Don't Let "Medicine" Become "Drugs"! How to Use This Painkiller Safely?

Author: Sunflower Children

Edited by: Gao Zhi

Date: October 8, 2023

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A Painkiller or a "Soft Drug"?

In 1977, the non-narcotic central analgesic Tramadol was first marketed in Germany, primarily used for treating various acute and chronic moderate pain. For parents of children with tumors, finding a suitable, easy-to-use, and safe pain relief medication for their child is a pressing need, ideally one that is easy to obtain. Tramadol fits these criteria well, which has led to its increased use among pediatric oncology patients in recent years.

However, it is crucial to remind everyone that Tramadol possesses both medicinal and narcotic "dual attributes."

While Tramadol is not a typical opioid, improper or excessive use can still lead to severe adverse events such as bradycardia, respiratory depression, and even coma. Moreover, it has a strong potential for both excitation and addiction; misuse can result in dependency, and withdrawal may be more challenging than with typical opioids. Its effects on the body are similar to those of morphine and heroin, which is why Tramadol is often referred to as a "soft drug."

In other words, when used correctly, Tramadol acts as a medication; when misused, it becomes a drug. It should never be treated as an ordinary painkiller, and one must exercise extreme caution when using it.

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Multiple Warnings: Don't Let "Medicine" Become "Drugs"!

The issues surrounding Tramadol's potential for addiction and abuse have increasingly drawn attention.

In 2006, addiction medicine expert He Rihui brought the problem of Tramadol misuse among adolescents to light and was the first to accept media interviews, prompting concentrated reporting by Xinhua News Agency and China Central Television. This raised awareness about the improper use of Tramadol, leading to increased national scrutiny and regulation of the drug.

In 2008 and 2015, the National Health Department classified Tramadol and cough syrups containing codeine as controlled substances.

In 2021, the National Medical Products Administration issued a notice revising the instructions for Tramadol injection and oral forms, adding multiple warnings about the risks of addiction, abuse, and even potential fatal overdose.

The degree of attention given by national regulatory agencies indicates that the dangers of improper Tramadol use cannot be ignored, as serious cases may even threaten life. Therefore, doctors must carefully assess the necessity and safety of prescribing Tramadol.

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How to Use Tramadol Safely?

Due to Tramadol's "dual attributes," it is essential for us to understand how to use it scientifically and reasonably, avoiding a situation where this painkiller "changes its face."

Tramadol is classified as a moderate analgesic and is generally used for short-term control of moderate pain. It has been in use for over 30 years in some European countries, yet there are very few articles published on its application in chronic cancer pain. Based on my experience in pediatric pain management, I offer the following medication suggestions:

1. If a child is experiencing pain during treatment, and the overall condition is well-controlled and not at the end-of-life stage, it is not recommended to use Tramadol. Instead, Ibuprofen can be used for short-term pain control. For severe pain, consult a specialist to consider using morphine. If morphine is difficult to obtain locally, and the child is 12 years or older with significant pain, a short-term use of Tramadol under a specialist's guidance, not exceeding the recommended dose, is advised, ideally not lasting more than a week.

2. If a child is in the end-of-life stage and experiencing persistent and progressively worsening pain due to disease progression, strong opioids should be considered directly. In secondary and higher medical institutions, reasonable access can be obtained as long as the conditions are met. Consult the hospital's pain management, oncology, or palliative care departments.

3. Both Tramadol and Codeine are primary representatives of weak opioids. These medications are effective for moderate pain, but for patients with advanced hematologic tumors, pain tends to escalate continually. Weak opioids are limited by associated adverse reactions when increasing doses and the difficulties in converting doses to strong opioids, thus their clinical use has gradually diminished, especially in children. Therefore, although Tramadol and Codeine are easier to obtain, they are not recommended for chronic cancer pain, particularly in children under 12.

4. For patients aged 14 and older with moderate pain, Tramadol may be used short-term if necessary, with a single dose generally ranging from 50 to 100 mg, and a maximum daily dose not exceeding 400 mg.

5. The use of Tramadol is generally prohibited for individuals with a history of opioid dependence, unexplained altered consciousness, respiratory dysfunction, elevated intracranial pressure, and infants under one year of age.

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Book Introduction:

As the average human lifespan increases, the problems associated with pain are becoming more pronounced. To help people better understand pain, multiple experts have compiled years of clinical experience into a comprehensive guide that covers the basic understanding, diagnosis, treatment, and management of pain in simple and accessible language, making it suitable for patients or their families.

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Column Author | Guo Yanru

Deputy Chief Physician, Palliative Care Department, Cangzhou People's Hospital, Hebei Province

Editor | Zuo Jia, Xia Yu

Typesetting | Xia Yu

Proofreading | Xiu Xiu