Tramadol

RE: Tramadol

Martin Atkinson — Sat, 14 Oct 2017 11:18:33 GMT

[quote user="bevs2251"]The animals do get an injection of meloxicam post-surgery. [/quote]That's a bit better then. Our routine neutering cases have an opioid with the pre. med and post op NSAID injection, they are not routinely sent home with anything, IME they do not need it. I know that a lot of others will beg to differ and this has been discussed in another thread so one star man - don't waste your time!

RE: Tramadol

bevs2251 — Sat, 14 Oct 2017 00:17:10 GMT

Agree, absolutely. The animals do get an injection of meloxicam post-surgery. It is in our SOPS to use Tramadol - corporate practice standards we must follow. I have decided to no longer give Tramadol post surgery for any other surgery apart from desexings. I might bring the issue up at next work teleconference - ask the bosses for their reasoning to use this. Older, opinionated female so not afraid to speak up !!

RE: Tramadol

Martin Atkinson — Fri, 13 Oct 2017 10:36:12 GMT

[quote user="bevs2251"]Where I work now, it is dispensed post-surgery for desexings. It is included in the cost, so presumably used because it is a lot cheaper than NSAID tablets ![/quote]I think that is totally unacceptable/unethical and I would not be party to it. What other cost-cutting exercises go on which compromise best practice I wonder? The additional benefit of NSAIDs is in the AI bit - its anti-inflammatory, so is addressing the source of pain not just masking it.

RE: Tramadol

bevs2251 — Fri, 13 Oct 2017 04:29:06 GMT

I don't like Tramadol. Where I work now, it is dispensed post-surgery for desexings. It is included in the cost, so presumably used because it is a lot cheaper than NSAID tablets ! Cats can have quite severe euphoric reactions. We use a dose of 1-2mg/kg bid. It is bitter to taste also, so a lot of little dog castrations won't take it at all.

I might use it as a second, third or additional option for OA/DJD/end-stage cases, certainly not as my first choice.

Took it twice myself for partially collapsed discs in the neck. Made me feel quite nauseous the next day (12 hours + later). Took it twice to ensure it wasn't just a one-off reaction. Ibuprofen worked much better !

RE: Tramadol

Thomas Johnson — Tue, 10 Oct 2017 15:34:06 GMT

[quote user="Neil Wheadon"]

[quote user="robloxley"] owner who might be eating the dog's tablets?[/quote]

Owners (but the dogs an interesting one isn't it?)

[/quote]

It's a very interesting question, I do wonder sometimes whether we should think more about withdrawal effects if dogs have been on medications such as tramadol or gabapentin for some time and we decide to take them off them. We tend to think about it with phenobarbitone, but I get the impression that's more to do with the risk of seizures than how the dog's feeling.

RE: Tramadol

Neil Wheadon — Tue, 10 Oct 2017 14:26:30 GMT

[quote user="robloxley"] owner who might be eating the dog's tablets?[/quote]

Owners (but the dogs an interesting one isn't it?)

We just don't know, how common this is do we?

I link it to clinical benefit and there is no other drug that I use that has such a skewed risk/benefit application

http://www.who.int/medicines/areas/quality_safety/6_1_Update.pdf

Neil

RE: Tramadol

Rob Loxley — Tue, 10 Oct 2017 13:14:39 GMT

[quote user="Neil Wheadon"]dd in the fact that it has the potential to cause addiction and the facts are out there makes me feel that it should be drug of last resort[/quote]

Are you worried about addiction in the dog, or in the owner who might be eating the dog's tablets?

RE: Tramadol

Martin Atkinson — Tue, 10 Oct 2017 10:51:18 GMT

[quote user="Neil Wheadon"] In practically every case the drug makes no difference and in some it has doped the dog up so badly that quality of life is affected (which goes a little against Martin's observations of no receptors)[/quote]Perhaps this is telling us that there are different receptor sites and its having no effect on pain receptors but is on the CNS. I'm only repeating what I've heard/read from different CPD but I've found the same as you. And that is not just for dogs but personally: when I had shingles a couple of years ago it felt like the time I came off my bike broke 3 ribs and took all the skin off my chest - i.e. very painful!! The Tramadol did very little but made me feel like a zombie so I'd rather put up with the pain. Paracetamol + codeine worked better that anything else.

RE: Tramadol

Bob Russell — Tue, 10 Oct 2017 10:20:03 GMT

All these drugs work well enough within their limitations. I tend to stick to 10mg/Kg for long-term Pardale.

