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. 2019 Oct 30;5(1):68.
doi: 10.1186/s40981-019-0289-z.

Therapeutic experience with tramadol for opioid dependence in a patient with chronic low back pain: a case report

Marie Shigematsu-Locatelli  1 , Takashi Kawano  2 , Tsuyoshi Koyama  1 , Hideki Iwata  1 , Atsushi Nishigaki  1 , Bun Aoyama  1 , Hiroki Tateiwa  1 , Noriko Kitaoka  1 , Masataka Yokoyama  1
Affiliations

Therapeutic experience with tramadol for opioid dependence in a patient with chronic low back pain: a case report

Marie Shigematsu-Locatelli et al. JA Clin Rep. .

Abstract

Background: Long-term opioid treatment for chronic non-cancer pain has become controversial, given the increasing prevalence of opioid dependence. However, there is little information on therapeutic strategies for this condition in Japanese patients. Here, we present a case of successful management of iatrogenic opioid dependence with tramadol in a patient with chronic low back pain.

Case presentation: A 68-year-old male suffering from intractable low back pain was referred to our pain clinic. He was previously treated in another hospital with transdermal fentanyl patches 6 mg/day and fentanyl sublingual tablets (100 μg as required) for this condition. On the basis of medical examination, including a review of the patient's medical history, physical examination, X-ray, and his family statement, we diagnosed him with iatrogenic opioid dependence due to inadequate fentanyl use. Then, we developed a treatment plan consisting in fentanyl detoxification with a weak opioid, tramadol. At first, the use of fentanyl sublingual tablets was interrupted after obtaining informed consent. Then, we reduced the dose of transdermal fentanyl 1 mg per 4-5 days replacing with oral sustained-release tramadol. The patient developed mild to moderate withdrawal symptoms during this period, which could be effectively managed by supportive treatments. The hospital psychiatry liaison team continuously provided the patient and his wife with information, counseling, and education regarding the treatment of opioid dependence. Throughout the detoxification process, his reported pain did not exacerbate, even slightly improved over time. The final prescription was sustained-release tramadol 300 mg/day without fentanyl, and his activities of daily living drastically improved. However, unfortunately, he died due to an aortic dissection of stent-graft edge 65 days after surgery.

Conclusions: Our case highlighted that sustained-release tramadol could be effectively applied as a detoxification agent for iatrogenic opioid dependence in patients with chronic non-cancer pain.

Keywords: Chronic pain; Opioid dependence; Tramadol.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
A radiograph of lateral lumbar spine. Compression fracture of L4 vertebral body is observed
Fig. 2
Fig. 2
Time course of fentanyl detoxification with sustained-release tramadol. Pain intensity was assessed using the NRS (Numerical Rating Scale)
See this image and copyright information in PMC

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