Schweiz Rundsch Med Prax. 1994 Nov 15;83(46):1292-5.
[Conservative and interventional therapy of chronic pancreatitis]

[Article in German]

Ell C.

Medizinische Klinik I mit Poliklinik der FAU, Erlangen-Nurnberg.

In chronic pancreatitis high-dose enzyme therapy is only indicated if an insufficiency of the exocrine gland exists. For pain conventional analgesics such as Paracetamol, Metamizol or Tramadol are indicated. In case of pancreolithiasis, ESWL is the method of choice. This treatment should be combined with papillotomy of the pancreatic sphincter to achieve a good access to the duct system. If strictures are seen during ERCP, balloon dilatation and consecutive implantation of a plastic prosthesis are necessary to permit regular flow of pancreatic juice. Stent-clogging is the main problem of drainage-procedures. Regular exchange of the stent is mandatory. Pseudocysts should be drained via the papilla if there is a connection between the cyst and the duct system. All others should be drained endoscopically, by puncturing the cyst through the gastric or duodenal wall, or percutaneously. Surgical procedures should be delayed whenever possible, since surgical treatment is invasive (e.g. Whipple's operation) and the long-term prognosis is poor.

Tramadol reference source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7973293&dopt=Abstract tramadol Ultram




Pol J Pharmacol. 1994 Jan-Apr;46(1-2):61-5.
Muscle rigidity induced by the opioid analgesic tramadol, but not by the non-opioid flupirtine.

Ossowska K, Wolfarth S.

Department of Neuro-Psychopharmacology, Polish Academy of Sciences, Krakow.

The influence of high doses of two analgesic drugs, tramadol and flupirtine on the electromyographic activity in the gastrocnemius soleus muscles was examined. Tramadol (100-200 mg/kg po) dose-dependently induced a tonic electromyographic activity, which is generally accepted as a model of the opiate-induced muscle rigidity. That effect was antagonized by intraperitoneal injection of naloxone (0.8 mg/kg ip). On the other hand, flupirtine even in the high doses (100-200 mg/kg po) did not induce any tonic electromyographic activity. The obtained results confirm an opiate-like action of tramadol, but not that of flupirtine, on the muscle tension.

Tramadol reference source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7981773&dopt=Abstract tramadol Ultram




Prescrire Int. 1998 Feb;7(33):9-12.
Tramadol: new preparation. Capsules: central analgesic; step 2 on the WHO scale.

[No authors listed]

The clinical assessment file on tramadol is of low quality. In acute postoperative pain and chronic pain there is no proof that tramadol has a better risk-benefit ratio than the paracetamol + codeine combination or other step 2 analgesics in the World Health Organisation classification. Like all other central analgesics, tramadol can have neuropsychological adverse effects, especially a risk of dependence and misuse.

Tramadol reference source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10183392&dopt=Abstract tramadol Ultram

msnotes.wustl.edu

Tramadol HCl, marketed as Ultram in the USA, was introduced as a non-scheduled drug in April 1995 based on the assumption that the risk of abuse was sufficiently low to warrant a non-scheduled status. However, approval was contingent upon the development of an innovative proactive surveillance program, to be overseen by an independent steering committee, which would detect unexpectedly high levels of abuse. The postmarketing surveillance program consisted of systematic collection and scientific evaluation of reports of suspected abuse in high-risk populations surveyed through an extensive key informant network of drug abuse specialists and all spontaneous reports of abuse received through the FDA MedWatch system. Methods to estimate the number of patients prescribed tramadol were also developed. Monthly rates of abuse were calculated as an index of the risk-benefit ratio (i.e., abuse cases per 100,000 patients prescribed the drug). The data for the 3 years since the drug was introduced show that the reported rate of abuse has been low. Although a period of experimentation seemed to occur in the first 18 months after its introduction--which reached a peak rate of approximately two cases per 100,000 patients exposed--during the 2 year period prior to June 1998, the reported rate of abuse has significantly (P = 0.011) declined, reaching levels of less than one case per 100,000 patients in the last 18 months. The overwhelming majority of abuse cases (97%) have been found to occur among individuals with a history of substance abuse and the abuse has been confined to isolated pockets around the country-notably none of which have significant populations of street drug abusers. Thus, the data support the decision not to schedule tramadol and, furthermore, suggest that a proactive post-marketing surveillance program can be successfully developed to effectively monitor abuse of new medications.

Tramadol reference source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10617309&dopt=Abstract tramadol Ultram




Arukoru Kenkyuto Yakubutsu Ison. 1994 Feb;29(1):40-51.
[Withdrawal characteristics following frequent intravenous administration of several opioids in rats]

[Article in Japanese]

Wakasa Y, Kawaguchi T, Yanagita T.

Central Institute for Experimental Animals, Preclinical Research Division, Kanagawa, Japan.

Characteristics of withdrawal signs of several opioids were compared in rats after short-term frequent intravenous infusions. Male Sprague-Dawley rats with catheters implanted in the jugular veins were infused with a fixed dose of a drug hourly for 72 hrs. Thirty min after the final infusion, naloxone 4 mg/kg, s.c. was administered and withdrawal signs were observed for 1 hr and the severity of the withdrawal signs was scored, classified into a behavioral sign score, autonomic sign score, and body weight loss score. As a result, total withdrawal scores of morphine, methadone, d-propoxyphene, loperamide, tramadol, and pentazocine were significantly higher than that of saline, with the highest score being observed for 4 mg/kg or more of morphine. The total score of ethylketocyclazocine was slightly but significantly higher than that of saline. Buprenorphine and thebaine produced no observable withdrawal signs. The behavioral sign score tended to be higher than the other 2 scores in the drugs showing relatively low but significant total scores such as tramadol, pentazocine, and ethylketocyclazocine, while the score of autonomic signs or the body weight loss tended to be higher in drugs showing high total scores. Thus, in the case of opioids, it is considered that the severity of withdrawal signs was mainly derived from the autonomic signs including diarrhea which may result in body weight loss.

Tramadol reference source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8135665&dopt=Abstract tramadol Ultram