OBJECTIVETo review the mechanisms and current clinical application of pharmacological interventions for phantom limb pain.

DATA SOURCESBoth Chinese and English language literatures were searched using MEDLINE (1982 - 2011), Pubmed (1982 - 2011) and the Index of Chinese Language Literature (1982 - 2011).

STUDY SELECTIONData from published articles about pharmacological management of phantom limb pain in recent domestic and foreign literature were selected. Data extraction Data were mainly extracted from 96 articles which are listed in the reference section of this review.

RESULTSBy reviewing the mechanisms and current clinical application of pharmacological interventions for phantom limb pain, including anticonvulsants, antidepressants, local anaesthetics, N-methyl-D-aspartate receptor antagonists, non-steroidal anti-inflammatory drugs, tramadol, opioids, calcitonin, capsaicin, beta-adrenergic blockers, clonidine, muscle relaxants, and emerging drugs, we examined the efficacy and safety of these medications, outlined the limitations and future directions.

CONCLUSIONSAlthough there is lack of evidence-based consensus guidelines for the pharmacological management of phantom limb pain, we recommend tricyclic antidepressants, gabapentin, tramadol, opioids, local anaesthetics and N-methyl-D-aspartate receptor antagonists as the rational options for the treatment of phantom limb pain.

Analgesics ; therapeutic use ; Analgesics, Opioid ; therapeutic use ; Anticonvulsants ; therapeutic use ; Antidepressive Agents ; therapeutic use ; Humans ; Phantom Limb ; drug therapy ; Tramadol ; therapeutic use

OBJECTIVE: To explore the effects of different analgesia methods after UPPP. METHOD: Ninety cases of patients uvulopalatopharyngoplasty were divided into 3 groups randomly, and 30 cases in each group. The group A was the blank control group without any analgesia measures. The cases in group B were treated with intramuscular injection of parecoxib sodium 40 mg after surgery immediately, and continued injecting 40 mg after 12 hours, 24 hours and 36 hours respectively. 100 mg tramadol replaced 40 mg parecoxib sodium in group C. The VAS scoring was performed after surgery 12, 24, 36, 48, 72, 96 hours in 3 groups, and we observed adverse reaction such as lethargy, nausea, vomiting, dizziness, skin rash and so on. RESULT: The group B and C reduced the pain significantly compared with blank control group. The pain scores in group B were significantly decreased than that in group C (P<. 05). CONCLUSION The analgesic effect of parecoxib sodium after UPPP is significant and better than tramadol. It is worthy to use widely in clinical due to its better effect and less side effect.
Analgesia ; methods ; Analgesics ; therapeutic use ; Humans ; Injections, Intramuscular ; Isoxazoles ; therapeutic use ; Pain Measurement ; Pain, Postoperative ; Palate ; surgery ; Pharynx ; surgery ; Tramadol ; therapeutic use ; Uvula ; surgery

OBJECTIVETo evaluate the efficacy and safety of tramadol hydrochloride with behavioral modification in delaying ejaculation in patients with premature ejaculation.

METHODSSeventy-two potent men with premature ejaculation were equally and randomly assigned to a treatment group and control group, the former received 50 mg tramadol hydrochloride with behavioral modification approximately 2 hours before planned sexual activity, while the latter underwent behavioral therapy only, both treated for 8 weeks. Intravaginal ejaculatory latency time (IELT), intercourse satisfaction of the partners, total therapeutic effectiveness, adverse reactions, and hepatic and renal function of the patients were recorded and compared before and after the treatment.

RESULTSBoth the treatment and the control groups showed significant differences from pretreatment in the mean IELT and intercourse satisfaction domain values (P < 0.01). The total rate of effectiveness was 72.2% in the treatment group and 47.2% in the control. The former exhibited even more significant improvement than the latter in the mean IELT, intercourse satisfaction domain values and total rate of effectiveness (P < 0.05). Adverse reactions occurred in 10 cases (27.8%), and no statistically significant differences were found in hepatic and renal function before and after treatment (P > 0.05).

CONCLUSIONTramadol hydrochloride with behavioral modification showed positive effects in prolonging IELT and improving partners' intercourse satisfaction. Yet more multicenter and double-blind studies are required to evaluate its efficacy and safety as a routine therapy for premature ejaculation.

