Many people with osteoarthritis and other rheumatic joint complaints tend to use the affected joint as little as possible. This is not wise. The joint becomes stiff and therefore hurts even more. That is why the doctor will usually prescribe a painkiller , so that you will experience fewer complaints during exercise. Initially you can take the best Paracetamol . This known agent only fights the pain , not the inflammations. Usually, inflammation of the joints also occurs in osteoarthritis . Then you have to switch to anti-inflammatory painkillers ( NSAIDs ) or the liquid green lip mussel with Curcumin and Black currant leaf . The latter is a natural anti-inflammatory. If these drugs do not all have the desired effect, your doctor will have Tramadol as the next option . This is a morphine-like painkiller that is prescribed for very severe pain.
Morphine is the oldest painkiller we know. It is a chemical compound that is found in opium .
Opium is the milky juice of the opium poppy or sleeping bulb ( Papaver somniferum ). It is won by carving the faded seed box with a knife. The milk juice drips out and dries brown. This is collected and purified. Subsequently, the opioid morphine and codeine are isolated from this solidified substance. Heroin is created by further chemical processing . In the Golden Age, opium was also a lucrative business of the VOC.
Morphine is a very strong painkiller. It blocks the pain receptors in the brain, so that the pain is not or hardly felt. As a result, you are less affected by the complaints caused by osteoarthritis or other rheumatic diseases. Morphine can also be reproduced synthetically. The most prescribed morphine-like drugs are based on Tramadol .
Tramadol is prescribed for severe pain in the joints. It belongs to the weak opioids,just like codeine . The analgesic effect is less than true morphine. That certainly applies to codeine. Therefore, this drug is usually only prescribed for cough. The effect of Tramadol against pain is more powerful than codeine. Tramadol has been available since 1977 in various forms of administration. This morphine-like painkiller is available as a tablet, capsule, effervescent tablet, drops, injection and suppository. This medication is only available on doctor’s prescription and can be prescribed in combination with Paracetamol. Tramadol will only work after an hour. It is the best option for persistent and severe, chronic joint pain.
Is Tramadol Addictive?
Morphine should not be marketed and used in any country in the world. After all, it is a highly addictive drug. In addiction, it is no longer about pain relief. This creates a mental dependence on morphine to get a quick ‘kick’. However, tramadol is not as addictive as the strong opioid morphine and methadone. When used in accordance with medical regulations, the chance is even very small that an addiction occurs. It is wise to phase out the use of Tramadol very gradually . This way you prevent withdrawal symptoms.
Tramadol Side effects
With the use of most medications, side effects may occur. That also applies to Tramadol. In the first week , your body has to get used to this medication. Then the side effects are the strongest. It involves nausea, constipation, excessive sweating and dizziness . The responsiveness decreases due to drowsiness . It is better not to sit behind the wheel of the car yourself or to operate dangerous machines. After about a week these side effects slowly but surely decrease. If they persist, it is wise to discuss this with your doctor.
nausea. Dizziness. Asthenia.
Constipation, vomiting. Dry mouth, hyperhidrosis. Confusion, headache, drowsiness, fatigue. Vasodilation (due to increased serotonin levels).
pressure on the stomach and feeling full, vomiting, diarrhea. Orthostatic hypotension or cardiovascular collapse (particularly in rapid iv administration or patients with stress), cardiovascular deregulation (palpitations, tachycardia). Fatigue. Skin rash, itching, urticaria, erythema.
dyspnoea, allergic reactions (eg bronchospasm, angioedema), anaphylaxis. Bradycardia, hypertension. Blurred vision, miosis, mydriasis. Mood changes, hallucinations, confusion, anxiety, nightmares, sleep disturbances, cognitive and sensory disorders, tremor, paraesthesia, motor weakness, coordination disorder, syncope, convulsions. Appetite changes. Mental disorders (including dysuria, urinary retention). Increase in liver enzyme values.
vertigo, ataxia. Myocardial ischemia, ECG abnormalities. Respiratory depression can occur. Stevens-Johnson syndrome, toxic epidermal necrolysis. Taste disorders, hiccups.
Other reports have also been reported: speech disorders, hypoglycaemia. Dependence can occur. Neonatal abstinence syndrome.
After stopping treatment with tramadol: withdrawal symptoms such as agitation, anxiety, nervousness, insomnia, hyperkinesia, tremor and gastrointestinal symptoms. Very rare (<0.01%): panic attacks, severe anxiety, hallucinations, paraesthesia, tinnitus and unusual CNS symptoms (confusion, delusions, depersonalization, derealisation and paranoia).
Adults and children
Oral: starting dose 50-100 mg every 4 to 6 hours, maximum 400 mg / day. According to the NHG Standard Pain: adults start dose 50 mg 1 to 4 × / day, if necessary increase every 3 to 5 days to a maximum of 400 mg per day. The dosage for children aged 12 to 18 years is 50-100 mg, if necessary a maximum of 4 × / day, a maximum of 400 mg per day. Retard capsule / tablet: 50-100 mg 2 × / day or 200 mg (‘Once-Daily’) 1 × / day, with inadequate analgesia gradually increase to 150-200 mg (Retard tablet) 2 × / day or 400 mg (‘Once -Daily ‘) 1 × / day.
Rectal: 100 mg 3-4 × / day. The maximum dose is 400 mg per day, except in special clinical circumstances.
Parenterally: 50-100 mg every 4-6 hours slow iv injection (50 mg per 1-2 minutes) or im or as an infusion.
- Oral: according to the NHG Standaard Pain: initial dose 10 to 25 mg 1 to 4 × / day, if necessary, increase slowly to a maximum of 100 mg / day.
