Intraindividual Differences in Pain Relief and Functional Improvement in Osteoarthritis with Diclofenac or Tramadol

Pavelka, Karel; Pelísková, Z; Stehlíková, Helena; Ratcliffe, S.; C, Repas

doi:10.2165/00044011-199816060-00002

Cited by 39 publications

(22 citation statements)

References 16 publications

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“…This is primarily explained by the findings of 1 study 17 that accounted for 74% of our meta-analysis, in which the authors compared dextropropoxyphene (a weak opioid) with diclofenac. In the other 2 comparisons of tramadol versus diclofenac 18 and controlled-release morphine versus nortriptyline 19 , the differences were not statistically significant.…”

Section: Effectiveness Of Opioids Compared With Other Drugsmentioning

confidence: 82%

Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects

Furlan

Sandoval²,

Mailis³

et al. 2006

Canadian Medical Association Journal

776

595

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C hronic non-cancer-related pain (CNCP) includes chronic pain of a nociceptive or neuropathic nature with variable influence by psychological and socioenvironmental factors. Opioids are the most potent analgesics available and are well established for the treatment of severe acute, 1 surgical 2 and cancer pain.3 However, their use to ameliorate CNCP is still controversial because of the side effects of opioids, the physical tolerance they build up (with the related withdrawal reactions and possibility of addiction) and anxiety over disapproval by regulatory bodies. 4The prevalence of CNCP varies according to the type of pain and the population studied. A study conducted in the United Kingdom in a community in the greater London area to quantify the prevalence of chronic pain found that 46.5% of the general population reported chronic pain; low-back problems and arthritis were the leading causes.5 A recent epidemiological study in Denmark 6 found that nearly 130 000 adults, corresponding to 3% of the Danish population, regularly used opioids. CNCP had a prevalence of 19%, and 12% of those who had CNCP used opioid medications.The objectives of this review were 4-fold: to determine the efficacy of opioids for CNCP compared with placebo; to compare the effectiveness of opioids for CNCP with that of other drugs; to identify categories of CNCP with better response to opioids; and to determine the most common side effects and complications of opioid therapy for CNCP, including incidences of opioid addiction and sexual dysfunction. MethodsWe followed the QUOROM guidelines for reporting metaanalyses of randomized controlled trials.7 We searched the literature up to May 2005 through the OVID interface: MEDLINE (from 1960), EMBASE (from 1988), the Cochrane Database of Systematic Reviews, the Cochrane Controlled Trials Register (CENTRAL), the ACP Journal Club and DARE. We also reviewed the reference lists in the articles, reviews and textbooks retrieved. Our search strategies for MEDLINE and EMBASE are available online as Appendix 1 and Appendix 2, respectively (all appendices for this article are available at www.cmaj.ca /cgi/content/full/174/11/1589/DC1). A single reviewer (J.A.S.) ran the electronic searches and entered the data into Reference Manager 10, removing all duplicates.Each of 2 independent reviewers (A.D.F., J.A.S.) screened Methods: This meta-analysis was carried out with these objectives: to compare the efficacy of opioids for CNCP with other drugs and placebo; to identify types of CNCP that respond better to opioids; and to determine the most common side effects of opioids. We searched MEDLINE, EMBASE, CENTRAL (up to May 2005) and reference lists for randomized controlled trials of any opioid administered by oral or transdermal routes or rectal suppositories for CNCP (defined as pain for longer than 6 mo). Extracted outcomes included pain, function or side effects. Methodological quality was assessed with the Jadad instrument; analyses were conducted with Revman 4.2.7.Results: Included were 41 randomized tr...

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Section: Effectiveness Of Opioids Compared With Other Drugsmentioning

confidence: 82%

Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects

Furlan

Sandoval²,

Mailis³

et al. 2006

Canadian Medical Association Journal

776

595

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“…Correspondingly, patients experienced greater functional improvement in the overall WOMAC pain, stiffness and function scores in the present study, compared with the study, (26.8% versus 19.2% with tramadol, and 27.5% versus 24.8% with diclofenac). 17 But as evident from the graphs mean scores for all the parameters has substantially increased in all the treatment groups with maximum increase in DIC+PPI group reflecting its maximum efficacy compared to tramadol group. This can be because diclofenac gets distributed in synovial fluid and has chondro protective and other action as mentioned like blockage of voltage-dependent sodium channels and acid-sensing ion channels (ASICs), positive allosteric modulation of KCNQ-and BK-potassium channels.…”

