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Evidence summaries

Tramadol for Cancer Pain

Tramadol may not be as effective an analgesic for cancer pain as morphine, but it may produce pain relief in some adults with pain due to cancer. Level of evidence: "C"

The quality of evidence is downgraded by study limitations (unclear allocation concealment and lack of blinding), and by imprecise results (few patients and outcome events).

Summary

A Cochrane review [Abstract] 1 included 10 studies with a total of 958 adult subjects with chronic malignant tumour-related pain. Pain intensities were described as moderate to severe, with most experiencing at least 4/10 with current treatment. Study length ranged from 1 day to 6 months. Doses of tramadol ranged from 50 mg as single dose to 600 mg per day, but doses of 300 mg per day to 400 mg per day were most common. There were 8 different active comparators and 1 comparison with placebo. There was little information available for any comparison and no firm conclusions could be drawn for any outcome.

Two studies (n=191) compared tramadol with buprenorphine. One study (n=131) reported a similar proportion of no or mild pain at 14 days.Three studies (n=300) compared tramadol with morphine. Only one study, combining tramadol, tramadol plus paracetamol, and paracetamol plus codeine as a single weak-opioid group reported results. Weak opioid produced reduction in pain of at least 30% from baseline in 47% of participants, compared with 82% of participants with morphine. Weak opioid produced reduction in pain of at least 50% in 42% of participants, compared with 75% of participants with morphine.

Clinical comments

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