Opioid use in Denmark: Almost 50% of tramadol users suffer from chronic pain
Opioids have been proven largely ineffective for chronic noncancer pain and their use comes with risks of dependency. Yet, a nationwide study conducted in Denmark shows that many patients with chronic noncancer pain receive inappropriate long-term treatment with the opioid painkiller tramadol.
By Carrinna A. Hansen
A nationwide study, recently published in the Scandinavian Journal of Pain, shows that 45.7% of Danish people with a prescription for the opioid tramadol have a chronic pain diagnosis. Data on tramadol purchases made by Danish citizens over the age of 16 was gathered over a twelve-year period and analyzed by the authors, resulting in a cohort of over 940,000 people being included in the study.
Opioids for chronic noncancer pain are known to be largely ineffective in the longer-term, in other words, beyond the acute phase of the trauma or pain condition. Accordingly, artificial morphine-like opioid agents for moderate to severe pain, such as tramadol (classed as a weak opioid), have been proven to be only modestly effective or not effective at all for chronic noncancer pain. Moreover, the risk of dependency is far more common than was known just a decade ago. As with conventional opioids, tramadol has been linked to apnea and death.
Does Denmark have an opioid problem?
The researchers state that, in light of what seems to be an almost global crisis of overuse, abuse and improper prescription of opioids, their study provides new knowledge of risk factors to be aware of. These characterise the long-term use of tramadol among the Danish population of chronic noncancer pain patients (155,981 individuals), as well as within the general noncancer population (124,304 individuals).
The study highlights a general need for increased care when prescribing opioid painkillers, especially for people with chronic noncancer pain. This should include a focus on comorbidities such as diabetes, pulmonary diseases, osteoporosis and dementia. Interestingly, the study also identifies some inequality in tramadol use between different regions of Denmark. Additionally, it is known that the metabolization of tramadol in the human body is variable and unpredictable, and is contingent on ethnic differences, meaning that the risk of developing opioid dependency differs among ethnic groups.
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