7/23/2019 Tramadol for OA

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The benefits of tramadol are small and the side effects may cause people to stop taking it which may

limit how useful tramadol is to treat osteoarthritis.

Tramadol is increasingly used for the treatment of OA because, in contrast to NSAIs !"eig #$$#%

&hang #$$'(, tramadol does not produce gastrointestinal bleeding or renal problems, and doesnot

affect articular cartilage. Tramadol is an atypical opioid, as it e)hibits a dual mechanism of action*tramadol acti+ates opioid receptors and descending inhibitory pain systems !ibson -/(. This dual

action makes tramadol an attracti+e option.

The effecti+eness of tramadol in OA is unclear* tramadol lacks peripheral action !i.e. it has no anti0

in1ammatory properties( and its effecti+eness may decline with chronic use !i.e. de+elopment of 

tolerance(, as part of its action is opioid0related. Nonetheless, the central action of tramadol could be

of great benefit as this action could decrease the central neuronal sensiti2ation produced by the

 persistent nocicepti+e peripheral input !3ett -4(. In addition, tolerance may not substantially affect

long term effecti+eness. Systematic re+iews ha+e shown that ''5 of participants prescribed opioids

for chronic noncancer pain continued to take opioids for up to #' months !6also #$$'(.