- Parenteral > 75 years: prolong the administration interval as required by prolonged excretion.
In hepatic or renal impairment (creatinine clearance <30 ml / min): consider extending the administration interval according to the needs of the patient; use of the retard tablet is not recommended.
In CYP2D6 polymorphisms: adjust the dosage or the agent as necessary in consultation with the pharmacist.
How To Take Tramadol?
Administration information: dissolve the effervescent tablets in water prior to use. Take the Retard capsule, Retard tablet or Once-Daily tablet without chewing with sufficient liquid. Take the drip liquid with liquid or sugar. In the case of swallowing disorders, use the effervescent tablet, dropper or suppository (immediate release) or, if necessary, open the Retard capsules and swallow the pellets with sufficient liquid without chewing (controlled release).
- Concomitant use of some morphine mimetics (tramadol, fentanyl, methadone, oxycodone and pethidine) with MAO inhibitors increases the risk of serotonergic syndrome (symptoms: spontaneous clonus, inducible clonus with agitation or diaphoresis, tremor, hyperreflexia, hypertonia, fever) Therefore, use of a morphinomimetic is contraindicated during or within 2 weeks after treatment with an MAO inhibitor. Concomitant use of tramadol with SSRIs or SNRIs can also lead to serotonin syndrome.
- Concomitant use of alcohol or other central depressants (such as anesthetics, antipsychotics, anxiolytics, hypnotics and sedatives) may increase the depressive effect on the central nervous system (more chance of respiratory depression, enhanced sedation).
- There is a greater risk of convulsions due to concomitant use of SSRIs (fluoxetine, fluvoxamine), serotonin and noradrenaline reuptake inhibitors (SNRIs), tricyclic antidepressants, antipsychotics and other agents that may lower the seizure threshold for seizures (bupropion, mirtazapine, tetrahydrocannabinol).
- In combination with vitamin K antagonists an increased INR with bleeding has been reported.
- Carbamazepine can reduce the plasma levels of tramadol and O-desmethyl tramadol by enzyme induction and reduce the analgesic effect.
- Pre- or post-operative administration of ondansetron may increase the need for tramadol.
- Ritonavir may increase the serum concentration of tramadol.
Tramadol in Pregnancy
- Tramadol passes the placenta.
- Teratogenesis: In humans, insufficient data. Has been found to be harmful in animals at high doses.
- Pharmacological effect: Chronic use can lead to neonatal abstinence syndrome. Application of high doses (even short-term) at the end of pregnancy can cause respiratory depression in the newborns.
- Advice: If pain treatment with opioids during pregnancy is desirable, limit the use of tramadol to single doses.
Tramadol in Lactation
- Transition in breast milk: Yes, in small quantities.
- Advice: (Chronic) use advised against. With a single dose, breastfeeding can be maintained.
- Uncontrolled epilepsy;
- Acute respiratory depression;
- Acute intoxication with alcohol, hypnotics, analgesics, opioids or other psychotropic drugs;
- Withdrawal symptoms in addicts;
- In children as postoperative analgesia in the home situation after tonsillectomy (primary source: NVA section on pediatric anesthesiology);
- At doses> 200 mg do not use the effervescent tablet in children and pregnant women with phenylketonuria.
- Exercise caution in brain trauma, increased intracranial pressure, shock, history of convulsive disorders, severe obstructive pulmonary disease (asthma, COPD), severe respiratory insufficiency or reduced respiratory reserve (particularly when concomitant use of central depressants is taking place or if the recommended dose is exceeded) and excessive mucus formation in the airways.
- Combination with sedatives such as benzodiazepines can lead to sedation, respiratory depression, coma and death. Limit the combination to patients for whom no other treatment is possible and use as low a dose as possible and as short as possible. Follow the patient accurately.
- Opioids can affect the hypothalamic-pituitary-adrenal cortex or the hypothalamic pituitary gonadal axis. The prolactin level may increase and cortisol and testosterone levels may decrease.
- In the case of acute abdominal pain, tramadol complicates the diagnosis.
- When using acute pain take into account that the analgesic effect about an hour later bet (iv faster).
- Convulsions have been reported at therapeutic doses; at doses higher than the recommended maximum dose (400 mg / day) the risk of convulsions increases. Epilepsy patients carefully monitor.
- Adverse symptoms have been reported with tramadol at therapeutic doses (1: 8,000). Tramadol can cause habituation, psychological and physical dependence during prolonged use. Therefore treatment with tramadol should be brief and intermittent in addicts-sensitive patients; reduce the dosage slowly after prolonged use. Use in addiction-sensitive patients is not recommended unless very strict medication control is performed.
- In homozygous patients with phenylketonuria, when using the effervescent tablets, the amount of aspartame must be included in the dietary requirement.
- The effervescent tablets contain sodium.
- Safety has not been established in children <1 year.
- Use can lead to reduced reaction and concentration. Many daily activities (eg driving a car) can suffer from this.
Respiratory depression, depression of the central nervous system (from stupor to coma), hypothermia, brady or tachycardia, hyper- or hypotension to shock, gastrointestinal disorders, dizziness, confusion, agitation, apathy to lethargy. Convulsions develop mainly in children. Pulmonary edema can occur.
naloxone, repeat if necessary after 2-3 min; max. 1.2 mg; children: 10 microg / kg body weight. Fight convulsions with diazepam. Naloxone can combat respiratory depression to bridge to respiration, but also increase the chance of convulsions. Treatment serotonin syndrome: external cooling when needed in hyperthermia, sedation with benzodiazepines (in neuromuscular disorders and agitation).