Tramadol hydrochloride is a strong pain reliever and sedative prescribed for patients with moderate to severe pain. The drug is produced only in Germany and imported from there throughout the world. Prescribed for adults and adolescents over 12 years of age. Widely known because often used for other purposes, but instead of drugs.
Tramal is sold in pharmacies with a prescription and is available in several forms. More often it is:
- Tablets with delayed release of Tramal 50 mg, 100 mg, 150 mg, 200 mg.
- Fast acting capsules,
- Oral drops,
- Tramal solution for injection.
Please note that the real medicine is not sold online. But the tramal-containing “Zaldiar”, which causes severe drug addiction, is widely advertised and distributed; it is purchased illegally only for the sake of a high. This poison has claimed many lives, beware of it!
Recommendations for use
The recommended dose is 100–200 mg (1–2 tablets) twice daily, preferably morning and evening. Your doctor will adjust the dose depending on the degree of pain and its response to tramalotherapy. Your doctor may prescribe a lower starting dose.
To slow down the effect of Tramal, the tablets should be swallowed whole with plenty of liquid. They should not be crushed or chewed. Crushing or chewing tablets causes rapid release of ingredients and increases the risk of side effects.
The maximum daily dose should not exceed 300-400 mg in elderly patients (over 75 years of age). If you miss a dose, take 1 dose as soon as you remember or as usual. But never take a double dose to make up for lost time! Always follow your doctor's advice on taking the drug. Do not give Tramal medicine to anyone else, even if they are in pain.
The drug should be stored at temperatures up to 30°C in a closed cabinet at a height of at least 1.5 m above the ground (out of reach of children), protected from light. Do not use Tramal if the expiration date has passed or the packaging is damaged.
Tramadol (Tramal) in the treatment of acute and chronic pain syndromes
ABOUT
The main method of treating acute and chronic pain syndromes in modern medicine is systemic pharmacotherapy. The latter can be carried out using different methods of introducing an analgesic into the body (oral, rectal, sublingual, transdermal, injection), but in any case, the drug, when absorbed, enters the systemic bloodstream, and then to the site of its action (unlike regional method of administration of the analgesic, for example, perineural, epidural).
To treat pain of low intensity, according to WHO recommendations [4], various non-opioid analgesics are used, and for pain of moderate and high intensity, opioid analgesics are used. Non-opioid painkillers have a predominantly peripheral effect at the level of the source of pain, have little analgesic potential and are therefore suitable only for the elimination of mild pain. Opioids are centrally acting analgesics, realized through the body's endogenous opioid system at the level of the spinal cord and brain by inhibiting the ascending flow of pain impulses. They differ from each other in their analgesic potential and ability to relieve moderate or severe pain. Due to their good analgesic properties, opioids are widely used in various fields of medicine dealing with intense pain, primarily in oncology and surgery [3,7].
A common feature of all opioids is the non-selective nature of their action, i.e., along with analgesia, they cause a number of other side effects and at the same time differ from each other in the degree of expression of certain properties, which is associated with the individual characteristics of their interaction with opioid receptors . An important condition for working correctly with opioids is knowledge of their mechanism of action.
Mechanism of action and classification of opioids
All known opioids are divided into four main classes depending on the nature of their interaction with receptors.
The main class consists of opioid agonists
or opioid m(mu) receptor agonists, including substances and drugs of varying analgesic power, including the powerful drug heroin, traditional strong opioid analgesics - morphine, fentanyl, piritramide, as well as less strong ones - promedol, prosidol, tramadol, codeine. This group of opioids is characterized by such side properties associated with depression of the stem structures and centers of the medulla oblongata, such as sedation (less often euphoria), general weakness, inhibition of the cough reflex, and in large doses - respiratory depression (bradypnea, apnea) and circulatory depression (hypotension, bradycardia) . Along with these inhibitory effects, opioid agonists have an activating effect on the vomiting centers with the possible development of nausea (vomiting), as well as on the smooth muscles of the hollow organs, which can result in motility disorders of the latter (constipation, urinary and bile retention, a tendency to bronchospasm). All of these serious side effects are most pronounced in the most powerful opioid analgesics (fentanyl, morphine) and are less common in drugs with less analgesic potential [3,7].
