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Tramadol for moderate cancer pain: a reappraisal
  1. Tatsuma Sakaguchi1,
  2. Toru Kajiyama1,
  3. Mafumi Miyake2 and
  4. Toshiro Katayama3
  1. 1 Department of Palliative Care, Kitano Hospital, Osaka, Japan
  2. 2 Department of Pharmacology, Kitano Hospital, Osaka, Japan
  3. 3 Department of Medical Engineering, Morinomiya University of Medical Sciences, Osaka, Japan
  1. Correspondence to Tatsuma Sakaguchi, Department of palliative care, Kitano Hospital, Osaka 530-8480, Japan; sakaguchi.tatsuma{at}

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According to the results of a recent trial, moving directly from non-opioid analgesics to strong opioids is increasingly preferred in palliative care.1 Then, will weak opioids be unnecessary in cancer pain management? One of the most useful weak opioids is tramadol, which is a centrally acting analgesic agonist of μ-opioid receptors. Moreover, tramadol differs from codeine, another weak opioid, in that it inhibits monoamine (norepinephrine–serotonin) reuptake as its analgesic mechanism of action, and has a once-daily extended-release formulation. Tramadol may be particularly useful for patients who are more sensitive to the adverse effects of strong opioids.2


We evaluated the effectiveness and safety of tramadol hydrochloride extended-release tablets in opioid-naïve patients with cancer pain in a retrospective, single-centre study (from March 2020 to February 2022). Medical records of 44 consecutive Japanese patients were extracted for whom tramadol hydrochloride extended-release tablets (Onetram; Nippon Shinyaku Co, Kyoto, Japan) were prescribed. Moderate and severe cancer pain was determined as an average pain intensity within 24 hours on a numerical rating scale (NRS) of 4–6 and 7–10, respectively. Two patients who became unable to take oral medication or died within 7 days of starting tramadol were excluded. Tramadol was prescribed initially at 100 mg once daily, then it could be increased sequentially up to 300 mg/day. If tramadol was completely ineffective or the patient was no longer able to take oral medication, tramadol was switched to strong opioids. For the treatment of …

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  • Contributors TS and TKaj contributed equally to the conception and design of the study, collection and analysis of the study data, interpretation and drafting of the manuscript. MM and TKat contributed to the collection and analysis of research data, and critical revision of the manuscript for important intellectual content.

  • Funding This research was supported by a grant from the Osaka Cancer Society in 2021.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.