Section: Efficacy Comparison Of Study Intergroups In Present Studymentioning

confidence: 83%

“…16 In an earlier study, IR tramadol was compared with IR diclofenac in OA patients. 17 Both medications were given as needed, to a maximum dose of 300mg/day for tramadol and 150mg/day for diclofenac. Correspondingly, patients experienced greater functional improvement in the overall WOMAC pain, stiffness and function scores in the present study, compared with the study, (26.8% versus 19.2% with tramadol, and 27.5% versus 24.8% with diclofenac).…”

Section: Efficacy Comparison Of Study Intergroups In Present Studymentioning

confidence: 99%

Incremental cost-effectiveness and tolerability of Diclofenac + Proton pump inhibitor compared to tramadol in the treatment of knee osteoarthritis

Majeed

Rasool

Ahmad

2018

Int J Basic Clin Pharmacol

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Background: In a climate of economic uncertainty, cost effectiveness analysis is a potentially important tool for making choices about health care interventions. Patients with knee osteoarthritis are treated mostly with Diclofenac (NSAID) + Proton Pump Inhibitors (PPI) and Tramadol (Opioids) in everyday practice.Aim: Present study was aimed to assess clinical effectiveness, adverse events and cost-effectiveness between Diclofenac + PPI and Tramadol.Methods: Authors conducted prospective randomised control open label study on 40 patients at Orthopedic OPD of tertiary care hospital. Patients were given either Tramadol controlled releases tablets (200mg CR OD) or Diclofenac sustained release tablets (100mg SR OD) + PPI (Omeprazole 20mg OD) for two weeks. Clinical effectiveness was assessed by KOOS osteoarthritis index score consisting of five parameters and visual analogue scale. Suspected ADRs were recorded and incremental cost effective ratio for both drugs was calculated.Results: After application of KOOS questionnaire Authors found net quality gain in symptoms was 24.45 in diclofenac +PPI group which was much higher against 14.15 found in tramadol group. Again ADR profile of tramadol was 29 with nausea and somnolence topping the list which was far more than only 10 in DIC +PPI group. Lastly cost-effective analysis was done where again DIC+PPI showed average cost effective ratio 5.73 verses tramadol 11.8 with an incremental cost-effectiveness ratio (ICER) of -2.72.Conclusions: Diclofenac +PPI is as effective as tramadol in the treatment of pain due to knee osteoarthritis with the potential for feAuthorsr side effects. Diclofenac + PPI was also found to be cost-effective when compared with tramado.

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“…However, almost all of the available current OA therapies have temporary effects. Tramadol was reported to provide pain control when used as alternative or supplementary to NSAIDs in a study where it was compared to diclofenac (20). The American Geriatric Society reported that patients receiving chronic opioid therapy have fewer life-threatening risks than those who receive long-term NSAID therapy (21).…”

Section: Discussionmentioning

confidence: 99%

Tramadol Iontophoresis Added to Treatment of Knee Osteoarthritis

et al. 2010

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Objective: The objective of the present study was to investigate whether tramadol iontophoresis added to therapy is superior to the therapy methods alone (transcutaneous electrical nerve stimulation (TENS), hot pack, ultrasound, and exercise therapy) in patients with knee OA. Materials and Methods: A total of 72 patients who admitted to the outpatient clinic of Physical Medicine and Rehabilitation were included in this study. The diagnosis was based on the American College of Rheumatology (ACR) criteria for knee OA. The patients were randomly separated into two groups. Group 1 received physical therapy and Group 2 received tramadol iontophoresis in addition to the therapy for a period of two weeks. Patients were evaluated according to pain and functional capacity assessed using visual analogue scale (VAS) and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) before therapy and following the 10th session, and at 1 and 3 months. Results: The mean age and duration of the knee pain were 58.53±8.38, 5.00±2.66 years in the control group and 58.15±7.70, 4.71±2.70 years in the tramadol iontophoresis group. There were no significant differences between groups in the mean age and duration of the knee pain, body mass index (BMI), VAS and WOMAC scores before therapy. Following the 10th session, and after 1 and 3 months, VAS and WOMAC scores were significantly decreased in both groups when compared with the baseline values (p<0.001). VAS scores were significantly lower in the tramadol iontophoresis group compared to controls following the 10th session (p<0.001). However, no significant difference was found between WOMAC scores of the tramadol iontophoresis and control groups (p>0.05). Conclusion:We conclude that tramadol iontophoresis added to physical therapy may be useful for relieving pain of knee OA during the treatment period. (Turk J Rheumatol 2010; 25: 174-8

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Intraindividual Differences in Pain Relief and Functional Improvement in Osteoarthritis with Diclofenac or Tramadol

Cited by 39 publications

References 16 publications

Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects

Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects

Incremental cost-effectiveness and tolerability of Diclofenac + Proton pump inhibitor compared to tramadol in the treatment of knee osteoarthritis

Tramadol Iontophoresis Added to Treatment of Knee Osteoarthritis

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