All opioid agonists, except tramadol, have a specific ability to cause dependence - physical and mental, therefore they are included in the category of controlled drugs by the International Narcotics Convention [17], and they are subject to special rules for prescription, prescription, recording, storage, transportation, reporting, determined by the relevant orders of the Ministry of Health of the Russian Federation [1]. Tramadol, which is an exception, is not a drug, since, according to extensive international and domestic experience, no clear data have been obtained for the development of dependence on tramadol. This drug is classified as a potent drug and is prescribed on a prescription form for potent substances [1,9]. A characteristic property of strong opioids is also tolerance, i.e., a decrease in the analgesic effect with increasing duration of administration of the opioid into the body, which requires a gradual increase in dose during long-term therapy to maintain pain relief [4,7]. Thus, the dose of morphine can increase tens of times compared to the initial one during treatment over several months, reaching or even exceeding 1000 mg/day.
The next class of opioids is partial agonists of opioid m receptors.
- represented by buprenorphine, which is similar in properties to morphine, but has a longer and somewhat less pronounced analgesic and other side effects.
Compared to other classical opioid agonists, buprenorphine has a lower narcotic potential, but in Russia it is also classified as a narcotic.
Unlike morphine, buprenorphine has a “ceiling” of analgesic dose, above which the analgesic effect ceases to increase. Different authors define this limit in the range of 2.4–5 mg/day [7,17], which may limit the continuation of buprenorphine therapy for chronic pain syndrome and is a signal for a transition to a more powerful opioid - morphine, which does not have a “ceiling” of analgesic dose .
Mixed opioid agonist–antagonist class
includes three drugs (pentazocine, butorphanol, nalbuphine), which are k(kappa) receptor agonists and m receptor antagonists. As k-receptor agonists, these opioids cause less pronounced analgesia than morphine and have a slightly different spectrum of side effects (sedation predominates, nausea, dizziness, and respiratory depression are less common). As m-receptor antagonists, opioids of this class can weaken or eliminate the effects of classical opioid agonists, including analgesia [3,7,17]. In this regard, the combined use of opioid agonists-antagonists and morphine analgesics is inappropriate.
Drugs of this class, like buprenorphine, are characterized by a “ceiling effect”. The latest generation agonists-antagonists butorphanol and nalbuphine (unlike pentazocine) are not included in the register of narcotic drugs and are classified as potent substances. They play an auxiliary role in the treatment of pain syndromes due to their antagonistic relationship with opioids of the main class of agonists.
Properties of s(sigma) receptor agonist
Ketamine has a moderate analgesic effect [7] and a whole complex of side activating effects (tachycardia, hypertension, psychomotor agitation).
The antagonist of opioids of all groups is naloxone, which quickly neutralizes all their effects, including analgesia.
Existing opioid analgesics differ not only in the nature of their interaction with certain opioid receptors, but also in the characteristics of their binding to them in terms of strength and duration. The higher the affinity of the opioid for the receptor, the stronger the analgesia; the longer the connection with the receptor, the longer the analgesia [7,17].
Choice of opioid for the treatment of moderate to severe pain
An important consequence of the above analysis of the mechanism of action of opioids is the generally accepted position about the main role in opioid therapy of pain of analgesics belonging to the class of opioid agonists [4], since drugs of all other groups have certain limitations (the “ceiling” effect of the analgesic dose, antagonism in relation to the most powerful analgesics of the morphine group, undesirable side properties). This situation is especially important to consider when treating chronic pain syndrome in order to obtain optimal pain relief results and avoid possible failures.
The range of existing opioid agonists is quite wide and includes, as mentioned above, analgesics of various potencies that can eliminate moderate and severe pain, and indications for the treatment of such pain exist in different areas of medicine.
In what cases is the prescription of an opioid analgesic for pain relief indicated and how to choose the right opioid? To do this, first of all, you must be guided by certain general rules.
- Indications for the prescription of an opioid arise when treatment with non-opioid analgesics does not eliminate pain, i.e. the pain is more than mild. When treating chronic pain syndrome in cancer patients, preference should be given to opioid agonists.
- When determining the intensity of pain, you should be guided by a simple verbal pain rating scale (VPS): 0 - no pain, 1 point - weak, 2 points - moderate, 3 points - severe, 4 points - the worst pain. For the treatment of pain of moderate and high intensity in Russia, the instructions of the Ministry of Health of the Russian Federation recommend: tramadol, prosidol for moderate pain, buprenorphine for severe pain and morphine or fentanyl (including in transdermal form) for the most severe pain [10[.
