IV tramadol: very efficacious treatment for pain and headache in the outpatient clinic

Abstract

Tramadol is used orally for chronic pain in the world and USA, but no IV form is available,except in Europe. We created and used an IV sterile preparation, to treat refractory pain and headaches in the outpatient clinic. Tramadol, 50mg per ml, was given IV in the clinic to patients with intractable pain and headaches. 79 patients were treated with IV tramadol, after placement of an IV line and pulse oximetry monitoring. A 50 mg test dose was given and 50-100mg was given every 7-10 minutes with monitoring of headache severity by the patient on a 0-10 VAS scale. All patients treated had response to IV tramadol. Average dose of tramadol was 423mg (range 250-1100mg), given over 95 minutes in the clinic. Average reduction in pain severity was 7.46/10 to 2.81/10 after treatment [p<.001, 2-taild t test]. No side effects other than transient drowsiness or nausea were noted in 6 patients. 21 patients were subsequently placed on oral tramadol.14 had failed prior oral tramadol for pain. Headaches returned within 24 hours in 2 patients not treated with oral tramadol. IV tramadol is quite effective in treating intractable pain, even where oral product failed. It also reduced migraines and headaches acutely in the clinic. It has virtually no toxicity IV and can be the starting point for oral treatment without titration. Typical dosage IV compares to daily oral dosing. Tramadol IV offers a new possibility in treating intractable pain and migraines effectively and safely in the clinic and should be studied in a double-blind manner. The mechanism(s)for its effects are discussed in the poster.