Pain management in dental practice: tramadol vs. codeine combinations.

Abstract

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.

TYPES OF STUDIES REVIEWED:

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.

CLINICAL IMPLICATIONS:

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.

• Authors: P A Moore
• Journal: Journal of the American Dental Association (1939) (J Am Dent Assoc) Vol. 130 Issue 7 Pg. 1075-9 (Jul 1999) ISSN: 0002-8177 [Print] England
• PMID: 10422401 (Publication Type: Journal Article, Review)

Chemical References

• Adrenergic Uptake Inhibitors
• Analgesics, Non-Narcotic
• Analgesics, Opioid
• Anti-Inflammatory Agents, Non-Steroidal
• Drug Combinations
• Acetaminophen
• Tramadol
• Codeine

Topics

• Acetaminophen (therapeutic use)
• Adrenergic Uptake Inhibitors (therapeutic use)
• Analgesics, Non-Narcotic (therapeutic use)
• Analgesics, Opioid (therapeutic use)
• Anti-Inflammatory Agents, Non-Steroidal (therapeutic use)
• Codeine (therapeutic use)
• Drug Combinations
• Drug Evaluation
• Facial Pain (drug therapy)
• Humans
• Pain, Postoperative (drug therapy)
• Tramadol (therapeutic use)