- Doctors authorized to work with drugs (most often in oncology and surgical institutions) have the right to prescribe opioid analgesics, which are classified as narcotic drugs.
- Opioids - non-narcotics classified as potent drugs (tramadol, butorphanol, nalbuphine) can be prescribed on a prescription form for potent drugs by any doctor in agreement with the head of the department if it is necessary to relieve pain in the patient that is not eliminated by non-opioid analgesics (articular, neurogenic and other non-oncological pain). Among opioid agonists, the only non-narcotic drug is tramadol.
Clinical pharmacology of tramadol
Tramadol (Tramal) is an opioid agonist that stands apart among all representatives of this class of opioids, primarily because, unlike them, it does not belong to narcotic drugs [1]. This is confirmed by extensive clinical experience of its use around the world and special scientific studies of its narcotic potential [7,12, 15,16, etc.].
Volunteers receiving maximum doses of tramadol (Tramal, hereafter referred to as “T”) and cancer patients treated long-term with this drug for pain were tested for drug dependence using the opioid antagonist naloxone. It is known that in heroin and other drug addicts, the introduction of naloxone into the body immediately causes the development of drug withdrawal syndrome (withdrawal syndrome), manifested by severe mental and physical symptoms: severe psychomotor agitation, fear of death, panic, acute cramping abdominal pain, vomiting, chills, trembling , tachycardia, etc. In the people studied, as in the animal experiment, against the background of long-term use of “T”, naloxone did not cause these symptoms or their manifestations were unclear and did not reach the “mild withdrawal syndrome” gradation. The likelihood of mental dependence on “T” is minimal; In the above studies, the drug did not reveal any euphoric or dysphoric effects. It has been established that in patients with opiate addiction, “T,” like placebo, does not lead to the elimination of subjective discomfort during abstinence [11], i.e., it does not have a drug-substituting effect (unlike other opioids studied - promedol, butorphanol, nalbuphine , buprenorphine).
Unlike other opioid agonists, T has a dual mechanism of action. It has been established that analgesia caused by “T” is not completely eliminated by the opioid antagonist naloxone and, along with the opioid mechanism, is realized through additional inhibition of pain impulses with the participation of the serotonin and adrenergic systems [13]. That is, according to the mechanism of analgesic action, “T” is not completely identical to other opioid agonists.
Recently, reports have appeared in the Russian media about the use of “T” by drug addicts as a substitute for heroin and other hard drugs. As a professional, I consider it necessary to provide clarification in connection with the erroneous interpretation of the properties of “T” by journalists. The television showed in detail the case of the death of a drug addict recorded by a video camera after the intravenous administration of retard “T” tablets, melted over a fire and somehow diluted, intended for oral administration. Such a mixture could contain any substances toxic to the body when introduced into the blood, so it is unlikely that “T” can be considered the root cause in this case.
In an article published by the newspaper “Moskovsky Komsomolets” on August 28, 2002, “T” is characterized as “a potent narcotic drug from the group of heroin synthetics, its action is very similar to methadone.” This characterization is absolutely untrue, so experts consider this publication as “unprofessional and biased.” “T” has nothing to do with either heroin or methadone, both in terms of pharmacological properties and clinical effects. It differs fundamentally from them and from other narcotic analgesics in that it has a milder effect and minimal narcotic potential, which is described in detail above. At the same time, uncontrolled use of “T”, like any other drug, can lead to serious consequences, since all medications without exception, when exceeding therapeutic doses, cause a variety of side effects and exhibit toxic properties. This also applies to a wide range of over-the-counter drugs, including analgesics. “T”, according to the order of the Ministry of Health of the Russian Federation dated August 23, 1999 No. 328 “On the rational prescribing of medicines, the rules for writing prescriptions for them and the procedure for their dispensing by pharmacies,” must be dispensed according to a doctor’s prescription written out on a form for potent drugs.
Below is a description of the main clinical effects of “T”, which are similar in nature to the effects of other opioid agonists, but are much less pronounced. This applies to both analgesia and side effects.
The analgesic potential “T”, according to various authors, ranges from 0.1 to 0.2 of the potential of morphine [4,7], it is equal to or slightly exceeds the potential of codeine; the effectiveness of 50 mg of “T” is equivalent to 1000 mg of metamizole [13], i.e. “T” belongs to analgesics intended for pain of moderate intensity.
