CR tramadol doses were titrated to a maximum of 200 mg, 300 mg or 400 mg per day. SR diclofenac doses were titrated to 75 mg or 100 mg once daily, or 75 mg twice a day based on pain relief and the presence of side effects. For rescue analgesic, patients took acetaminophen as needed, up to 650 mg three times a day.
While μ-opioid agonists have undesirable effects on gastrointestinal function, resulting in nausea, emesis, abdominal cramps and especially constipation, these effects are less severe with tramadol, and attenuate over time ( 38 ). Compared with other centrally acting analgesics, tramadol has no clinically relevant cardiovascular effects ( 37 ) and insignificant effects on respiration ( 14 ). Tramadol has only a minor delaying effect on colonic transit, and no effect on upper gastrointestinal transit or gut smooth muscle tone ( 38 ).
An immediate-release (IR) formulation of tramadol was compared with NSAIDs in two randomized, double-blind trials ( 21, 22 ) in patients with OA pain of at least moderate intensity.
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