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Tramadol (Ultram) versus Other

Compared with NSAIDs, Tramadol does not aggravate hypertension or congestive heart failure, nor does it have the potential to cause peptic ulcers.

Compared with opioid analgesics, Tramadol does not induce significant respiratory depression, constipation, or have significant abuse potential.

Tramadol vs. Morphine
  • Efficacy:
    • Postoperative analgesia after tonsillectomy: Both analgesics are effective for postoperative pain relief in children after tonsillectomy. However, morphine may give better postoperative pain relief 1. Tramadol is better tolerated.
    • Postoperative analgesia after urological surgery: In the postoperative period, pain scores and the average time for analgesic requirement are similar for both. However, the incidences of allergic rash, itching, respiratory depression and sedation score are greater with the morphine 19.
    • Posttraumatic pain: Analgesia is similar with both tramadol and morphine for the management of pain in trauma 2.
    • Pain after abdominal surgery: Tramadol given by intramuscular injection has postoperative analgesic activity similar to morphine. In multicenter trial comparing tramadol and morphine for pain after abdominal surgery after the first dose, pain intensity was reduced 36.2% with tramadol, and 51% with morphine 3.
    • Postoperative pain: Tramadol shows pain relief similar to morphine 4.
    • Severe pain: For patients with severe pain, morphine is superior.
    • Chronic pancreatitis: Tramadol and morphine are potent analgesics in severe chronic pancreatitis pain when individually titrated. However, in clinical study tramadol interfered significantly less with gastrointestinal function and was more often rated as an excellent analgesic than morphine 17.
    • Intraoperative analgesia: In clinical study there was no difference between the use of tramadol and morphine to treat pain after laparoscopic cholecystectomy from 90 min after the end of surgery. Morphine was more effective than tramadol as an intraoperative analgesic 26.
  • Side effects and tolerability:
    Tramadol appeared to cause more nausea and vomiting than morphine. Morphine produces more sleepiness 18.
    Tramadol has smaller inhibitory effect on gastric emptying compared with morphine 14.

Tramadol vs. Metamizole

A randomized double-blind design on 10 volunteers compared tramadol (50 and 100 mg) and metamizole (500 and 1,000 mg); both were given orally.

Constant painful stimuli were applied by controlled electrical stimulation of tooth pulp. Analgesia was monitored by verbal pain rating, by measurement of the current necessary to evoke sensation in a tooth and with the aid of the amplitude of somatosensory evoked potential. All 3 algesimetric methods showed in complete agreement higher analgesia by the 100-mg dose of tramadol. The mean relative potencies of metamizole and tramadol were found to be 1:23 in agreement with clinical studies 5.

Tramadol vs. Buprenorphine

Buprenorphine appears to produce more potent and longer acting analgesic effect compared to tramadol, although slightly delayed 27.

Tramadol vs. Pentazocine
  • Postoperative pain: In clinical trial the first dose of tramadol was significantly more effective than pentazocine after the 1st h and throughout the subsequent 5 h. Final judgments on efficacy and acceptability were in favor of tramadol 28.
  • Postoperative pain following prolapsed intervertebral disc repair: Results of the comparative study showed both treatments provide equivalent analgesia for the six hours observation period. The global assessment of analgesia by patient and observer was not significantly different, although less additional analgesic was required in the pentazocine group. Side effects were quite common in both groups, and occurred more frequently in the pentazocine group 29.
  • Acute pain: Tramadol (50 mg) has shown to have an analgesic effect about equal to that of the pentazocine (50 mg). The incidence of side effects from tramadol appears to be less than that with the pentazocine 29.

Tramadol vs. Pethidine
  • Efficacy:
    • Labour pain: Tramadol 100 mg is as effective as pethidine 75 mg 6.
    • Analgesia for adenotonsillectomy: The results of comparative study suggest that pethidine given with induction of anaesthesia provides better analgesia during and after tonsillo-adenoidectomy than does tramadol. The delay to recovery of spontaneous respiration with pethidine suggests a greater safety profile of tramadol 20.
  • Side effects and tolerability:
    Tramadol has superior safety profile. Pethidine is associated with a significantly higher frequency of adverse events and a significantly lower respiratory rate in the neonates 6.
    In comparative study tramadol was shown not to be associated with respiratory depression, unlike equipotent dose of pethidine 9.

Tramadol vs. Acetaminophen-Propoxyphene
  • Efficacy:
    • Postoperative pain: The 75 mg dose of tramadol is generally more effective than the acetaminophen-propoxyphene (650/100 mg). The tramadol 150 mg is significantly superior to the acetaminophen-propoxyphene 7.
  • Side effects and tolerability: Tramadol is associated with higher frequency of dizziness 7.

Tramadol vs. Meperidine
  • Efficacy:
    • Postoperative pain: Meperidine and tramadol produce comparable analgesia, with a different time course profile 11.
    • Postoperative pain relief after tonsillectomy: Meperidine appears to be more effective for pain relief and provides better emergence characteristics than tramadol after tonsillectomy in children 21.
  • Side effects and tolerability:
    Meperidine induces sedation and respiratory depression while tramadol does not. Incidence of nausea and vomiting is higher with tramadol 11.