Adolescent ; Adult ; Behavior Therapy ; Ejaculation ; Humans ; Male ; Middle Aged ; Sexual Dysfunction, Physiological ; therapy ; Tramadol ; adverse effects ; therapeutic use ; Treatment Outcome

PURPOSE: Optimal analgesia in ambulatory urology patients still remains a challenge. The aim of this study was to examine if the pre-emptive use of intravenous tramadol can reduce pain after ureteroscopic lithotripsy in patients diagnosed with unilateral ureteral stones. MATERIALS AND METHODS: This prospective pilot cohort study included 74 patients diagnosed with unilateral ureteral stones who underwent ureteroscopic lithotripsy under general anesthesia in the Urology Clinic at the Clinical Center of Serbia from March to June 2012. All patients were randomly allocated to two groups: one group (38 patients) received intravenous infusion of tramadol 100 mg in 500 mL 0.9%NaCl one hour before the procedure, while the other group (36 patients) received 500 mL 0.9%NaCl at the same time. Visual analogue scale (VAS) scores were recorded once prior to surgery and two times after the surgery (1 h and 6 h, respectively). The patients were prescribed additional postoperative analgesia (diclofenac 75 mg i.m.) when required. Pre-emptive effects of tramadol were assessed measuring pain scores, VAS1 and VAS2, intraoperative fentanyl consumption, and postoperative analgesic requirement. RESULTS: The average VAS1 score in the tramadol group was significantly lower than that in the non-tramadol group. The difference in average VAS2 score values between the two groups was not statistically significant; however, there were more patients who experienced severe pain in the non-tramadol group (p<0.01). The number of patients that required postoperative analgesia was not statistically different between the groups. CONCLUSION: Pre-emptive tramadol did reduce early postoperative pain. The patients who received pre-emptive tramadol were less likely to experience severe post-operative pain.
Adult ; Analgesics, Opioid/*administration & dosage/therapeutic use ; Female ; Humans ; *Lithotripsy ; Male ; Middle Aged ; Pain/*prevention & control ; Pain Measurement ; Tramadol/*administration & dosage/therapeutic use ; *Ureteroscopy

BACKGROUNDPain is a common post-operative complication. Incidence of pain directly affects patients' quality of life in terms of patient physiology, psychology, and social characteristics. This study was to understand clinical attitudes with regards to Beijing surgeons, and patients' attitude towards pain treatment after orthopedic surgery.

METHODSA hospital-based cross-sectional and cluster sample survey of 40 hospitals in Beijing was conducted, including 20 level III (tier three) and 20 level II (tier two) general hospitals. Enrolled subjects completed a specifically designed interview-questionnaire.

RESULTSThe prevalence of pain 2 weeks post-orthopedic surgery was high in Beijing (96.1%). Meanwhile, collected data indicated most subjects in Beijing suffered moderate to severe pain, 45.1% and 41.4%, respectively, post-surgery. And for the concern of patients before surgery, most subjects chose full recovery from surgery (78.6%), as well as, the pain after operation was 39.2% ranked the third. According to the data from the study, Tramadol use was more common in Level III hospitals, where Somiton was preferred in Level II hospitals. When it came to the education of pain before and after operation, more patients get educated before operation than after it. In our study, case physicians or attending physicians enacted education before and after surgery. Related to the sense of patients, among the surgeons preferring post-operative analgesia, 67.6% considered administration when receiving complaints of moderate level pain, 50.0% indicated they will terminate analgesic treatment once pain degree scale wise decreases to benign pain.

CONCLUSIONSThe majority of orthopedic patients experience post-operative pain. Identification of post-operative pain will facilitate future awareness on pain treatment and nursing care in Beijing hospitals, with pain relief through regulated improvements in strategic pain management.

Adult ; Cross-Sectional Studies ; Female ; Humans ; Male ; Orthopedics ; Pain, Postoperative ; drug therapy ; Postoperative Period ; Surveys and Questionnaires ; Tramadol ; therapeutic use ; Young Adult

The patient was a 44-yr-old man with end-stage renal disease who had developed chorea as a result of hypoglycemic injury to the basal ganglia and thalamus and who was subsequently diagnosed with depression and restless legs syndrome (RLS). For proper management, the presence of a complex medical condition including two contrasting diseases, chorea and RLS, had to be considered. Tramadol improved the pain and dysesthetic restlessness in his feet and legs, and this was gradually followed by improvements in his depressed mood, insomnia, lethargy, and feelings of hopelessness. This case suggests that the dopaminergic system participates intricately with the opioid, serotoninergic, and noradrenergic systems in the pathophysiology of RLS and pain and indirectly of depression and insomnia.
Adult ; Analgesics, Opioid/therapeutic use ; Anti-Dyskinesia Agents/therapeutic use ; Chorea/*complications/pathology ; Citalopram/therapeutic use ; Drug Therapy, Combination ; Haloperidol/therapeutic use ; Humans ; Kidney Failure, Chronic/*complications ; Magnetic Resonance Imaging ; Male ; Restless Legs Syndrome/*complications/drug therapy/pathology ; Serotonin Uptake Inhibitors/therapeutic use ; Tramadol/therapeutic use

