Tramadol for neuropathic pain
Not all pain has a physical cause. Nociceptive pain is where you suffer tissue damage and the nerves carry a warning signal to the brain about it. Neuropathic pain arises from damage to, or disease affecting, the peripheral nervous system itself (the word 'neuropathy' derives from the Greek neuro meaning 'nerve' and pathy meaning 'disease'). A variety of "phantom" symptoms may be experienced from the sensation of being burnt, to the type of pain normally associated with a shooting or stabbing. Equally common is unusual sensitivity to usually not unpleasant physical contact (called dysesthesia). The problem in treating neuropathic pain is that the patient often does not present with an obvious physical cause for the sensations. |
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As a result, clinical practice standards vary between countries and the treatment regimes differ depending on the diagnosis. Some classify the symptoms as presented with a greater balance in favour of psychological factors and shift the therapy towards drugs that treat depressive illnesses. Others focus on physical symptomology and favour anticonvulsants, muscle relaxants, etc. But the use of many of the primary drugs in these regimes is limited by their side-effects. Because Tramadol is an artificial opiate, it has a unique pain-killing quality. Four randomised trials involving 338 patients compared Tramadol to other drugs and/or a placebo control. The placebo results show that dosages between 100-400mg offer effective relief from peripheral neuropathic pain. The two other research projects involved fewer than forty participants in comparing Tramadol to morphine and to Clomipramine respectively. These trials were inconclusive as to which of the drugs was the more effective.
Neuropathic pain arising in cancer patients
When first seeking medical examination and diagnosis, between 30-50% of patients are motivated by pain. As their condition progresses, the percentage of cancer patients experiencing moderate to severe pain increases. In the terminal phase, almost all patients depend on drugs to manage their pain (inasmuch as it can be managed). One of the factors complicating diagnosis and control is that many of the treatments used to treat the progression of cancer have moderate to severe side-effects in their own right. Thus, distinguishing between the pain caused by the malignant growths and that induced by chemotherapy or radiotherapy is challenging. When they first appeared, clinicians resisted the use of opioids in oncology cases but, more recently, the profession has accepted the use of Tramadol for all pain management purposes, no matter what its cause may be. This change of view derives from the amassing evidence that demonstrates not only that the drug is effective and safe in the treatment of pain itself, but also that the relief stemming from its use qualitatively improves the mental outlook of patients and assists them to face their physical decline with greater equanimity.
