Subscribe
VBCN - July 2015 Volume 2, No 2 - Chronic Pain
Chase Doyle

National Harbor, MD—The analgesic effects of tramadol (Ultram), 1 of the 5 most often prescribed opioids in the world, may be sex-dependent, according to a study presented at the 2015 American Academy of Pain Medicine annual meeting. Male patients taking tramadol for pain relief were significantly more likely to have a poor response compared with female patients, said Brian Meshkin, President and Chief Executive Officer, Proove Biosciences, Irvine, CA.

“Our results suggest that there may be a very strong correlation between gender and tramadol response,” Mr Meshkin and colleagues noted. “This study and future similar studies may help clinicians understand the role of gender differences in tramadol response and guide their prescription decisions.”

Tramadol is an opioid-like pain reliever used to treat moderate-to-severe pain. It has a dual mechanism of action, binding weakly to the mu-1 opioid receptor in the brain, and acting as a weak antidepressant or selective serotonin reuptake inhibitor, Mr Meshkin told Value-Based Care in Neurology. Although individually weak, these 2 mechanisms work together synergistically to provide a measure of pain relief, Mr Meshkin said.

“Physicians traditionally use this type of drug as one of the first opioid pain medications that they would prescribe a patient, because its risk for misuse or abuse is lower, and its strength of providing analgesic relief is lower,” he said.

The nature of its mechanism of action suggested that the response to tramadol, as to other opioid medications, could be influenced by sex.

“There was an inclination that there may be some genetic components to it, as well as phenotypic components, such as age, race, or gender, or co-occurring disorders,” Mr Meshkin said. “Anecdotally, you will sometimes hear doctors suggest that certain psychiatric medications will impact people differently based on their gender.”

From a patient population of more than 75,000 patients, the investigators randomly selected 130 patients with chronic pain from 10 clinical sites in the United States. The patients were taking tramadol exclusively for their pain, without any other narcotics or psychiatric medication.

Mr Meshkin and his colleagues then analyzed data of the completed Medi­cation Efficacy Differentiation Scale (MEDScale) of all 130 patients in the study. The MEDScale is a retrospective assessment scale ranging from 0 to 5. A score of 0 to 3 signals poor responders, and a score of 4 to 5 indicated good responders.

“The MEDScale provides insight into the degree of therapeutic efficacy of medications, and is a function of patient-reported response to their medication in contrast to their pain scale, in order to provide quality control,” said Mr Meshkin.

He noted that the study showed a significant association between sex and tramadol response. Male patients were associated with a poor response to tramadol and female patients were associated with a good response (P = .023).

“If we can reduce the guesswork for a doctor, then that is a valuable service,” he said.

Related Items
Simvastatin plus Vitamin D May Prevent Headaches in Adults with Migraines
Chase Doyle
VBCN - November 2016 Volume 3, No 3 published on November 22, 2016 in Migraine Update
The Causes and Consequences of Misdiagnosing Multiple Sclerosis
Chase Doyle
VBCN - November 2016 Volume 3, No 3 published on November 22, 2016 in Multiple Sclerosis
Brain–Computer Interfaces Breaking New Ground in Patients with Neurologic Disability
Chase Doyle
VBCN - November 2016 Volume 3, No 3 published on November 22, 2016 in Brain Technology
Idalopirdine Improves Cognition in Patients with Moderate Alzheimer’s Disease
Chase Doyle
VBCN - November 2016 Volume 3, No 3 published on November 22, 2016 in Alzheimer’s Disease/Dementia
Pro and Con: Do Cognitive-Enhancing Activities Prevent Dementia?
Chase Doyle
VBCN - November 2016 Volume 3, No 3 published on November 22, 2016 in Alzheimer’s Disease/Dementia
Alzheimer’s Prevention Clinic: A New Approach to Disease Management Shows Benefits
Chase Doyle
VBCN - November 2016 Volume 3, No 3 published on November 22, 2016 in Alzheimer’s Disease/Dementia
Neuro-Oncology Update for Neurologists
Chase Doyle
Web Exclusives: Value-Based Care - November 2016 published on November 21, 2016 in Neurology News
Better Care Is Less Costly; Quality Improvement Through Process Management
Chase Doyle
VBCN - July 2016 Volume 3, No 2 published on July 25, 2016 in Value in Neurology
Ocrelizumab Promotes No Evidence of Disease Activity in Multiple Sclerosis
Chase Doyle
VBCN - July 2016 Volume 3, No 2 published on July 25, 2016 in Emerging Therapies
Emerging Disease-Modifying Therapies for Multiple Sclerosis
Chase Doyle
VBCN - July 2016 Volume 3, No 2 published on July 25, 2016 in Emerging Therapies
Last modified: August 5, 2015
  • Rheumatology Practice Management
  • Lynx CME
  • American Health & Drug Benefits
  • Value-Based Cancer Care
  • Value-Based Care in Myeloma
  • Value-Based Care in Neurology