The most important criterion for the safety of any opioid is the severity of its central depressive effect on breathing and circulation. Numerous studies have not established significant respiratory depression in postoperative patients under the influence of “T” in the range of therapeutic doses from 0.5 to 2 mg per 1 kg of body weight, even with intravenous bolus administration, while morphine at a therapeutic dose of 0.14 mg/kg statistically significantly and significantly reduces the respiratory rate and increases the CO2 tension in the exhaled air [13]. That is, in recommended doses, “T” does not cause respiratory depression, but it cannot be ruled out that it is possible if these doses are exceeded. “T” does not have a depressing effect on blood circulation. In contrast, when administered intravenously at 0.75–1.5 mg/kg, it can increase systolic and diastolic blood pressure by 10–15 mmHg. and slightly increase the heart rate with a rapid return to initial values, which is explained by the sympathomimetic component of its action [13]. It does not affect the level of histamine in the blood or mental functions [13]. "T" is metabolized in the liver. Only one of its metabolites is active. The half-life of “T” when administered orally or intravenously is 5–6 hours; it may increase in patients with impaired liver and kidney function. About 90% of the oral dose of T is excreted by the kidneys [14]. "T" has favorable pharmacokinetic characteristics. Its absolute availability with intramuscular administration approaches 100%, with rectal administration - 78%, with oral administration - 68% (with a subsequent increase with continued therapy). These figures are significantly higher than those of morphine and pethidine. Peak plasma concentrations when administered orally [14] are achieved within 1.6–2 hours.
Experience of clinical use of Tramal
The first publications on the use of “T” in the clinic date back to the early 80s of the twentieth century, i.e. its medical use already has a 20-year history. During this time, indications for treatment “T” for various acute and chronic pain syndromes were determined, its analgesic and side properties, optimal methods and methods of its use in various fields of medicine were determined: in oncology, surgery, traumatology, rheumatology, neurology, cardiology, etc. .
In the practice of the Moscow Research Institute of Orthopedics named after. P. A. Herzen “T” is widely used for the treatment of both acute (postoperative - p/o BS) and chronic (CHP) pain syndrome in cancer patients. The overall experience of its use at the institute exceeds 6,000 observations, and the duration of therapy ranged from several days to many months for chronic heart disease.
When prescribing “T” we are guided by the general principles of drug treatment of pain syndromes [10]. The main criterion is the intensity of pain, assessed according to the above scale (SVO). The indication for prescribing “T” for both chronic heart disease and p/o heart disease is pain of moderate intensity (2 points according to the ShVO). There is no need to prescribe “T” for mild pain (1 point according to the ShVO), where pain relief can be achieved with the help of non-opioid analgesics (various NSAIDs, paracetamol). “T” is also not indicated for severe pain (3–4 points according to the ShVO), since it is not sufficient to eliminate it, and in these cases more powerful opioids should be used to avoid further intensification of the pain syndrome.
Most often, when conducting opioid therapy, including “T”, it is advisable to combine an opioid with non-opioid components in order to increase the effectiveness and tolerability of pain relief, although monotherapy is also quite acceptable.
It is pathogenetically justified to supplement “T” with one of the non-opioid analgesics of peripheral action, suppressing the production of the pain mediator prostaglandin at the site of pain (ketoprofen, lornoxicam, diclofenac, etc.) and/or central action, inhibiting this mediator at the level of pain structures of the spinal cord (paracetamol). This allows you to get complete pain relief while reducing the need for opioids, i.e. when using it in reduced doses and with less likelihood of side effects. Clinical confirmation of the advisability of such tactics for working with opioids is contained in numerous publications, including the works of employees of our institute [3,5,8,10, etc.].
The choice of dosage form, dose of “T” and drugs for combination with it depends on the nature of the pain syndrome, its localization, and the individual characteristics of the patient.
Dosage forms and dosages of Tramal
. Tramal is presented in various forms:
Solution for injection (ampoules 1 and 2 ml), 50 mg in 1 ml.
Capsules 50 mg
Suppositories 100 mg
Retard tablets 100 mg, 150 mg.
Recommended single dose 50–100 mg; daily up to 400 mg. The drug is administered 4 times a day. Tramal in the indicated forms is produced and available in Russia.
Tramal for chronic pain syndrome
of different origins is widely and successfully used. In this article we look at this using the example of chronic pain syndrome (CPS) of oncological origin, which we constantly deal with in our work.
