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Question
A recent study looked at
Back pain is the most common pain complaint worldwide
-Accounted for about 9% of all ED visits.
Summary: ED use of tramadol for back pain doubled from 2007 to 2016 despite an overall decrease in opioid use (in that period)
Tramadol -- either administered in the ED or prescribed -- was used in 8.4% of back pain visits in 2016, up from 4.1% in 2007 (P=0.001).
In 2007, overall opioid use was 53.5%; in 2016, it was 46.5% (P=0.001). The largest drop was in hydrocodone use.
A recent study in JAMA looked at the risk of death in 90,000 people one year after filling a Rx for tramadol vs. one of several other analgesics such as naproxen, diclofenac or codeine.
All patients were aged 50 years or older and has osteoarthritis.
Initial Rx for tramadol was associated with a higher rate of mortality than with NSAIDs (but not compared to codeine).
Answer
References
Zeng et al., 2019. Association of Tramadol With All-Cause Mortality Among Patients With Osteoarthritis. JAMA 2019 March 12;321(10):969-982.
Mullins et al., 2020. Trends in Evaluation and Management of Back Pain in United States Emergency Departments (2007-2016). AAAPM 2020.