Monday, March 18, 2019

Tramadol Linked to Higher Mortality Risk in Osteoarthritis

New tramadol use among patients with osteoarthritis is associated with increased mortality risk, an observational study in JAMA suggests. Some guidelines recommend tramadol, a weak opioid agonist, to manage osteoarthritis pain.

Using U.K electronic medical records, researchers matched patients with hip, knee, or hand osteoarthritis who began taking tramadol to those who began naproxen, diclofenac, celecoxib, etoricoxib (not approved in U.S.), or codeine. Nearly 90,000 patients aged 50 and older were included.

Patients who started using tramadol had a higher mortality rate over the ensuing year than users of every other medication except codeine. For example, the mortality rate was 23.5 per 1000 person-years with tramadol versus 13.8 per 1000 with naproxen.
The authors caution that the findings "were susceptible to confounding by indication," given that tramadol users had greater comorbidity than NSAID users before propensity score matching.

My Take:
Some guidelines are recommending Tramadol as a replacement for Oxycodone in light of the skyrocketing death rate associated with its’ use. Tramadol is used in opioid agonist therapy (OAT), a treatment used to help addicts overcome opioid addiction. While it is an effective pain killer, it has addiction and overuse issues as well.

Osteoarthritis is best treated with anti-inflammatory agents, although I recommend natural substances in lieu of the Cox 2 inhibitors listed above.

Omega-3 fatty acids (fish oil), Black current seed oil and sesame seed oil all support healthy prostaglandin synthesis in the body. Turmeric and Boswellia are excellent natural anti-inflammatory herbs that are tolerated well with minimal side effects (both can irritate the digestive tract).

Improving circulation to bone is an overlooked aspect in the treatment of osteoarthritis. Grape seed extract strengthens the vascular wall and can restore circulation to damaged joints. I recommend 1 mg per pound of body weight for the first week, then reduce to 100 mg per day.
Supporting glycosaminoglycan synthesis (GAGs synthesis) is not an anti-inflammatory measure as often suggested in conventional medicine.

The use of glucosamine sulfate, chondroitin sulfate and other GAGs products provide ground substance to the body. Ground substance is used to manufacture connective tissue – muscle, ligament, tendon, bone and cartilage. Adding GAGs products to the diet actually promotes connective tissue repair. The reduction in inflammation is secondary to healing.

Bottom Line:
There are many viable options to taking Tramadol for osteoarthritis. If you are currently taking this medication, please review the risks and alternative therapies available from your prescribing physician.

Source: March 13, 2019 New England Journal of Medicine

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