Tramadol vs. Oxycodone
  • Efficacy:
    • Postoperative pain after maxillofacial surgery: In comparative study the potency ratio of tramadol to oxycodone was found to be approximately 8:1. There was no significant difference in the VAS scores for pain. Tramadol was found to provide adequate analgesia after maxillofacial surgery without risk of respiratory depression 24.
  • Side effects and tolerability:
    Incidence of nausea is slightly greater with tramadol than with oxycodone 24.
    Oxycodone causes significant respiratory depression. On the contrary, Tramadol is not associated with respiratory depression 10.

Tramadol vs. Clonidine

Heroin withdrawal management: Comparative study indicates that tramadol is more effective in managing withdrawal than clonidine, and may be especially useful in outpatient detoxification 12.

Tramadol vs. Hydrocodone/Acetaminophen

Tramadol provides inferior analgesia to hydrocodone-acetaminophen in patients with acute musculoskeletal pain 25.

Tramadol abuse/dependence potencial is significantly less than for hydrocodone 13.

Tramadol vs. Ketorolac
  • Efficacy:
    • Renal colic: Both ketorolac (30 mg intramuscular) and tramadol (1 mg/kg subcutaneous) are effective in renal colic. Both have an efficacy greater than 80% when used separately and almost 100% when used in combination. The analgesic effect of ketorolac is observed earlier than that of tramadol 8.
    • Postoperative pain during maxillofacial surgery: Ketorolac and Tramadol produce comparable, effective and low cost postoperative analgesia during maxillofacial surgery 22.
    • Laparoscopic procedure: Tramadol is a better analgesic compared to ketorolac for patients undergoing day care gynaecological laparoscopic procedure 23.
  • Side effects and tolerability: Tramadol is associated with higher incidence of vomiting 22.

Tramadol vs. Diclofenac sodium

Acute migraine attacks: The comparative study evaluated the efficacy of intramuscular tramadol 100 mg in acute migraine attack and compared it with that of IM diclofenac sodium 75 mg.

Two-hour pain response rate was 80% for both tramadol and diclofenac groups. There were no statistically significant differences among groups in terms of 48-h pain response, rescue treatment, associated symptoms' response, headache recurrence and adverse event rates. Fifteen (75%) patients in the tramadol group and 16 (80%) patients in the diclofenac group stated that they may prefer the same drug for future admissions 15.

Posttonsillectomy analgesia: Oral tramadol can deliver the same analgesic efficacy as oral diclofenac for posttonsillectomy pain relief, which might be beneficial for avoiding the adverse effects of NSAIDs 30

Tramadol vs. Lornoxicam
  • Efficacy:
    • Postoperative pain: The randomized double-blind study compared intramuscular lornoxicam and tramadol in 76 patients with moderate to unbearable pain following arthroscopic reconstruction of the anterior cruciate ligament using the patella bone-tendon-bone technique. Patients receiving a single dose of lornoxicam 16 mg experienced significantly greater total pain relief than patients receiving tramadol 100 mg over the following 8 hours. Lornoxicam had greater analgesic efficacy than tramadol in patients with moderate baseline pain but was of equivalent efficacy in those with severe/unbearable baseline pain. Fewer patients in the lornoxicam group required rescue analgesic (58% vs. 77%, respectively). Patients' global impression of efficacy showed lornoxicam to be superior to tramadol with 82% and 49% of patients, respectively, rating treatment as good, very good, or excellent. Following multiple-dose administration of lornoxicam (8 mg tid) or tramadol (100 mg tid) for 3 days, efficacy profiles similar to those following a single dose were obtained. Thus, slightly fewer patients in the lornoxicam group required rescue drug, and patients' global impression of efficacy again favored lornoxicam 16.
  • Side effects and tolerability: Significantly fewer patients reported one or more adverse events with lornoxicam than with tramadol (14 vs. 24, respectively) 16.

Further reading

References
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  • 2. Vergnion M, Degesves S, Garcet L, Magotteaux V. Tramadol, an alternative to morphine for treating posttraumatic pain in the prehospital situation. Anesth Analg. 2001 Jun;92(6):1543-6. PubMed
  • 3. Gritti G, Verri M, Launo C, Palermo S, Novelli GP, Casali R, Paoletti F, Boanelli A, Tufano R, Leone D. Multicenter trial comparing tramadol and morphine for pain after abdominal surgery. Drugs Exp Clin Res. 1998;24(1):9-16. PubMed
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  • 6. Viegas OA, Khaw B, Ratnam SS. Tramadol in labour pain in primiparous patients. A prospective comparative clinical trial. Eur J Obstet Gynecol Reprod Biol. 1993 May;49(3):131-5. PubMed
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Published: March 31, 2008
Last updated: April 09, 2011

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