Taking into account the institute’s experience in the use of “T” for the treatment of CHD in more than 1000 patients, it is advisable to prescribe it for uncomplicated moderate (2 points) somatic CHD (damage by a tumor or its metastases to the skeletal bones, soft tissues, muscles, skin, external lymph nodes) or visceral (damage to internal organs and/or membranes - pleura, peritoneum, internal lymph nodes) type. All incurable cancer patients go through this phase of CHD, and the duration of moderate-intensity CHD varies widely, which is determined by individual tumor growth rates.
Practice shows that the use of “T” is not indicated for severe chronic heart disease complicated by a neuropathic component caused by the involvement of nerve formations. In these cases, stronger opioid analgesics are required in combination with complex special therapy.
“T” is prescribed when the initial non-opioid therapy (NSAIDs, paracetamol preparations) becomes insufficiently effective, while maintaining this therapy, which has its own pathogenetic focus, complementing the action of the opioid.
The presence of different dosage forms makes it possible to choose the optimal one for a particular patient. In most cases, the usual oral forms are applicable (capsules, retard tablets), and in the absence of this possibility (patients with dysphagia due to cancer of the esophagus, stomach), another non-invasive method of administration can be used - rectal. In the form of a “T” injection for long-term treatment of CHD, it is usually not used due to its invasiveness.
For long-term therapy, the most convenient are retard tablets, which should be taken twice a day: 100 – 150 – 200 mg every 12 hours. The duration of action of all other forms of “T” is 5–6 hours, so they are taken 4 times a day.
Selection of the optimal dose “T” begins with a minimum single dose of 50 mg (1 capsule) in order to assess both the analgesic effect and tolerability of the drug. With good analgesia and tolerability, this single dose is maintained, administered 3-4 times a day (taking into account the duration of analgesia). If pain relief is insufficient, after 40–60 minutes you should take a second similar dose and evaluate its effect. If after 1 hour sufficient pain relief is achieved, then therapy is carried out in single doses of 100 mg up to 4 times a day (capsules or suppositories), but it is more advisable to recommend that the patient take long-term retard tablets 150–200 mg 2 times a day, which is much more convenient (the first dose in the morning after sleep, the second dose in the evening before bed). Additional non-opioid analgesics are prescribed according to your own regimen.
A clinical study “T” in cancer patients with chronic heart disease [6,7,8] showed that with initial moderate pain (2 points), the drug always eliminates it, but with more severe pain, pain relief with the above therapeutic doses is not achieved, so if a single a dose of “T” 100 mg in non-retarded form is insufficient to relieve pain, which means that the intensity of pain has been underestimated and it is necessary to intensify analgesic therapy. This can be achieved either by switching from T to a stronger opioid while maintaining the same non-opioid therapy, or by additionally prescribing another non-narcotic analgesic that has not previously been used. For example, if after prescribing “T” against the background of previous therapy with diclofenac, ketoprofen or other NSAIDs, the pain has decreased, but has not stopped (mild pain remains), it is advisable to add one of the paracetamol drugs: Panadol 500–1000 mg 4 times a day or Solpadeine ( contains, in addition to paracetamol, small doses of codeine and caffeine) in the same doses as paracetamol. Solpadeine, despite the presence of codeine, is not a registered drug due to the minimal dose of codeine, which, however, well complements the “T” effect, as an opioid of the same class [9]. A similar combination of “T” with non-narcotic analgesics can be effective for a more or less long period, depending on the course of the oncological process.
Such therapy (as long as it is effective) is more accessible to patients than drug treatment, given the not yet formed system of fully providing cancer patients with narcotic analgesics in our country.
T-based treatment for CHD is usually well tolerated by patients. When analgesia is achieved, the quality of life improves - night sleep, mood, physical activity. This “T” compares favorably with more powerful opioids (morphine, buprenorphine), which, while causing analgesia, simultaneously lead to depression of physical and mental activity and other significant side effects. Assessing the tolerability of "T", it should be said that the nature of its side properties is not fundamentally different from those inherent in morphine and its derivatives, however, the frequency and degree of their severity in "T" is much less. It is a much milder opioid than morphine, both in analgesic and side effects.
