Impiego di tramadolo nelle diverse patologie dolorose

Abstract

Pain represents a major health problem that afflicts a significant number of patients, resulting in personal suffering, reduced productivity and substantial health care costs, specially in chronic conditions. Chronic pain, such as low back pain, osteoarthritis, neuropathic and oncologic pain, requires a global management based on clinical evaluation, defining of the adequate therapeutic strategy and assiduous cares. Generally, patients with chronic pain need two different analgesic formulation: one at fixed doses and prolonged duration of action for control of baseline pain and one fast-release drug for treatment of breakthrough pain. Main guidelines recommend use of the same active principle for both these formulations. Tramadol, a dual action analgesic agent, used for controlling moderate to severe pain control in acute and chronic diseases, is available in several different oral formulations. This is important because, apart from efficacy and tolerability, that are the most important criteria to evaluate a therapy, the choice of a formulation with an uncomplicated dosing regimen can increase compliance and, consequently, clinical results, and ameliorate patient quality of life. For the treatment of chronic pain, the appropriate analgesic dosage can be achieved through a gradual titration: this permits to minimize adverse effects and cost of therapy.With tramadol this action can be realized with 50 mg extended-release capsules, that represent the minimal effective dose. When adequate pain relief is obtained, it’s possible to reduce frequency and complexity of dosing regimen using a new once-daily tablet of tramadol. Fast-release orodispersible tramadol tablet, with its practical advantage (rapid disintegration in the mouth without need of water), can be used for the control of breakthrough and acute pain. The cost of treatment with tramadol results relatively low, also when two daily episodes of breakthrough pain are considered.