Tramadol is not a long term solution

Dear Dr. Roach: I had a half knee replacement nine years ago with nerve damaged on the side that was not replaced. The only pain relief that would work was the Tylenol 3 with codeine. I had back surgery, and I also had nerves damaged on the left side above the hip. My surgeon has me on 900 mg gabapentin to take with 600 mg ibuprofen every eight hours to contain the pain. Sometimes I cannot make it eight hours. When the pain is too severe, I use the Tylenol 3 with codeine.

A very popular and effective painkiller now is tramadol. I asked my primary care physician if I could try the tramadol, and she refused. Her only answer is that tramadol has been a controlled substance in New York for the past four years. What is your opinion of tramadol? — J.M.

Codeine and tramadol are relatively short-acting synthetic opioids with similar structures. Although tramadol was originally marketed as being safer, they both have the potential for habituation. Neither of these drugs is a good choice for long-term use in people with chronic pain, although if used cautiously at reasonable and stable doses, it might be reasonable in combination with the gabapentin. Opioids are not appropriate for people at high risk for substance misuse.

Your primary care doctor is wise to be concerned about concomitant use. Their toxicities overlap. Further, some preparations of tramadol come with acetaminophen (Tylenol). If taken in combination with Tylenol with codeine, the excess Tylenol can be potentially deadly.

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