According to the literature and our own experience [2,3,7,8], side symptoms during treatment with “T” are observed in approximately half of the patients and are most often manifested by transient drowsiness, less often by nausea (very rarely vomiting), dry mouth. Constipation, which complicates therapy with codeine or morphine, is not characteristic of T, nor is urinary retention. Transient dizziness may occur. Drowsiness and nausea that appear at the beginning of treatment with T usually stop within 1–2 weeks and in most cases do not require correction. If such symptoms are present, patients are advised to lie down after taking “T” for 30–40 minutes. For persistent nausea, the use of an antiemetic is indicated (metoclopramide 10–20 mg 3–4 times a day with gradual cessation as the nausea subsides). The frequency and severity of these side symptoms are similar when using different dosage forms of “T”. When using suppositories, symptoms of irritation of the rectal mucosa (pain and tenesmus) are possible. To avoid these phenomena, the suppository should be inserted as deep as possible - beyond the sphincter, into the cavity of the rectal ampulla.
We did not observe any cases of respiratory and circulatory depression under the influence of “T” at the indicated therapeutic doses, and they are also not described in the literature [2,3,5,6,7,13].
Our data on the effectiveness and safety of “T” in cancer patients with chronic heart disease are confirmed by the results of a multicenter study of “T” in Russia for various pain syndromes in 2000 outpatients [2].
In our practice, Tramal is the drug of choice among opioids of medium analgesic potency for the treatment of moderate-intensity chronic heart disease.
. Its advantages:
- effectiveness combined with good tolerability and the absence of dangerous side effects;
- status of a non-narcotic drug, which increases its availability for patients, facilitates the work of medical personnel in prescribing and recording it.
Tramal in the treatment of postoperative pain
. The majority of surgical interventions in various fields of surgery, including oncology, are moderately traumatic operations. In oncology, these are such widespread operations as radical mastectomy, thyroidectomy, transvaginal amputation of the cervix, removal of soft tissue tumors, etc. Compared to radical intracavitary operations, these operations are less traumatic, but quite extensive and are accompanied by significant postoperative pain syndrome, requiring the use of opioids. analgesics. However, traditional opioids (morphine, promedol, etc.) are not suitable for patients after such operations, since their use, especially in the early period after general anesthesia, is dangerous for the development of central respiratory depression and requires monitoring the patient in an intensive care unit. Meanwhile, due to their condition, patients after such operations do not require hospitalization in the intensive care unit, but they require good and safe pain relief.
Our institute has developed and over the past years has been constantly using the optimal tactics of p/o anesthesia for operations of this type. It consists of combining “T” with peripheral analgesics from a number of NSAIDs or metamizole. We consider it preferable to use one of the NSAIDs on the principle of preventive analgesia, i.e., with the administration of the first dose before the start of surgery and with continued therapy with this drug after surgery in combination with “T”. This tactic has been successfully used in more than 5000 patients [5,8,10].
Prophylactic preoperative doses of NSAIDs are 30 mg for ketorolac, 100 mg for ketoprofen, and 8 mg for lornoxicam; dose of metamizole – 1000 mg. Postoperative analgesia is supported by the planned use of one of the indicated peripheral analgesics in the recommended daily dose in combination with “T”, the average analgesic daily dose of which, according to our data, ranges from 345±29 mg on the 1st day after surgery to 205±16 mg (4th day). In this case, good analgesia is achieved in the active state of operated patients without serious side symptoms characteristic of morphine and promedol (drowsiness, lethargy, hypoventilation of the lungs).
The developed method of postoperative pain relief based on “T” in combination with one of the peripherally acting analgesics is effective, safe, and allows pain relief to be provided to the patient in the general ward, without special intensive observation.
Conclusion
Tramadol (Tramal) occupies a special place among all opioid analgesics, which is determined by the unique mechanism of central action and clinical pharmacology. It differs from traditional morphine-type narcotic analgesics by having a less pronounced analgesic effect, but at the same time by less pronounced side properties. In analgesic doses, it is devoid of the main dangerous properties of morphine and its analogues - a depressive effect on vital functions and the ability to cause opioid addiction. Therefore, it is safer than other opioids and is classified not as a narcotic, but as a potent drug. Tramadol also has advantages over the traditional opioid of similar analgesic potency - codeine, which belongs to a number of drugs and does not have so many different non-invasive and injectable forms.
All these features of tramadol make it possible to successfully and widely use it for the treatment of acute and chronic pain syndromes of moderate intensity in various fields of medicine, including oncology and surgery, where its role is especially great.
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