Pain management in dental practice: Tramadol vs. codeine combinations

Background. Tramadol hydrochloride is a novel, centrally acting analgesic w ith two complementary of action: opioid and aminergic First marketed in 199 4, tramadol is frequently prescribed by physicians for the management of mo derate-to-moderately severe chronic pain; The author evaluates its unique a nalgesic pharmacology and limited clinical utility for managing acute pain in denistry. Types of Studies Reviewed. Clinical drug trials in medicine and dentistry w ere reviewed to assess analgesic efficacy. Postmarketing surveillance studi es and reports of adverse drug events were evaluated to determine short-and long-term safety. Results, Tramadol's maximum analgesic efficacy for relieving acute pain aft er oral surgery appears to be similar to that of 60 milligrams of codeine a lone but less than that of a full therapeutic dose of a nonsteroidal anti-i nflammatory drug or a codeine combination, such as aspirine/codeine or acet aminophen/codeine. Adverse events reported by patients receiving tramadol t herapy since it was approved by the Food and Drug-Administration suggest a risk of seizures, drug abuse and anaphylactoid reactions. Clinical Implications. Tramadol has limited indication for management of ac ute pain in dentistry, possibly as an alternative analgesic when gastrointe stinal side effects contraindicate the use of nonsteroidal anti-inflammator y drugs and when codeine/acetaminophen combination analgesics are not well- tolerated or are contraindicated.