Pain management in dental practice: tramadol vs. codeine combinations.
BACKGROUND
Tramadol hydrochloride is a novel, centrally acting analgesic with two complementary mechanisms of action: opioid and aminergic. First marketed in 1994, tramadol is frequently prescribed by physicians for the management of moderate-to-moderately severe chronic pain. The author evaluates its unique analgesic pharmacology and limited clinical utility for managing acute pain in dentistry.


METHODS
Clinical drug trials in medicine and dentistry were reviewed to assess analgesic efficacy. Postmarketing surveillance studies and reports of adverse drug events were evaluated to determine short- and long-term safety.


RESULTS
Tramadol's maximum analgesic efficacy for relieving acute pain after oral surgery appears to be similar to that of 60 milligrams of codeine alone but less than that of a full therapeutic dose of a nonsteroidal anti-inflammatory drug or a codeine combination, such as aspirin/codeine or acetaminophen/codeine. Adverse events reported by patients receiving tramadol therapy since it was approved by the Food and Drug Administration suggest a risk of seizures, drug abuse and anaphylactoid reactions.


CONCLUSIONS
Tramadol has limited indication for management of acute pain in dentistry, possibly as an alternative analgesic when gastrointestinal side effects contraindicate the use of nonsteroidal anti-inflammatory drugs and when codeine/acetaminophen combination analgesics are not well-tolerated or are contraindicated.
Moore
P A
PA
Department of Public Health Dentistry, University of Pittsburgh School of Dental Medicine, Pa. 15261, USA.
D000082:Acetaminophen / Q000627:therapeutic use; D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use*; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003061:Codeine / Q000627:therapeutic use; D004338:Drug Combinations; D004341:Drug Evaluation; D005157:Facial Pain / Q000188:drug therapy*; D006801:Humans; D010149:Postoperative Pain / Q000188:drug therapy*; D014147:Tramadol / Q000627:therapeutic use*
D018759:Adrenergic Uptake Inhibitors; D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004338:Drug Combinations; D000082:Acetaminophen; D014147:Tramadol; D003061:Codeine