Tramadol for Depression
Tramadol is a centrally acting analgesic. The chemical name for tramadol hydrochloride is ( ± ) cis -2- [(dimethylamino)methyl]-1-(3-methoxyphenyl) cyclohexanol hydrochloride. The molecular weight of tramadol hydrochloride is 299.8
Perceptions of Pain in Primary Care
A quote from Martin PR. Headaches. In: King NJ, Remenji A, eds. Health Care: A Behavioral Approach. Sydney, Australia: Grune & Stratton; 1986:145-157. "Millions of patients with pain present to primary care. Pain is the most common reason for a patient to seek the attention of a physician, whether it turns out to be due to an acute medical condition that can easily be treated or, in many cases, a chronic painful condition that is going to require a lifetime of management," began Sharon M. Weinstein, MD, who is Associate Professor of Anesthesiology and Adjunct Associate Professor of Neurology and Oncology at the University of Utah School of Medicine in Salt Lake City. Dr. Weinstein is also Director of the Pain Medicine and Palliative Care Program at the Huntsman Cancer Institute; and Director of the Pain Medicine and Palliative Care Program at the Salt Lake City Veterans Affairs Medical Center. "The primary-care physician is in a position to make interventions early on that may prevent chronic pain as well as manage it."
How to use:
Take Tramadol medication by mouth as prescribed. It is usually taken every 4 to 6 hours as needed. Use this medication exactly as prescribed. Do not increase your dose, use it more frequently or use it for a longer period of time than prescribed because this drug can be habit-forming. Also, if used for an extended period of time, do not suddenly stop using this drug without your doctor's approval. When used for extended periods, this medication may not work as well and may require different dosing. Consult your doctor if the medication stops working well.
Controlling Chronic Nonmalignant Pain (see reference)
"What about tramadol?" asked Dr. Doyle.
"Tramadol has a mixed mechanism of action," replied Dr. Weinstein. It is thought to bind to some opioid receptors and inhibit reuptake of norepinephrine and serotonin, giving it both opioid-like and antidepressant-like effects. "Many patients do well on it, but one has to monitor for side effects and drug interactions. Tramadol can lower seizure thresholds in patients who take other drugs that do the same or who have a tendency for seizures. Furthermore, it shouldn’t be mixed with an opioid agonist drug, because its opioid receptor binding might behave like a partial agonist or mixed agonist at the receptor site. The patient may go into a partial withdrawal state," she explained.
"Tramadol might have a unique role in certain central states. It may be uniquely useful in fibromyalgia, for example," offered Dr. Brookoff. "Generally, I think it has been pretty safe if the doses aren’t escalated. But some people who respond to it may be escalating their doses up to very high levels." He said he has seen patients taking 200 mg several times a day, "and maybe they are turning it into a different drug, getting a different effect from it."
"Agreed," said Dr. Weinstein. "We don’t really understand where the ceiling is with that and what the mechanisms of action are. I have seen a few patients who get to a high dose and do quite well unpredictably."
Reference: Khouzam HR. Chronic pain and its management in primary care. South Med J.