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      Tramadol/paracetamol fixed-dose combination in the treatment of moderate to severe pain

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          Pain is the most common reason patients seek medical attention and pain relief has been put forward as an ethical obligation of clinicians and a fundamental human right. However, pain management is challenging because the pathophysiology of pain is complex and not completely understood. Widely used analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol (acetaminophen) have been associated with adverse events. Adverse event rates are of concern, especially in long-term treatment or at high doses. Paracetamol and NSAIDs are available by prescription, over the counter, and in combination preparations. Patients may be unaware of the risk associated with high dosages or long-term use of paracetamol and NSAIDs. Clinicians should encourage patients to disclose all medications they take in a “do ask, do tell” approach that includes patient education about the risks and benefits of common pain relievers. The ideal pain reliever would have few risks and enhanced analgesic efficacy. Fixed-dose combination analgesics with two or more agents may offer additive or synergistic benefits to treat the multiple mechanisms of pain. Therefore, pain may be effectively treated while toxicity is reduced due to lower doses. One recent fixed-dose combination analgesic product combines tramadol, a centrally acting weak opioid analgesic, with low-dose paracetamol. Evidence-based guidelines recognize the potential value of combination analgesics in specific situations. The current guideline-based paradigm for pain treatment recommends NSAIDs for ongoing use with analgesics such as opioids to manage flares. However, the treatment model should evolve how to use low-dose combination products to manage pain with occasional use of NSAIDs for flares to avoid long-term and high-dose treatment with these analgesics. A next step in pain management guidelines should be targeted therapy when possible, or low-dose combination therapy or both, to achieve maximal efficacy with minimal toxicity.

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          Author and article information

          J Pain Res
          J Pain Res
          Journal of Pain Research
          Dove Medical Press
          29 August 2012
          : 5
          : 327-346
          [1 ]Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
          [2 ]Association of Chronic Pain Patients, Houston, TX, USA
          [3 ]Arthritis Center Twente (MST and UT), Enschede, The Netherlands
          [4 ]Anaesthetics Laboratory, St Bartholomew’s Hospital, London, UK
          [5 ]Department of Endocrinology, Diabetology and Osteology, Kantonsspital St Gallen, St Gallen, Switzerland
          [6 ]Centro de Salud Universitario Goya, Madrid, Spain
          [7 ]Kansas University Medical Center, Kansas City, KS, USA
          [8 ]International Clinic Research, Leawood, KS, USA
          [9 ]Department of Pain Management, Beaumont Hospital, Beaumont, Dublin, Ireland
          [10 ]Service de Médecine Interne et Consultation de la Douleur, Hôpital Dieu, Paris, France
          [11 ]Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia, PA, USA
          Author notes
          Correspondence: Joseph V Pergolizzi Jr, NEMA Research, Inc, 840-111th Avenue N, Naples, FL 34108-1877, USA, Tel +1 239 597 3662, Fax +1 239 597 7566, Email jpjmd@ 123456msn.com
          © 2012 Pergolizzi Jr et al, publisher and licensee Dove Medical Press Ltd.

          This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

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