Article reprinted with permission of DVM360 – June 02
2018. DVM360 MAGAZINE is a copyrighted publication of
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JOURNAL SCAN
Study shows Tramadol has no effect
on osteoarthritis pain scores
Commonly prescribed drug not associated with improvement when compared with NSAID;
experts vary on whether it still has a place in veterinary pain management.
By Kristi Reimer Fender
When researchers attempted to demonstrate
measurable effects of tramadol on osteoarthritis pain,
they came up empty. Researchers from the University
of Georgia have found that tramadol is ineffective in
alleviating signs of pain associated with osteoarthritis
in dogs, according to a release from the Morris
Animal Foundation (MAF), which funded the study.
The research team published their results in the Feb.
15 issue of the Journal of the American Veterinary
Medical Association.
“The data shows conclusively that tramadol is not
an effective drug in treating the pain associated
with arthritis in the dog, despite its common
recommendation,” says Steven Budsberg, DVM, MS,
DACVS, professor of surgery and director of clinical
research at the University of Georgia College of
Veterinary Medicine, in the MAF release. “This use of
tramadol is a classic example of failing to acknowledge
and control for bias when evaluating a potential
treatment.”
placebo and the nonsteroidal anti-inflammatory drug
carprofen in client-owned dogs in a randomized,
blinded, placebo- and positive-controlled crossover
study, according to the study abstract.
Dogs with osteoarthritis of the elbow or knee were
assigned to receive each of the three treatments in a
random order, with each treatment arm lasting 10 days.
Improvement was measured using vertical impulse,
peak vertical force and Canine Brief Pain Inventory
scores to assess gait and pain levels. The results
showed no improvement when tramadol was given
compared to either baseline or placebo. Carprofen
was associated with significant improvement in
results.
We reached out to several veterinary pain experts
who contribute to dvm360 and the Fetch dvm360
conferences for their thoughts on the study. As
experts often do, they diverge in their assessment
of whether tramadol has a role in veterinary practice
going forward.
The team at the University of Georgia, led by Dr.
Budsberg, compared the use of tramadol with both a
OPINIONS
Opinion No. 1: ‘Why would you use it?’ - Dr. Michael Petty
Michael Petty, DVM, CVPP, CVMA, CCRT, CAAPM, owner of Arbor Pointe Veterinary Hospital and Animal Pain Center
in Canton, Michigan, comes down squarely on the “don’t use it” end of the spectrum. He says veterinary pain experts
have known for a number of years that orally administered tramadol doesn’t work well for the treatment or prevention
of acute pain, “and those of us with pain practices have suspected for several years that tramadol doesn’t work for
chronic pain either,” he continues
“This is based on personal experience—not always the best measure—and on some pharmacokinetic studies showing
that the active metabolite is not detectable in many dogs receiving tramadol, even those receiving several hundred
milligrams per dose,” he says. “The study by Budsberg and his colleagues is a good one and underlines that tramadol
is not a drug that can be depended on for chronic pain issues.”
Dr. Petty says tramadol is a serotonin reuptake inhibitor, which can help with mood, and this could account for what
some people see as a positive result when giving it. But it also has a history of causing serotonin syndrome, even at
small doses and upon the first administration to a particular dog or cat. “You have a drug that is a controlled substance,
has the potential for human abuse, has no studies showing it works in either acute or chronic pain, and might kill
your patient,” Dr. Petty concludes. “Everyone who wants to prescribe it to a patient needs to imagine the courtroom
scenario where you’re trying to defend your decision to use it on an animal that came to harm.”
Issue 05 | NOVEMBER 2018 | 33