Pain Control: Tramadol
Margo McCaffery MS, RN, FAAN
Chris Pasero MS, RN

$3.95 		AJN, American Journal of Nursing
February 2003 
Volume 103  Number 2
Pages 71 - 73
 
  PDF Version Available!

ABSTRACT
Outline

  • RECOMMENDED DOSING

  • INDICATIONS

  • Chronic pain.

  • Neuropathic pain.

  • Acute pain.

  • ADVERSE EFFECTS AND PRECAUTIONS

  • REFERENCES

    • The synthetic analgesic tramadol hydrochloride (Ultram), first introduced in Germany in 1977 and approved for oral use in the United States in 1995, is referred to as an atypical opioid because of its opioid and nonopioid mechanisms of action. Tramadol binds weakly as an agonist to the µ-opioid receptors in the central nervous system and also inhibits the reuptake of norepinephrine and serotonin. 1 The analgesic action of tramadol appears to result from a complementary effect of these two mechanisms. 2

    Tramadol is available in a 50-mg tablet, which in one clinical trial produced analgesia equal to that of acetaminophen 300 mg plus codeine 30 mg. 1,3 A combination of tramadol 37.5 mg and acetaminophen 325 mg, Ultracet, was recently approved by the Food and Drug Administration for short-term (five-day maximum) management of acute pain. 4

    RECOMMENDED DOSING

    Initial slow titration of tramadol may minimize adverse effects such as nausea, vomiting, and dysphoria. 4,5 The starting dosage for moderate chronic pain is 25 mg daily for three days, followed by gradual increases over several days to 50 mg every four to six hours. 1 Dosing may be increased to 100 mg every four to six hours, but the daily dosage should not exceed 400 mg 1 and should be limited to 250 to 300 mg in patients age 60 and older. 2 The American Geriatric Society’s guideline, The Management of Persistent Pain in Older Persons, recommends caution in using tramadol in the elderly. 6

    Both tramadol alone and tramadol with acetaminophen have a daily-dosage ceiling that makes them unsuitable for treating severe pain or mild-to-moderate escalating pain. The most appropriate use of tramadol appears to be treating ...

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