The few patients we have on Tramadol at the moment do get benefit so I would not consider it useless in practice but the fashion got a little out of control.

I did watch the programme because I like Louis Theroux's non judgemental approach to the worst of humanity.

This was an area where people had to do hard physical work, were injured often and the cheap medical fix was opiate painkillers. There was a sudden restriction to supplies when Tramadol prescription became more controlled. Heroin was cheaper and more widely available.

The rest of the problem is poverty and boredom related. A depressing result of industry modernising and moving to cheaper labour parts of the world.

We will always face the difficulties caused by arthritis waxing and waning. (See 'No Way To Treat A Friend!!)

RE: Tramadol

Lucy Fleming — Tue, 10 Oct 2017 09:59:05 GMT

It's definitely an odd one - certainly the published evidence suggests efficacy is likely to be poor/ non-existent in a lot of dogs, unless at very high doses (when sedation side effects seem to be very likely). I have found that most owners that have had tramadol mention that the side effects weren't actually that enjoyable to them!

Having said that, I have used it as an adjunct in chronic pain cases (mostly OA) in addition to nsaid and owners have reported an improvement in the dog's mobility. Entirely a placebo effect? I rarely use it as a sole agent as I don't feel it is massively effective then.

Other drugs are a challenge - paracetamol/ pardale is useful. I'm using it more and more for a top up for breakthrough type pain. Does anyone else instruct owners to use for 5d then give a 2 day break with long term use? The problem I find with gabapentin is that it's a difficult one to trial and see - incremental dosing to avoid side effects means that it's more challenging to assess for the analgesic effect, IMO, so it puts me off using it a bit.

RE: Tramadol

Neil Wheadon — Tue, 10 Oct 2017 09:16:47 GMT

[quote user="Michael Woodhouse"](we have some dogs also on Tramadol and it seems to help, I'm not worried about the potential for misuse myself. That could be the same for so many drugs we hand out)[/quote]

I genuinely feel Tramadol does more harm than good in dogs. As a locum who sees a lot of everyone elses chronic cases I am in a position to ask the client how there pet is responding to the drug. In this respect I'm a stranger, the client isn't trying to give me an answer that they want me to hear as I am not a 'respected face that they deal with for the majority of the time' In practically every case the drug makes no difference and in some it has doped the dog up so badly that quality of life is affected (which goes a little against Martin's observations of no receptors)

Add in the fact that it has the potential to cause addiction and the facts are out there makes me feel that it should be drug of last resort. However I do concede that with a client looking for something else it will be prescribed. The circle I can't square is the fact that we won't reach for paracetamol because there may be a contraindication, but we happily reach for a drug where we simply don't know what it's doing.

Interesting discussion in regards Paracetamol. My only input is that the BSAVA dose may be far to low according to a vet that is a recognised expert on anaesthesia whom I have locummed for.

Neil

RE: Tramadol

Michael Woodhouse — Tue, 10 Oct 2017 00:31:34 GMT

[quote user="Busybee"]For those using paracetamol as an addition to an NSAID, which formulation do you use? We have Pardale V on shelf but I've been put off using it in conjunction with NSAIDs due to the data sheet warning not to use alongside them. If something went wrong, you can bet the client will have read that part of the data sheet! [/quote]

Pardale V. At licensed data sheet dose (not the unreferenced BSAVA dose that is much lower). Get off licence form signed.

We've had dogs on full dose for literally years and zero problems (I was worried about liver).

Works very well. I've also had a couple of people take the dog off Pardale and put them on human paracetamol and having explained the legal situation, what can I really do? I'd not outright prescribe it but that also seems to work just fine.....

(we have some dogs also on Tramadol and it seems to help, I'm not worried about the potential for misuse myself. That could be the same for so many drugs we hand out)

RE: Tramadol

Eilidh Corr — Mon, 09 Oct 2017 23:25:17 GMT

I agree with these sentiments about tramadol - I too used to use it a lot and now prescribe it much less. I reach for Pardale first if something more than an NSAID is required, always explaining to the owners that it's only licensed for 5 days, and not alongside NSAIDs, but that I never use it at label doses anyway (which seem obscenely high to me). Most clients appreciate that we're running out of licensed options for pain relief. I think gabapentin is also potentially a drug of misuse so I'm cautious with this too.

I do miss PLT (I'm sure I'm in line for mass extinction sometime soon ...)

