Warnings about use of tramadol

EAR DR. ROACH » I’m 78 and a male. I had a total hip replacement on the right side 28 days ago. After the surgery, I was hospitalized two nights with physical therapy, then went home with six supervised therapy sessions. I walk with a slight limp that I am working on. Everything was a breeze until I stopped the tramadol I was given for pain (100 mg, four times a day, 19 days). No one told me that I could experience withdrawal symptoms within 12 hours if I stopped cold turkey. I’ve weaned myself off it, but I’m wondering if I am too critical about not being warned. — J.F. DEAR READER » I don’t think you are too critical at all. Tramadol (a common brand name is Ultram) is an opioid (a synthetic derivative of opium, in the same category as oxycodone) painkiller. Many physicians have been under the impression that it is a safer drug to use than others in this category; however, tramadol has clear risks similar to all of the drugs in this category. Its boxed warning (the highest degree of warning to physicians in the official package insert) reminds doctors: “Tramadol exposes patients and other users to the risks of opioid addiction, abuse and misuse, which can lead to overdose and death. Assess each patient’s risk prior to prescribing tramadol, and monitor all patients regularly for the development of these behaviors and conditions.” It is particularly dangerous in children. You should have been warned about its potential side effects and how to taper off the medication safely. Again, the package insert clearly states “Do not abruptly discontinue.”

Tramadol certainly may be an appropriate medication for acute pain relief, which is absolutely indicated in someone with a major surgery, like your hip replacement. However, more information should have been provided to you or your family at the time you received it, including written information. Surgeons should give only enough pills to cover the expected duration of need. I am glad you wrote to share your experience.

DEAR DR. ROACH » I have a mole on my left hand and wonder if liquid nitrogen can be used to remove it. — D.R.B. DEAR READER » There are many different kinds of skin lesions, and the term “mole” is not specific. The most common skin lesion called a mole is a melanocytic nevus (a melanocyte is a pigment-making cell in the skin, so most moles are darker than underlying skin; the word “nevus” is a Latin term meaning “birthmark,” but some moles are present at birth while others are acquired during lifetime). These are benign lesions, and do not require any treatment other than watching them to be sure they do not change or grow, which might indicate a more serious skin condition.

A dermatologist evaluating a skin lesion will consider whether it is concerning enough to remove. If so, the specimen is sent for pathological evaluation. Liquid nitrogen is not used to remove a concerning mole, as the pathologist needs to have the architecture, which requires a sharp biopsy.

There are other benign lesions that can be treated with liquid nitrogen. For example, a seborrheic keratosis is a dark, raised, “stuck-on”-appearing lesion that may resemble a wart or a mole. If the clinician examining it is sure of the diagnosis, then liquid nitrogen is an effective way of removing it, with a good cosmetic result.

READERS: The booklet on stroke explains this condition that is deservedly feared by all. Readers can obtain a copy by writing: Dr. Roach Book No. 902 628 Virginia Dr. Orlando, FL 32803 Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

Contact Dr. Roach at ToYourGoodHealth@med. cornell.edu.