High use of tramadol in Germany: an analysis of statutory health insurance data.
OBJECTIVE
Tramadol is a weak opioid according to the World Health Organization pain ladder step II. It is one of the most prescribed analgesic substances in Germany, but tramadol and the step II opioids are very controversially discussed. We analysed patients with filled tramadol prescriptions with special emphasis on high use.


METHODS
We used data from a German statutory health insurance for the year 2007. Patients older than 17 years with at least one tramadol prescription were analysed concerning demographic data, pain diagnoses, comorbidities, concomitant opioids, physician contacts and number of different prescribed substances. We fitted a logistic regression model to find relevant associations with high use (defined as >180 daily defined doses per year).


RESULTS
From 22 ,946 insurants with filled tramadol prescriptions, 7.9% (n = 1812) are identified as high users; 90.9% of all tramadol patients and 93.1% of the high users have at least one pain diagnosis. The most frequent diagnoses are back pain (78.4% vs 77.1%) and arthritis pain (37.9% vs 41.8%). The results of the logistic regression model show associations between high use of tramadol and rising age, unspecific pain diagnoses, psychiatric co-morbidities, additional prescribed strong opioids and a high number of physician contacts.


CONCLUSIONS
Despite some limitations, this study shows the prescriptions of tramadol in Germany in an authentic way. It seems that there are some 'challenging' patients that present a treatment dilemma for some prescribers. This might result in a high use of tramadol.
Department for Health Economics, Health Policy and Outcome Research, Centre for Social Policy Research, University of Bremen, Bremen, Germany. ktholen@zes.uni-bremen.de
Kathrin
K
Tholen
Falk
F
Hoffmann
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D005858:Germany; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014147:Tramadol / Q000008:administration & dosage / Q000627:therapeutic use*; D055815:Young Adult
D000701:Analgesics, Opioid; D014147:Tramadol