Survival Impact of Long-Term Tramadol Use on Breast Cancer for Patients with Chronic Pain: A Propensity Score-Matched Population-Based Cohort Study.

Mingyang Sun,Jiaqiang Zhang,Chia-Lun Chang,Szu-Yuan Wu,Chang-Yun Lu

doi:10.3390/jpm12030384

Abstract

Purpose: The impact of tramadol analgesic use before breast cancer diagnosis on survival in patients with chronic pain is unclear. Therefore, we designed a propensity score-matched population-based cohort study to compare the breast cancer-related survival of patients with chronic pain who received long-term tramadol analgesic treatment with that of those who did not receive such treatment. Patients and Methods: We included patients with chronic pain and categorized them into two groups according to their analgesic use, comparing their breast cancer-related survival; patients with breast cancer and chronic pain who were prescribed ≥180 defined daily doses (DDDs) of tramadol analgesics per year >3 months before breast cancer diagnosis comprised the case group, and those who were prescribed non-tramadol analgesics before breast cancer diagnosis comprised the control group. Patients in both groups were matched at a ratio of 1:5. Results: The matching process yielded a final cohort of 624 patients (104 and 520 in the case and control groups, respectively) who were eligible for further analysis. According to both univariate and multivariate Cox regression analyses, the adjusted hazard ratio for all-cause death in the case group compared with in the control group was 3.45 (95% confidence interval = 2.36–5.04; p < 0.001). Conclusion: Long-term tramadol analgesic use prior to breast cancer diagnosis might be associated with poor overall survival in patients with chronic pain compared with such patients that did not receive long-term tramadol analgesic treatment.

Highlights

Chronic pain is one of the most common reasons that patients seek medical attention [1]
Age, comorbidities, income levels, urbanization, menopausal status, Human Epidermal Growth factor Receptor-2 (HER2) status, nodal surgical types, American Joint Committee on Cancer (AJCC) clinical stage, hormone receptor status, breast surgical types, differentiation of tumor, chemotherapy, and adjuvant radiotherapy were similar after head-to-head propensity score matching (PSM) of the two groups, with no significant differences in the variables observed between the groups
Our study showed chronic pain patients with breast cancer having long-term tramadol analgesic use before breast cancer diagnosis were associated with poor Overall survival (OS) compared with those having non-tramadol analgesic use

Summary

Introduction

Chronic pain is one of the most common reasons that patients seek medical attention [1]. The treatment of chronic pain begins with and should always include nonpharmacological approaches [2]. Tramadol, which is mixed mechanism opioids with additional norepinephrine and serotonin reuptake inhibition, are of uncertain benefit for patients with chronic pain [4,5]. Tramadol may be considered as second or third line treatment for patients with chronic pain such as fibromyalgia who have not responded to initial therapy with other medications. These opioid medications have the same risks associated with all opioids and must be used judiciously and carefully [6]

Methods

Results

Discussion

Conclusion