Copped some downvotes for saying Tramadol had its uses in a medicine comment one week ago – since then, the anaesthetists seem to have closed their sudoku app and evened the votes out, but it got me thinking, why is hating on tramadol so in vogue?
I did IM for a few years before deciding to swap to anaesthesia and tramadol was public enemy number one. It was frequently deleted from med charts as a form of "medication rationalisation" even if the patient presented with acute on chronic pain/cough/weird rash/anything that had nothing to do with tramadol.
Pimp questions focussed on how it was a "dirty drug" and therefore "bad."
When reviewing chronic pain patients attendings would pontificate that it was "just a weak opioid" and therefore "bad" and deprescribe it. Then a few days later prescribe a strong opioid patch for analgesia…
They would comment on how it had "variable metabolism" based on genetic polymorphism and was therefore "bad" and then prescribe codeine or oxycodone…
They would comment on how it was "just a weak opioid" and therefore had no role to play in pain management. Either they need "a proper opioid" or none.
They would say it had identical effects as "all other opioids" and the side effects were the same severity.
They would say that tramadol was to blame for any patient who developed delirium.
Basically, they said a load of questionable shit and I ate it up at the time because I was doing IM; not pain/anaesthesia/addictions/other. It took me a solid year of study and experience to get over my hangup on tramadol and start using it as indicated.
I frequently get interns/residents/registrars telling me their medical attendings told them to stop the tramadol I charted post-op – despite the patient being in agony despite being hooked up to ketamine, clonidine, PCAs, regional catheters, and everything else under the sun following their major surgeries…
I feel it's the equivalent of me walking around and crossing off warfarin on every acute pain patient's med chart because it's "bad."
So, why am I wrong? Why is tramadol "bad?" Why do people believe it has no indications for use, ever? If I'm overlooking something I need to be corrected considering my speciality. I won't be upset if I get exposed for being a moron.
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