A very common medication combo prescribed to patients with chronic pain is tramadol (Ultram) plus an antidepressant. However, new research may call into question whether this is a good idea. Let’s dig in.
Depression and Pain
One of the biggest chicken and egg controversies that has been zinging around in chronic pain treatment circles for decades is whether pain causes depression or depression causes pain. I’ve always been mostly in the former camp, but many physicians are in the latter.
Because of this association patients in pain are often prescribed antidepressants. In addition, when they still have pain, a common pain killer that’s prescribed is Tramadol. What’s that?
Tramadol is also called Ultram here in the U.S. and ConZip elsewhere. While many patients don’t know this, it’s actually an opioid that acts at a different pain receptor than traditional narcotics. It’s also a prodrug.
Some types of narcotic analgesics, called prodrug opioids, rely on a particular liver enzyme (CYP2D6) to convert them into a form the body can use to target pain. It was already known, from a study published earlier this year, that SSRIs like those mentioned above, decrease the pain–relieving abilities of these prodrug analgesics.
More recently, researchers looked at the records of patients who were either admitted for observation or were hospitalized as inpatients for pain control. The patients reviewed had been given tramadol for a minimum of 24 hours. The study showed that patients who were also taking SSRIs needed up to four times the amount of tramadol to control their “breakthrough” pain than those who were not taking the antidepressants.
What’s the Answer?
Many people who suffer from chronic pain are depressed and take medications. Many people who have chronic pain also take pain medications. So what’s the answer?
The answer is to figure out what’s causing the pain and treat it without surgery using interventional orthopedics. To start on that journey, read my book, orthopedics 2.0:
The upshot? Be cautious about taking Tramadol with an antidepressant drug. In the meantime, your best move is to make sure that you figure out what’s causing the pain and get it treated without surgery!