Abstract
Current knowledge on pathogenesis of osteoarticular pain, as well as the consequent several, especially on the gastrointestinal, renal, and cardiovascular systems, side effects of NSAIDs, makes it difficult to perform an optimal management of this mixed typology of pain. This is especially observable in elderly patients, the most frequently affected by osteoarthritis (OA). Tramadol is an analgesic drug, the action of which has a twofold action. It has a weak affinity to mu opioid receptors and, at the same time, can result in inhibition of the reuptake of noradrenaline and serotonin in nociceptorial descending inhibitory control system. These two mechanisms, “opioidergic” and “nonopioidergic,” are the grounds for contrasting certain types of pain that are generally less responsive to opioids, such as neuropathic pain or mixed OA pain. The extended-release formulation of tramadol has good efficacy and tolerability and acts through a dosing schedule that allows a high level of patients compliance to therapies with a good recovery outcome for the patients' functional status.
Highlights
Pain is the most common symptom of osteoarthritis (OA), and, as pain levels rise, patients experience a reduced range of motion with a consequent increase of disability [1].Pain and function limitations substantially reduce the life quality of people affected by OA
In the past 30 years, the treatment guidelines for OA chronic pain suggested a multistage treatment algorithm based on increasing analgesic potency for greater efficacy and tolerability (Figure 1)
Tramadol is recommended in those patients where use of oral nonselective NSAIDs and COX-2 selective inhibitors can be problematic [63]
Summary
Pain is the most common symptom of osteoarthritis (OA), and, as pain levels rise, patients experience a reduced range of motion with a consequent increase of disability [1]. A management strategy for such patients should require individualized therapies that are able to ensure a positive risk/benefit profile. It should provide analgesia outcomes covering an extended period of time. Reducing the frequent administration of the IR, it allows to obtain a major compliance to therapy with a more consistent round the clock pain relief. Another factor to take into consideration is that many patients often forget to take their dose of IR medication until the pain returns, a phenomenon known as “chasing the pain.”. COX-2 inhibitors or nonselective NSAIDs ± gastroprotective agent or nonacetylated salicylates
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