This study was designed to assess the effectiveness of a modified silk ligature twisted with wire for inducing advanced periodontitis. Periodontitis was induced in five premolars and one molar of 20 healthy dogs over a 60-day period. The dogs were divided into four groups according to the ligature-inducing materials used: soft moistened food only, wire ligature (WL), silk ligature (SL) and twisted ligature with silk and wire (SWL). Periodontal indices were recorded, and dental radiographs were taken before and after 60 days of ligation. The ligatures were checked daily and the day the ligature fell out was noted. The period during which the ligatures were maintained was significantly shorter for the SL group compared to the SWL group (p < 0.05). Results of the clinical examination showed that almost all periodontal status parameters including the plaque index, gingival index, clinical attachment level, and bleeding on probing were significantly exacerbated in the SWL group compared to the other groups (p < 0.05). Radiographic evaluation demonstrated that alveolar bone levels were significantly lower in the SWL group than the other groups on day 60 (p < 0.05). These results suggested that experimental periodontitis induced by SWL could be an effective method for investigating periodontitis in canine models.
Alveolar Bone Loss/veterinary ; Analgesics, Opioid/therapeutic use ; Animals ; Dog Diseases/*pathology ; Dogs ; Ligation/instrumentation/methods/*veterinary ; Materials Testing/veterinary ; Pain/drug therapy/veterinary ; Periodontitis/pathology/*veterinary ; Tramadol/therapeutic use

OBJECTIVETo explore the effect of lappaconitine on patient-controlled intravenous analgesia (PCIA) and serum complement 3 and 4 (C3 and C4) levels of cancer patients undergoing rectum surgery.

METHODSTotally 60 patients, who were scheduled for rectum carcinoma surgery, were recruited to the study and assigned in 3 groups, the blank control group, the tramadol group, and the lappaconitine group, 20 in each group. Lappaconitine (8 mg) was intravenously dripped to patients in the lappaconitine group 30 min before ending the operation. PCIA started as soon as the end of the surgery and the total dose of lappaconitine was 36 mg. Patients of the tramadol group were treated with tramadol (100 mg) intravenously within 30 min before ending the operation. The dripping was completed within 30 min. PCIA was started as soon as the end of the surgery and the total dose of lappaconitine was 36 mg. Tramadol (100 mg) was intravenously dripped to patients in the tramadol group 30 min before ending the operation. PICA was started as soon as the end of the surgery and the total dose of tramadol was 900 mg. Pethidine (50 mg) and droperidol (2. 5 mg) was intramuscularly injected to patients in the blank control group for pain relief according to their complaints. Pain degrees were assessed by visual analog scale (VAS) 12 h before surgery, 12, 24, 48, and 72 h after surgery. Blood samples were withdrawn at the same time point. Contents of serum C3 and C4 were determined by immunoturbidimetry.

RESULTSVAS scores of the blank control group were significantly higher after surgery than before surgery (P <0. 01). There was no statistical difference in VAS scores between before surgery and after surgery in the tramadol group and the lappaconitine group (P >0. 05). VAS scores were significantly lower at each post-surgery time point in the tramadol group and the lappaconitine group than in the blank control group with statistical difference (P < 0.01). There was no statistical difference in VAS scores at each post-surgery time point between the tramadol group and the lappaconitine group (P >0. 05). Compared with before surgery, contents of serum C3 and C4 significantly decreased in all of the three groups at 12, 24, and 48 h after surgery (P < 0.05, P < 0.01). They recovered to the pre-surgery level till 72 h after surgery (P > 0.05). Serum C3 and C4 contents at 48 h after surgery were higher in the tramadol group than in the blank control group (P < 0.05). Serum C3 and C4 contents at 24 and 48 h after surgery were higher in the lappaconitine group than in the blank control group (P < 0.05). There was no statistical difference in serum C3 and C4 contents at each time point between the tramadol group and the lappaconitine group (P > 0.05). VAS scores were obviously negatively correlated with serum contents of C3 and C4 (r = -0.622, r = -0.649, P < 0.01).

