Tramadol for management of fibromyalgia pain and symptoms: Systematic review

Abstract

Summary Background Fibromyalgia is a heterogeneous condition that appears to be associated with physiological and biochemical disturbances of pain modulation, and that consequently affects numerous other facets of life. Tramadol is currently being explored as an option to manage fibromyalgia pain and other symptoms because of its inhibitory activity of reuptake of neurotransmitters, but its safety and efficacy have not yet been established in these patients. Objective To evaluate the effectiveness and safety of tramadol on the management of symptoms of the syndrome. Methods We searched CENTRAL, MEDLINE, EMBASE, LILACS, Opengrey, ClinicalTrials.gov and WHO‐ICTRP for randomised controlled trials analysing the association between tramadol used for fibromyalgia either single‐agent or in combination with other drugs. Two reviewers independently extracted data and assessed risk of bias using the Cochrane risk‐of‐bias tool for all included studies. Quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results Four RCTs comprising 459 patients were included. Tramadol—either as a single‐agent or in combination with an antidepressant or analgesic—had a positive effect on pain. Tramadol combined with analgesic showed improved quality of life over placebo as measured by the Fibromyalgia Impact Questionnaire at 91 days. However, this difference did not hold for tramadol as a single agent against placebo. The evidence in these articles was rated “low” using the GRADE approach. No serious adverse events were reported. No improvement in depression and quality of sleep were observed. Conclusions This systematic review found a dearth of clinical trials on tramadol in patients with fibromyalgia. Although the combination of monoamine and opioid mechanism of tramadol has shown positive effects for fibromyalgia, the available evidence is not sufficient to support or refute the use of tramadol in clinical practice for pain or symptom management. Protocol registration number in the PROSPERO database: CRD42017062139.

EEG and Sleep Effects of Tramadol Suggest Potential Antidepressant Effects with Different Mechanisms of Action

“…In healthy volunteers, artificially induced alpha activity during NREM sleep produces fibromyalgia-like symptoms; therefore, increased alpha activity may even be the source of these symptoms [ 49 ]. The alpha EEG power reducing effects of tramadol during NREM sleep reported in our study are in line with recent clinical evidence that suggests the positive effect of tramadol on the symptoms of fibromyalgia [ 48 ].…”

“…On the other hand, alpha wave intrusion in delta sleep has been observed in patients with major depression and patients with fibromyalgia [ 46 , 47 ]. Fibromyalgia is associated with chronic and diffuse musculoskeletal pain, which often co-occurs with sleep disturbances and mood changes [ 48 ]. In healthy volunteers, artificially induced alpha activity during NREM sleep produces fibromyalgia-like symptoms; therefore, increased alpha activity may even be the source of these symptoms [ 49 ].…”

The Anxiety and Pain of Fibromyalgia Patients during the COVID-19 Pandemic

“…The increase of pVAS ratings observed during OTC and NSAID analgesics is indicative of patient behaviour. Both are part of self-management plan for many FM patients despite inconclusive clinically significant benefits (Derry et al, 2017; Rocha et al, 2020). We therefore interpret our findings as indicative of intake of these analgesics in the presence of heightened pain.…”

Spezielle Schmerztherapie bei rheumatischen Erkrankungen

“…Eine klare Kontraindikation zum Einsatz von Opioiden besteht bei funktionellen und psychiatrischen Erkrankungen mit assoziierten Schmerzen. Bei der Fibromyalgie wird zwar Tramadol aufgrund seiner zusätzlichen Noradrenalin wiederaufnahmehemmenden Eigenschaften zur Therapie diskutiert, in einer kürzlich erschienenen Metaanalyse konnte aber nicht genügend Evidenz angeführt werden, weder für eine negative noch für eine positive Empfehlung [62]. Die aktualisierte LONTS Leitlinie konnte in diesem Punkt ebenfalls keinen eindeutigen Konsens erzielen, wobei sich ein Teil der Fachgesellschaften für die Möglichkeit des Einsatzes von Tramadol bei Fibromyalgie aussprach [61].…”