Journal Article | Others

October 01, 2020



Doctor Marvin JinoBugna, MD

Introduction:

Pain is an unpleasant sensory or emotional experience caused by a known or hidden trigger. Different types of pain are classified based on its duration, pathophysiology, cause, and site of occurrence. Chronic pain occurs as a result of complicated pathophysiological events triggered by a specific response to pain stimuli and alterations in the conduction of pain in the nervous system. Chronic pain causes significant physical and psychological problems and reduces working capacity.

 

Managing pain is a compelling and universal requirement in health care. Ineffective pain management can lead to a marked decrease in clinical and psychological outcomes and patients’ overall quality of life. Effective management of pain results in improved patient outcomes and increased patient satisfaction. Improved interventions can enhance patients’ attitudes to and perceptions of pain.

 

Relevance:

The fixed-dose combination of tramadol and paracetamol provides multimodal analgesia and good pain control in many patients with acute or chronic pain. The combination has synergistic action so that the lower doses of single substances are needed to improves the pharmacological profile. The combination of drugs results to an analgesic with a low potential for abuse and dependence.Furthermore, this makes possible the use of the medication without restrictive prescribing regimen and makes it more accessible to patients for the relief of moderate to severe pain.

 

Objectives:

The consensus aims to identify the different types of pain and its role in the body. It also seeks to determine the role and effectivity of fixed-dose combination of tramadol and paracetamol in managing moderate to severe pain. In addition, it identifies mitigating strategies that may be useful for patient’s pain management

 

Highlights:

Nonsteroidal Anti-inflammatory Drugs (NSAIDs) and paracetamol are effective pain relievers but recent studies have raised safety concerns particularly when these agents are used at high doses, long-term, or in special patient populations.

 

Paracetamolor acetaminophenis often grouped withNSAIDs. However, it is actually an aniline analgesic. It is the analgesic of choice for mild to moderate pain and to reduce fever.Its mechanism of action is still unknown although several models have been used to explain its analgesic properties. Toxicity from paracetamol overdose may result to significant liver injury and failure.

            NSAIDs inhibit prostaglandins that cause pain. They are very effective analgesics but they have certain side effects. They can cause peptic ulcers, interstitial nephritis, and can aggravate bleeding.Their use has also been associated with bronchospasm due to the shifting of the arachidonic acid pathway to lipoxygenase, creating more leukotrienes that cause airway constriction and increase mucus production.Moreover, short term use of NSAIDs was associated with increased risk of death in patients with a history of myocardial infarction.

 

It is therefore imperative that NSAID use, including that of cyclooxygenase inhibitors (COX),be restricted to pain related to tissue damage and/or inflammation.They are to be used cautiouslyin patients with or at elevated risk for cardiovascular disease or gastrointestinal complications. Their use in the elderly population is limited to those needing therapy for chronic pain. They are to be avoided among patients aged 75 years and above.

 

Tramadol is an opioid analgesic, effective in relieving pain that does not respond to paracetamol. It should be used with caution in those patients with a history of alcohol or drug abuse as some risk of dependency does exist. Opioid analgesics are effective but are associated with adverse events as well as concerns over tolerance and addiction.

 

Combination agents may offer analgesic synergy that allows them to provide effective analgesia at reduced doses.Fixed-dose combinations such as tramadol/paracetamol for the treatment of chronic pain syndromes are promising, showing safe and effective pain relief with good tolerability and safety profiles.

 

The fixed-dose combination of paracetamol/tramadol offers synergistic effects for pain relief. Paracetamol blocks the production of chemicals in the body that are responsible for pain and fever while tramadol exerts its effect by acting on parts of the central nervous system which process pain signals.

  

Conclusion:

Tramadol and Paracetamol in fixed-dose combination providegood pain control in many patients with acute or chronic pain. Its combination produces a better analgesic effect which is reached with lower doses of the single substances, compared to that of equal doses used in single treatment.

 

The fixed-dose combination of tramadol and paracetamol is an analgesic with a low potential for abuse and dependence. It is not limited by a restrictive prescribing regimen which makes it more accessible to patients for the relief of moderate to severe pain.However, further studies are warranted to establish the long-term efficacy and safety of these products.

 

Reference:

Pergolizzi Jr., J. et al. Tramadol/Paracetamol Fixed-Dose Combination in the Treatment of Moderate to Severe Pain. Journal of Pain Research. 28 August 2012.

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