Question & Answer

In the news brief about tramadol (CONZIP, ULTRACET, ULTRAM) in your February 2020 issue, you noted that Public Citizen’s Health Research Group has designated this drug as Do Not Use because unlike other opioids, it can cause seizures. What are your recommended alternatives to tramadol?

Tramadol is an opioid analgesic that is frequently prescribed to patients following minor surgical procedures who do not really need an opioid for acute (sudden, short-term) pain control. For many such patients, treatment with a nonsteroidal anti-inflammatory medication (NSAIDs) — such as naproxen (ALEVE, ANAPROX DS, NAPRELAN, NAPROSYN) or ibuprofen (ADVIL, IBU-TAB, MOTRIN, TAB-PROFEN) — or acetaminophen (TYLENOL) often provides sufficient post-procedural pain relief.

For patients with severe pain for a short time after traumatic injuries or major surgery or severe chronic pain from advanced cancer for whom treatment with an opioid is appropriate, there are numerous opioids available that do not carry the same risk of seizure that tramadol does. These include codeine (TYLENOL WITH CODEINE), fentanyl (ACTIQ, DURAGESIC, FENTORA, LAZANDA, SUBSYS), hydrocodone (ANEXSIA, HYSINGLA ER, NORCO, REPREXAIN) and oxycodone (OXAYDO, OXYCET, OXYCONTIN, PERCOCET, PERCODAN, ROXICET, ROXICODONE, XTAMPZA ER), among others.

Finally, opioids have not been shown to be safe and effective for long-term treatment of chronic noncancer pain due to conditions like arthritis and low back pain. Nondrug approaches to chronic noncancer pain management — such as physical therapy, meditation, exercise and weight loss — may be harder to implement than painkiller medications, but they are safe and effective for many patients. When analgesics are needed for such pain, non-opioid options like NSAIDs or acetaminophen should be the primary choice.