The benets of tramadol are small and the side effects may cause people to stop taking it which

may
limit how useful tramadol is to treat osteoarthritis.
Tramadol is increasingly used for the treatment of OA because, in contrast to NSAIDs (Reig 2002;
Zhang 2004), tramadol does not produce gastrointestinal bleeding or renal problems, and doesnot
affect articular cartilage. Tramadol is an atypical opioid, as it exhibits a dual mechanism of action:
tramadol activates opioid receptors and descending inhibitory pain systems (Gibson 1996). This dual
action makes tramadol an attractive option.
The effectiveness of tramadol in OA is unclear: tramadol lacks peripheral action (i.e. it has no antiinammatory properties) and its effectiveness may decline with chronic use (i.e. development of
tolerance), as part of its action is opioid-related. Nonetheless, the central action of tramadol could be
of great benet as this action could decrease the central neuronal sensitization produced by the
persistent nociceptive peripheral input (Jett 1997). In addition, tolerance may not substantially affect
long term effectiveness. Systematic reviews have shown that 44% of participants prescribed opioids
for chronic noncancer pain continued to take opioids for up to 24 months (Kalso 2004).