co-proxamol versus tramadol

[chouanne]

Has Tramadol replaced co-proxamol in term of prescribing anti pain relief for arthritis and joint diseases?
My husband was prescribed Tramadol for 1 year until he was operated on his shoulder. He complained of sleepness, even drowsiness and lack of energy. I thought it was a sort of sedative-pain relief medication. What is the main purpose of Tramadol?

[johnep]

Simply an opioid analgesic with drowsiness and sedating side effects characteristic of the group.

johnep

[Mensfuff]

Has Tramadol replaced co-proxamol in term of prescribing anti pain relief for arthritis and joint diseases?
My husband was prescribed Tramadol for 1 year until he was operated on his shoulder. He complained of sleepness, even drowsiness and lack of energy. I thought it was a sort of sedative-pain relief medication. What is the main purpose of Tramadol?

Dextropropoxyphene/Norpropoxyphene (constituent of Co-proxamol/active metabolite repectively) isn't the most useful opioid. It has a very long half-life (so takes a while to start working, and a while to stop working as well [several days in this case]) and isn't the best partner for paracetamol (which has a relatively short half life) (Paracetamol [325mg] and Dextropropoxyphene [32.5mg] being the ingredients in one Co-Proxamol tablet).

As such Tramadol (a single drug, not a combination product like Co-proxamol) would be an effective analgesic (pain-killing) alternative.

Tramadol has other activities other than activating Opiate receptors (which is how true opiates work, such as morphine etc.). It has SNRI (Serotonin and Noradrenaline re-uptake inhibitor) activity as well. If more serotonin is available (as less is re-uptaken into the pre-synaptic neurone) then a proportion will be converted into melatonin*, causing increased sedation and lethargy. As well as this, happiness and contentedness is usually associated with release of endorphins (a painkiller created by the body) which would result in an extra way of increasing analgesia.

A better alternative would be to use Paracetamol (500-1000mg [ONE or TWO tablets {500mg tablets}] four times a day [QDS] when required [PRN]) as well as using Codeine Phosphate (30-60mg [ONE or TWO {30mg tablets}] four times a day [QDS] when required [PRN]) as well, as this would provide flexibility to the patient (i.e. if there is no/little pain, Codeine may only be needed once or twice a day)

This would follow the standard guidelines (forgotten which guidelines) for pain management up to stage 2, and if this doesn't relieve the pain completely, then more effective methods can be used (introducing a NSAID etc.).




* In SAD (seasonal affective disorder), the reduced amount of light detected (UV wavelengths i assume) by the body causes production of more Melatonin (the sleep hormone), causing the normal tiredness felt at night-time. As Melatonin is created from Serotonin (the 'happy hormone'), Serotonin is depleted when the nights are longest (e.g. winter time). As Serotonin is lowest at this time of year (due to lots being coverted to Melatonin), some people feel very low during this season - hence 'Seasonal Affective Disorder'

Hope this helps

[Rafael]

whoever taught you that a weak opoid and paracetamol are followed by NSIAD in the step-wise management ladder, was wrong.

[Fleegle]

I think he means the NSAID would be introduced in combination.