórios não Esteroides/uso terapêutico , Aspirina/uso terapêutico , Carragenina , Edema/tratamento farmacológico , Formaldeído/efeitos adversos , Naloxona/farmacologia , Úlcera Gástrica/induzido quimicamente , Úlcera Gástrica/tratamento farmacológico , Úlcera
14.
Mol Pain ; 18: 17448069221089784, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35418262

RESUMO

Pulsed radiofrequency (PRF) therapy is one of the most common treatment options for neuropathic pain, albeit the underlying mechanism has not been hitherto elucidated. In this study, we investigated the efficacy and mechanism of PRF therapy on resiniferatoxin (RTX)-induced mechanical allodynia, which has been used as a model of postherpetic neuralgia (PHN). Adult male rats were intraperitoneally injected with a vehicle or RTX. Furthermore, PRF current was applied on a unilateral sciatic nerve in all RTX-treated rats. On both ipsilateral and contralateral sides, the paw mechanical withdrawal thresholds were examined and L4-6 dorsal root ganglia (DRG) were harvested. In the DRG of rats with RTX-induced mechanical allodynia, NaV1.7, a voltage-gated Na+ channel, was upregulated following the enhancement of extracellular signal-regulated kinase phosphorylation. Early PRF therapy, which was applied 1 week after RTX exposure, suppressed this NaV1.7 upregulation and showed an anti-allodynic effect; however, late PRF therapy, which was applied after 5 weeks of RTX exposure, failed to inhibit allodynia. Interestingly, late PRF therapy became effective after daily tramadol administration for 7 days, starting from 2 weeks after RTX exposure. Both early PRF therapy and late PRF therapy combined with early tramadol treatment suppressed NaV1.7 upregulation in the DRG of rats with RTX-induced mechanical allodynia. Therefore, NaV1.7 upregulation in DRG is related to the development of RTX-induced neuropathic pain; moreover, PRF therapy may be effective in the clinical management of patients with PHN via NaV1.7 upregulation inhibition.


Assuntos
MAP Quinases Reguladas por Sinal Extracelular , Canal de Sódio Disparado por Voltagem NAV1.7 , Neuralgia Pós-Herpética , Neuralgia , Terapia por Radiofrequência , Tramadol , Animais , Diterpenos , MAP Quinases Reguladas por Sinal Extracelular/metabolismo , Gânglios Espinais , Humanos , Hiperalgesia/terapia , Masculino , Canal de Sódio Disparado por Voltagem NAV1.7/metabolismo , Neuralgia/induzido quimicamente , Neuralgia/terapia , Neurônios , Fosforilação , Ratos , Ratos Sprague-Dawley , Canais de Sódio , Tramadol/farmacologia , Regulação para Cima
15.
Drug Alcohol Depend ; 235: 109434, 2022 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-35405460

RESUMO

BACKGROUND: Prior research demonstrates a high prevalence of substance use, including opioid use, among those who have had personal or vicarious contact with the correctional system. Relatedly, alongside patterns of rising opioid use in general, opioid use during pregnancy is becoming a growing public health concern. Still, risk factors for prescription opioid use during pregnancy remain understudied. This study is the first to assess the connection between a women's personal or vicarious exposure to incarceration in the 12 months prior to birth and patterns of prenatal opioid use. METHODS: Data are from the Pregnancy Risk Assessment Monitoring System (PRAMS) in 2019 (N = 17,551 mothers). Logistic and multinomial logistic regression are used to assess the association between incarceration exposure and patterns of opioid use during pregnancy. RESULTS: Incarceration-exposed women were more likely to use all eight types of prescription opioids assessed in this study (Hydrocodone, Codeine, Oxycodone, Tramadol, Hydromorphone/Meperidine, Oxymorphone, Morphine, and Fentanyl). After adjustment for control variables, incarceration-exposed women were significantly more likely to report any prescription opioid use during pregnancy (OR = 1.745, 95% CI = 1.194, 2.554). Furthermore, relative to no opioid use, incarceration exposure was also associated with illicit prescription opioid use (RRR = 2.979, 1.533, 5.791). CONCLUSIONS: Incarceration exposure in the year prior to birth is associated with higher odds of prescription opioid use. These findings add to the burgeoning literature that details a women's exposure to incarceration is a risk marker for substance use and engagement in health risk behaviors that can jeopardize maternal and infant wellbeing.