CONCLUSIONSLappaconitine (used at the dose in this study) showed better pain relief effect after surgery. Besides, it could inhibit the surgic wound and pain, and elevate serum contents of C3 and C4.

Aconitine ; analogs & derivatives ; therapeutic use ; Analgesia, Patient-Controlled ; methods ; Analgesics, Non-Narcotic ; therapeutic use ; Complement C3 ; metabolism ; Digestive System Surgical Procedures ; Humans ; Neoplasms ; Orthopedic Procedures ; Pain Measurement ; Pain, Postoperative ; Postoperative Period ; Rectum ; surgery ; Tramadol

OBJECTIVE: To observe postoperative analgesia and preemptive analgesia of Tramadol hydrochloride sustained release tablets for nasal endoscopic operation. METHOD: A total of 188 patients undergoing nasal endoscopic operation were randomized into the experimental group and control group, with 94 patients in each group. Each patient in experimental group was gaved on Tramadol hydrochloride sustained release tablets at 12h, 24h, 48h, postoperation and before the cleaning up procession respectively, the control group was not administered. VAS scores were observed at 12, 24, and 48 hours after operation. The discomfort reaction during postoperation and cleaning up procession such as insomnia, impatien, nervous, frightening, syncope and shock were also observed and recorded. RESULT: Visuala analogue scale scores of the experimental groups after 12, 24 hours and 48h were significantly lower than the control group. The discomfort reaction appear more frequently in control group. CONCLUSION Tramadol hydrochloride sustained release tablets effectively relieves postoperative pain of nasal endoscopic operation. It can also decrease the discomfort reaction during postoperation and cleaning up procession and facilitate recovering of patients.
Adolescent ; Adult ; Analgesics, Opioid ; administration & dosage ; therapeutic use ; Delayed-Action Preparations ; Endoscopy ; methods ; Female ; Humans ; Male ; Middle Aged ; Nasal Surgical Procedures ; methods ; Pain Measurement ; Pain, Postoperative ; drug therapy ; Postoperative Period ; Tramadol ; administration & dosage ; therapeutic use ; Young Adult

BACKGROUNDEarly studies showed that naloxone infusion decreases the incidence of morphine-related side effects from intravenous patient-controlled analgesia. This study aimed to determine whether naloxone preserved analgesia while minimizing side effects caused by intravenous tramadol administration.

METHODSEighty patients undergoing general anesthesia for cervical vertebrae surgery were randomly divided into four groups. All patients received 1 mg/kg tramadol 30 minutes before the end of surgery, followed by a continuous infusion with 0.3 mg x kg(-1) x h(-1) tramadol with no naloxone (group I, n = 20), 0.05 microg x kg(-1) x h(-1) naloxone (group II, n = 20), 0.1 microg x kg(-1) x h(-1) naloxone (group III, n = 20) and 0.2 microg x kg(-1) x h(-1) naloxone (group IV, n = 20). Visual analog scales (VAS) for pain during rest and cough, nausea five-point scale (NFPS) for nausea and vomiting, and ramsay sedation score (RSS) for sedation were assessed at 2, 6, 12, 24 and 48 hours postoperatively. Analgesia and side effects were evaluated by blinded observers.

RESULTSSeventy-eight patients were included in this study. The intravenous tramadol administration provided the satisfied analgesia. There was no significant difference in either resting or coughing VAS scores among naloxone groups and control group. Compared with control group, sedation was less in groups II, III, and IV at 6, 12, and 24 hours (P < 0.05); nausea was less in groups II, III and IV than group I at 2, 6, 12, 24 and 48 hours postoperatively (P < 0.05). The incidence of vomiting in the control group was 35% vs. 10% for the highest dose naloxone group (group IV) (P < 0.01).

CONCLUSIONA small-dose naloxone infusion could reduce tramadol induced side effects without reversing its analgesic effects.

Analgesia, Patient-Controlled ; methods ; Analgesics, Opioid ; administration & dosage ; adverse effects ; therapeutic use ; Anesthesia, General ; methods ; Cervical Vertebrae ; surgery ; Female ; Humans ; Infusions, Intravenous ; Male ; Middle Aged ; Naloxone ; administration & dosage ; adverse effects ; therapeutic use ; Narcotic Antagonists ; administration & dosage ; adverse effects ; therapeutic use ; Nausea ; chemically induced ; Tramadol ; administration & dosage ; adverse effects ; therapeutic use