Tramadol for managing pain in patients with chronic kidney disease

Tramadol for PainPain is a frequently reported problem with most of the general population, especially with chronic kidney diseases patients. There is a highly reported occurrence of pain amongst CKD patients to the tune of seventy percent.  For the general population, it is no different affecting nearly 24% of the population at any instant of time.

This is a highly concerning situation known to specifically affect patients suffering from a poor quality of life. Similarly, the odds of survival are also stacked against those undergoing dialysis. According to a study by Murtagh, dialysis patients had reported a mean pain prevalence of 48% over a huge deviation extending between 8% and 82%. The sources of pain were identified to be musculoskeletal (62%), followed by gastrointestinal (13%), genitourinary (10%), oncological (10%), and the remaining cardiovascular.

Why and how do kidney patients encounter continuous pain?

Acute pain sensation occurs due to the stimulation of sensory neurons found throughout the body commonly called nociceptors. Those receiving inputs from the outer body tissues are responsible for somatic pain while those receiving similar inputs from internal organs cause visceral pain. Nociceptors can be stimulated by several forces such as mechanical, thermal, chemical and inflammatory causes. The action potentials so generated from the stimulation are then transported to the brain and spinal cord via peripheral nerves.

Pain that has lasted longer than the period of three months is classified as chronic pain. It may arise from prolonged injury to the tissues surrounding the nociceptors, lesion or disease affecting the somatosensory system, known as neuropathic pain. In the event of tissue damage, acute inflammation of cells may be seen which in turn stimulates nociceptors giving rise to acute pain.

How does Tramadol help overcome chronic pain?

The first step of pharmacologic intervention basically involves the use of non-opioid analgesics such as Tramadol, a centrally acting agent that prevents the uptake of norepinephrine and serotonin by nerve cells and instead acts on micro-opioid receptors thereby reducing feelings of chronic pain in the patient. At any step in the process, the drug may be combined with antidepressant and analgesics in order to aid quick recovery. It is a widely preferred drug because unlike other painkillers it is not known to be nephrotoxic. The active metabolite in the drug, O-Dimethyl Tramadol is actually produced in the liver and excreted by the kidneys. The higher dissolution of the compound in the blood stream may, however, cause respiratory depression in a few people. After getting Tramadol prescribed, one should never combine the medication with serotonin inhibitor drugs, as it may prove fatal.

Why is Tramadol preferred over other opioids?

The majority of opioids recommended for chronic kidney disease are known to undergo biotransformation and renal excretion acts as the primal route for elimination. The retention of the toxic compounds released by the drug may cause respiratory depression, suppression of the central nervous system and hypotension. This is especially true with opioids such as morphine, oxycodone, and propoxyphene. Tramadol, on the other hand, is harmless and probably the most effective drug available in the market for chronic kidney pain related issues.