Assuntos
Transtornos Relacionados ao Uso de Opioides , Tramadol , Analgésicos Opioides/efeitos adversos , Feminino , Humanos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Oxicodona/uso terapêutico , Gravidez , Prescrições , Tramadol/uso terapêutico
16.
Clin Drug Investig ; 42(5): 403-416, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35435639

RESUMO

BACKGROUND AND OBJECTIVES: Knee osteoarthritis pain is a chronic form of pain for which conventional non-steroidal anti-inflammatory drugs may provide insufficient analgesia. Twice-daily tramadol hydrochloride (65% sustained-release/35% immediate-release) bilayer tablets are a novel formulation of tramadol developed for managing chronic pain. The objectives of this study were to examine the effectiveness and safety of this formulation in patients with chronic knee osteoarthritis pain. METHODS: This was a multicenter, randomized, placebo-controlled, double-blind, parallel-group, treatment-withdrawal study. Patients with a reduction in Numeric Rating Scale (NRS) for pain of ≥2 points during a 1-3-week, open-label, tramadol dose-escalation period (100-300 mg/day) were randomized to continue tramadol or switched to placebo for 4 weeks (double-blind period). Patients with inadequate efficacy (increase in NRS ≥2 points/patient request) were withdrawn. Outcomes included the time to inadequate analgesic efficacy from randomization (primary endpoint), the cumulative retention rate, and safety. RESULTS: Overall, 249 and 160 patients entered the dose-escalation and double-blind periods, respectively (tramadol 79; placebo 81). Kaplan-Meier analysis revealed superiority of tramadol (log-rank p = 0.042), and a hazard ratio of 0.50 (95% confidence interval [CI] 0.25-0.99). Documentation of an inadequate analgesic effect was less frequent in the tramadol group (15.4%, 95% CI 8.2-25.3% vs. 30.9%, 95% CI 21.1-42.1%). The cumulative retention rate was greater in the tramadol group (83.7% vs. 69.0%). Adverse events occurred in 80.6% (200/248) of patients in the open-label period, and in 38.5% (30/78) and 13.6% (11/81) of patients in the tramadol and placebo groups, respectively, in the double-blind period. Opioid-associated adverse events, such as nausea, vomiting, constipation, somnolence, and dizziness, were the most frequent events. CONCLUSION: This study demonstrated the analgesic efficacy and safety of sustained-release tramadol tablets with an immediate-release component for chronic knee osteoarthritis pain. TRIAL REGISTRATION: JapicCTI-132103 (Japan Pharmaceutical Information Center; registration date February 25, 2015).


Assuntos
Dor Crônica , Osteoartrite do Joelho , Tramadol , Analgésicos/uso terapêutico , Analgésicos Opioides , Dor Crônica/diagnóstico , Dor Crônica/tratamento farmacológico , Preparações de Ação Retardada , Método Duplo-Cego , Humanos , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/tratamento farmacológico , Comprimidos , Tramadol/efeitos adversos
17.
Synapse ; 76(7-8): e22232, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35313383

RESUMO

Tramadol is widely used to control pain in various diseases, but the relevant mechanisms are less known despite the severe risks of abuse. The medial prefrontal cortex (mPFC) is one of the critical centers of the reward system. Studies have shown that orexins and endocannabinoids are likely to play an important role in addiction. In this study, the effect of orexin receptor-2 (OX2R) and endocannabinoid receptor-1 (CB1R) blockade on the neuronal activity of mPFC was investigated in response to tramadol in male rats. Tramadol was injected intraperitoneally, and its effects on the firing of mPFC pyramidal neurons were investigated using in vivo extracellular single-unit recording. Tramadol affected the pyramidal neuronal activity of the mPFC. AM251 (18 nmol/4 µl), as a selective CB1R antagonist, and TCS-OX2-29 (50 nmol/4 µl), as a selective OX2R antagonist, individually or simultaneously were microinjected into the lateral ventricle of the brain (intracerebroventricular, ICV). The results showed that the ratio of neurons with the excitatory/inhibitory or no responses was significantly changed by tramadol (p < .05). These changes were prevented by blockade of CB1Rs alone or blockade of OX2Rs and CB1Rs simultaneously (p < .05). However, blockade of these receptors in the vehicle group had no significant effect on neuronal activity. The findings of this study indicate the potential role of orexin and endocannabinoid systems in mediating the effects of tramadol in mPFC and the possible interaction between the two systems via OX2 and CB1 receptors. However, further studies are needed to identify these effects by examining intracellular signaling.


Assuntos
Antagonistas dos Receptores de Orexina , Tramadol , Animais , Antagonistas de Receptores de Canabinoides/farmacologia , Endocanabinoides , Masculino , Neurônios , Antagonistas dos Receptores de Orexina/farmacologia , Receptores de Orexina/metabolismo , Córtex Pré-Frontal/metabolismo , Ratos , Receptor CB1 de Canabinoide , Receptores de Canabinoides , Tramadol/farmacologia
18.
Obstet Gynecol ; 139(4): 545-553, 2022 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-35271551