RE: Tramadol

Busybee — Mon, 09 Oct 2017 22:41:06 GMT

For those using paracetamol as an addition to an NSAID, which formulation do you use? We have Pardale V on shelf but I've been put off using it in conjunction with NSAIDs due to the data sheet warning not to use alongside them. If something went wrong, you can bet the client will have read that part of the data sheet!

RE: Tramadol

Allison Gleadhill — Mon, 09 Oct 2017 22:20:02 GMT

Not an excuse to hand out tramadol but I think what we dispense is a small proportion of what is floating around & likely to be abused. I've just put through our pharmacological waste a shed load of tramadol coedine & diclofenac which one of our receptionist had been given but not used as a safe way of disposing ôf it. I had a client last week mention all the spare tramadol she had at home that the pharmacy which dispensed it wouldn't take back. I expect it will go in her bin and not be sold on the black market but it is there. Waste of nhs money as well as plenty available for those who are inclined to abuse it.

RE: Tramadol

bob lehner — Mon, 09 Oct 2017 20:41:44 GMT

I too have been puzzled by the rise in tramadol use over the past 10 years or so. It came out of nowhere and was suddenly flavour of the month. Every practice I visit seems to have bucket loads of it in the CD cabinet (or occasionally just out on the dispensary shelf - which I try and discourage). However, talking to practitioners in recent months it does seem to be rather falling out of favour and on the decline. I agree - it is a drug which should be treated with respect and not dished out like sweeties.

RE: Tramadol

Rob Loxley — Mon, 09 Oct 2017 19:44:20 GMT

[quote user="Neil Wheadon"]I honestly believe is a drug that has no place in our profession[/quote]

Not sure I agree entirely, I do think there are cases that benefit. I do think it became very popular ~5yrs ago and maybe has receded a little - the move to sched 3 might have had an impact? Looking at our dispensing it has reduced - maybe we've realised it's no 'wonder-drug' - and I personally have moved back to paracetamol as 1st adjunct to NSAID.

[quote user="Neil Wheadon"]are we really sure the dog is getting it?[/quote]

Or any of the SSRIs or TCAs or codeine or benzodiazepenes that we might dispense?

RE: Tramadol

Noweia — Mon, 09 Oct 2017 18:13:30 GMT

I tend to try it in dogs where and NSAID alone is not enough, or contraindicated. I give a short course first, and if the owner feels it has helped they can get more. Most tend to come back for more so I assume it must have some effect in at least a few dogs!

RE: Tramadol

Martin Atkinson — Mon, 09 Oct 2017 16:25:28 GMT

Dogs largely lack the appropriate receptors for Tramadol and of those that do it maybe only have a very short duration of an hour or so, so its effect is very variable to say the least and it would only be an analgesic of last resort here.

Re the human connection: wasn't Ant or Dec or both addicted to Tramadol? And the increase in large crashes in the professional cycling peloton a couple of years back was partly blamed on the (legal) use of Tramadol as a performance enhancer as it (obviously) masks pain and give a feeling of euphoria. Before the anti-cycling brigade jump in on this, other sports are just as guilty of doping if not more so, they just don't have as advanced an anti-doping programme so they don't get caught.

RE: Tramadol

David Mills — Mon, 09 Oct 2017 16:16:27 GMT

I appreciate the sentiment but unsure of the prevalence of abuse.

However, anecdote time. Given my clientele in the charity sector, you would suspect if a set of clients (statistically) were going to abuse it, ours would. However, have seen very few issues with it. There are some who "lose" their px after a few days, and they aren't given more. It is strictly enforced that only a month at a time, and no more repeats in that time.

It can be useful I think in some animals, mainly as a mild sedative to relax them rather than any great painkilling effect. However, I haven't used any for months. My current favourite is combining an nsaid and pardale, especially post-op ortho cases, and longer term OA cases.

RE: Tramadol

Bob Russell — Mon, 09 Oct 2017 15:36:14 GMT

We went through a period of using it quite often. It was being prescribed for patients by one of the referral centres.

I consider it useful at times but we now have few patients on it. It was a fashion for a bit.

We have always been very cautious with its dispensing but cannot completely rule out misuse.

One patient with really bad hips. Had hip replacement but that was complicated. Really does help her. Another one has it intermittently for suspected pancreatitis flare ups.

I do consider it has a place in practice but not perhaps as wide as thought a few years ago.

¼ of a population will not become addicted to heroin as a result of Tramadol access. Poor medical care where it is used in place of good diagnostic and surgical treatment?

Did not see the programme!