Using tramadol to treat chronic low-back pain.

Low-back pain is very common. The lower area of the back is made up of several vertebrae, disks of soft cartilage, joints, muscles, ligaments and nerve tissue. Its function is to connect the upper area of the chest and arms to the lower area of the pelvis and legs, providing the power and strength to stand, walk and lift, and the mobility to bend, turn and twist. If the lower back is not functioning well, almost every daily activity is affected.

Research evidence suggests that up to 85% of people will experience pain in this area of the back at some point in their lives. In most cases, the pain passes quite quickly, easing within no more than four to six weeks and allowing the same degree of mobility as previously enjoyed. But some estimates have pain persisting for one year or longer in up to 30% of all cases.

If pain does persist and significantly impairs mobility, painkillers of increasing strength may be required to allow everyday life to continue. The use of mild analgesics over time is not a problem but, if you feel that something stronger is necessary, it may be necessary to take one of the opioids such as tramadol. The difficulty is that, taken over time, any opioid may become habit forming. It is therefore necessary to balance the effectiveness of the drug against the risk that you may become addicted to it.

Published at the end of 2007, a Cochrane Review examined a number of randomized, double-blind studies involving some 950 participants into the use of oral opioids to treat low-back pain. The studies either compared tramadol (an atypical opioid) to a placebo or a morphine-based opioid to a non-steroidal anti-inflammatory drug (NSAID) such as naproxen for more than one month. Studies comparing different opioids were excluded from the review. Without exception, all those receiving an opioid reported a reduction in the level of pain experienced and an improvement in their ability to continue their everyday lives. This does not mean that there was any change in the mobility of the back itself. None of the painkilling drugs on the market have any direct effect on the joints or musculature to relieve stiffness or restore function. All that happens is that people are better able to move within their physical limitations without the accompanying pain.

The authors of the Review therefore conclude that the use of tramadol for short-term pain relief is safe and effective. Although a small percentage of people reported mild headaches and an occasional feeling of nausea, there are no adverse side effects for the vast majority of people taking this drug. It may be considered a reliable response to moderate to severe low-back pain. But there are no formal studies examining the long-term management of low-back pain using opioids. Thus, their use should always be discussed with your physician if you propose to take it over any extended period. The fact that some people become dependent on tramadol is well documented. So you should combine drug therapy with other forms of treatment to reduce the risk of addiction while continuing to lead a relatively normal life. Used wisely, tramadol will give you the relief from pain while your back problems are resolved (to the extent that medical science can resolve them).