RESUMO

OBJECTIVE: To investigate whether exposure to tramadol during early pregnancy is associated with an increased risk of spontaneous abortion or major congenital malformations. METHODS: The study is a nationwide cohort study including all registered pregnancies in Denmark between January 1, 1997, and December 31, 2016. The Danish National Prescription Register was used to identify maternal exposure to tramadol. Pregnancies with maternal exposure to tramadol were matched with pregnancies without maternal exposure to tramadol in a ratio of up to 1:4 using propensity scoring. The primary outcomes were spontaneous abortion and major congenital malformations. Cox proportional hazards regression was used to estimate the hazard ratios (HRs) of spontaneous abortion, and log binominal models were used to estimate the relative risk ratios (RRs) of major congenital malformations. RESULTS: A total of 36,467 (tramadol exposure n=7,310) and 18,907 (tramadol exposure n=3,796) pregnancies were included in the analyses of spontaneous abortion and major congenital malformations, respectively. Spontaneous abortion occurred in 893 (12.2%) pregnancies with maternal exposure to tramadol and in 3,471 (11.9%) pregnancies without maternal exposure to tramadol (HR 1.06, 95% CI 0.99-1.14). A major congenital malformation occurred in the offspring of 151 (4.0%) pregnancies with maternal exposure to tramadol, compared with 579 (3.8%) in pregnancies without maternal exposure to tramadol (RR 1.04, 95% CI 0.87-1.24). CONCLUSION: Exposure to tramadol during early pregnancy does not appear to be associated with an increased risk of spontaneous abortion or major congenital malformations.


Assuntos
Aborto Espontâneo , Tramadol , Aborto Espontâneo/induzido quimicamente , Aborto Espontâneo/epidemiologia , Estudos de Coortes , Feminino , Humanos , Exposição Materna , Gravidez , Modelos de Riscos Proporcionais , Tramadol/efeitos adversos
19.
Asian J Psychiatr ; 71: 103080, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35305452

RESUMO

BACKGROUND: Strict adherence to pharmacological dosage regimens is a prerequisite to the success of most treatments, particularly for patients in drug abuse programs. The compliance of tramadol, an atypical non-scheduled narcotic analgesic, using objective method has not been adequately studied in an Indian setting. AIM: To evaluate the compliance and pattern of drug use among opioid-dependent subjects prescribed tramadol based on urinalysis. METHOD: Fifty male opioid-dependent patients (ICD 10), seeking treatment at a tertiary de-addiction treatment centre of North India on tramadol prescription for atleast past four weeks were included. Self-reported substance use was recorded using semi-structured proforma. Ten ml of urine was collected for the assessment of compliance of tramadol of other substance use (morphine, buprenorphine, dextropropoxyphene, pentazocine, cannabis, benzodiazepines, pheniramine). All these drugs were analyzed using the immunoassay-based Cassette test and Gas Chromatography in human urine. RESULT: Mean age of the participants was 42.8 years and the mean duration of opioid use was 15.9years. The urine specimen of all subjects tested positive for tramadol. Urinalysis revealed benzodiazepines, cannabis, and pheniramine to be the most common substances of use in this population. It was seen that agreement of self-reporting and urine test results was good for morphine (κ = 0.558) and cannabis (κ = 0.312) and was poor for buprenorphine, pentazocine, and pheniramine. CONCLUSION: The study demonstrates the continued use of several illicit or non-prescribed medications in a medication-assisted opioid treatment population. The results affirm the reliability of urinalysis as an adjunct for testing compliance in such a population.


Assuntos
Buprenorfina , Transtornos Relacionados ao Uso de Opioides , Tramadol , Adulto , Analgésicos/uso terapêutico , Analgésicos Opioides/uso terapêutico , Benzodiazepinas , Buprenorfina/uso terapêutico , Estudos Transversais , Humanos , Masculino , Morfina , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Pentazocina , Feniramina , Reprodutibilidade dos Testes , Centros de Atenção Terciária , Tramadol/uso terapêutico , Urinálise
20.
Dtsch Med Wochenschr ; 147(6): 344-348, 2022 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-35291041

RESUMO

Osteoarthritis (OA) is a very common disease. As a consequence of the ageing society, osteoarthritis prevalence will further increase. Age itself, trauma, unequal load distribution and overweight are risk factors. Cellular senescence and overweight have been in the focus of scientific interest for the last few years. Both risk factors are able to facilitate joint inflammation, independent of a mechanical approach. Senescent chondrocytes as well as adipocytes can produce increased amounts of inflammatory cytokines. Cornerstones of the therapy are patient education including information on the character/course of the disease and intentional weight loss. Although NSAIDs can be recommended as analgesics, their contraindications limit the widespread use. Alternatively, acetaminophen or low-potency opioids such as tramadol might be considered. Topical NSAIDs and intraarticular glucocorticoid injections can be helpful in pain reduction particularly in knee osteoarthritis. There is still no general recommendation for nutritional supplements including chondroitin or glycosaminoglycan, but they might be considered as an accompanying therapy. With the current non-approval of the nerve growth factor (NGF)-antibody tanezumab, a new therapeutical option for OA suffered a setback. Unfortunately, the results of the phase 2 study on the Wnt inhibitor lorecivivint are barely encouraging. However, the results of the according phase 3 study are eagerly awaited.


Assuntos
Osteoartrite do Joelho , Tramadol , Analgésicos/efeitos adversos , Anti-Inflamatórios não Esteroides/uso terapêutico , Humanos , Osteoartrite do Joelho/induzido quimicamente , Osteoartrite do Joelho/tratamento farmacológico , Sobrepeso , Tramadol/uso terapêutico
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