Page 22 - Delaware Medical Journal - September/October 2020
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Editorial Response: The Painful Truth: Why Tramadol May Not Be the Ideal Analgesic
Peter Rocca, MD November 19, 2010 was a dark day
Food and Drug Administration (FDA) decided to pull propoxyphene- containing medication (Darvon, Darvocet) off the market. Its reason was that the medication had been linked to arrythmia. The year before it was pulled, 10 million patients had been prescribed propoxyphene. What was not clear to
me was why it had taken us 55 years to identify this risk. (Eli Lilly had obtained its patent for the drug in 1955.)
Rheumatologists treat a lot of patients with osteoarthritis (OA). Globally, approximately 240 million people are affected by OA, including over 30 million in the United States, which has increased from 21
million in 1990 and 27 million in 2005.1
The prevalence of OA increases with age, with just under 10% of men and 18% of women over the age of 60 years reporting symptomatic OA.2 The treatment of OA can be challenging due to the fact that advancing age usually results in both worsening of the
disease as well as comorbidities that increase the risk of adverse events from medications used to treat OA.
There are nonpharmacologic options for OA, including weight loss, walking aids, and exercise, e.g. isometric contraction of the quadriceps for knee OA. Unfortunately, these options fail to always provide adequate and reverse disability in some patients with hip and knee OA. Unfortunately, some
older patients are deemed to not be surgical candidates due to comorbidity that would increase operative mortality. Furthermore, some situations, e.g. severe spinal stenosis, are not easily correctable in the OR.
Medications are frequently used in the symptomatic patient with OA. They can formulations may be inadequate in patients with advanced disease. Intra-articular use of glucosteroids or hyaluronic acid may be helpful, but should be employed judiciously as the effects are temporary.
In clinical trials, the effect sizes for acetaminophen are very small, suggesting that few of those treated experience suggested that use of acetaminophen as monotherapy may be ineffective.3 In my experience, it is inadequate for patients with advanced disease.
More than 20 different non-steroidal
available commercially, and these agents
are used worldwide for their analgesic, for multiple medical conditions. Their role
in the treatment of OA is unequivocal and the increased risk of serious complications. carry an approximate 1% risk of serious gastropathy in all comers, e.g. bleeding, perforation, or hospitalization, but the risk increases with advancing age. In addition, as other highly protein-bound drugs may be
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Del Med J | September/October 2020 | Vol. 92 | No. 5
