If tramadol does increase the risk of death, we want to understand why and what to do about it (for example, is it an easily avoidable risk, such as an interaction with other medications?). We’ll need more research to confirm - or refute - the findings. While the higher rates of death among tramadol users is worrisome, it’s not clear that tramadol is the actual culprit. If you take tramadol, talk to your doctor about this study. In fact, many studies try to avoid these sorts of errors, but they are impossible to avoid completely. The authors of the study acknowledge this possibility and took measures to limit it. In other words, the very reason your doctor chose tramadol could make this medication appear riskier than it really is. Yet kidney disease could increase the risk of other health problems, including a higher rate of death, which could then be attributed to the tramadol. For example, for a person who has both kidney disease and arthritis, doctors may prescribe tramadol rather than naproxen because the latter may worsen kidney disease. With this new study of tramadol, confounding is a real concern. How could confounding affect the study results? It is a confounder that must be accounted for if the research is to have credibility. But what if those with the unhealthy diet also smoked far more than the healthy eaters? The smoking could be the real culprit. One might conclude that dietary choices led to poorer heart health. For example, let’s say two groups are compared for the risk of heart attack and the group with the higher risk has a less healthy diet. It means an unexpected or external factor - not the one actually being examined - has led to the observed results. But a major source of error in studies is called confounding. Maybe the dose of the treatment was too high or too low. Perhaps there were too few participants to find meaningful differences. Medical research studies may draw faulty conclusions for a number of reasons. In fact, the patients for whom tramadol is prescribed could make it look riskier than it truly is. However, because of the study’s design, the researchers could not determine whether tramadol treatment actually caused the higher rates of death. Meanwhile, people treated with codeine had a similar risk of death to people treated with tramadol. etoricoxib: 2.5% of the tramadol group died vs.diclofenac: 3.5% of the tramadol group died vs.naproxen: 2.2% of the tramadol group died vs.Those prescribed tramadol had a higher risk of death than those prescribed anti-inflammatory medications. All participants were at least 50 years old and had osteoarthritis. Researchers publishing in the medical journal JAMA examined the risk of death among nearly 90,000 people one year after filling a first prescription for tramadol or one of several other commonly recommended pain relievers, such as naproxen (Aleve, Naprosyn), diclofenac (Cataflam, Voltaren), or codeine. Several professional societies, including the American Academy of Orthopaedic Surgeons, include it in their guidelines as a recommended drug for osteoarthritis. Classified as a Schedule IV drug, tramadol is considered useful as a pain reliever with a low potential for abuse.ĭespite these concerns, tramadol is one of many common treatments recommended for osteoarthritis and other painful conditions. Ox圜ontin is a Schedule II drug (it also has high abuse potential, but has an accepted medical use). Heroin, for example, is a Schedule I drug (high abuse potential and no acceptable medical use). For example, a doctor can only prescribe a maximum of five refills, and a new prescription is required every 6 months.Ĭompared with other controlled substances, tramadol is at the safer end of the spectrum. This means that although it may have accepted use in medical care, it also has potential for abuse or addiction and therefore is more tightly regulated. In 2014, the FDA designated tramadol as a controlled substance. However, because there were cases of abuse and addiction with its use, the thinking and warnings changed. When first approved in 1995, tramadol was not considered an opiate (like morphine or oxycodone) even though it acted in similar ways. Now, according to a new study, the common prescription pain medication tramadol may earn a similar warning. You aren’t on your own in this: your doctor, your pharmacist, and a trove of information are available for your review. Recently, I wrote about how newly approved drugs often accumulate new warnings about their safety, including a gout medication that garnered a new warning due to an increased risk of death. From minor side effects to life-threatening allergic reactions, every decision to take a medication should be made only after the expected benefits are weighed against the known risks. All medications come with a dose of risk.
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