As a veterinarian who frequently works with pet owners to manage chronic and painful conditions, I have long utilized tramadol as one of the many weapons in our arsenal to battle pain and support the quality of life of dogs and cats in my care.
So imagine my surprise and potential embarrassment to review a recent study in the Journal of the American Veterinary Medical Association (JAVMA) which reports on the lack of effectiveness of tramadol in dogs. So should we stop using Tramadol in dogs?
Tramadol has been touted and utilized as an “opioid-like” drug for pain but studies in dogs have suggested that dogs produce very little of the active metabolite that activates the mu opioid receptor responsible for such analgesic effects. Nevertheless, many veterinarians (myself included) were trained prescribing tramadol and have used it in our practices and felt that it was helpful to many patients.
A study published on Feb 15, 2018 evaluated a randomized, controlled, and placebo controlled study to evaluate the effectiveness of tramadol. Randomized and placebo-controlled studies represent a “gold-standard” clinical study design as it removes many (but not all) potential sources of study bias or false results.
This was a particularly interesting study design in that dogs with osteoarthritis were randomly scheduled to receive 3 treatments in random order. They received either carprofen (an NSAID or “aspirin-like” drug), a placebo consisting of lactose powder, or tramadol and continued each medication for 10 days.
While under treatment, they had measurements on force platforms performed to look for gait changes at the beginning and end of treatment with each drug. What they found is that dogs treated with carprofen had significant improvement but that placebo and tramadol treatments resulted in no change in force measurements.
In addition, all dogs were scored on a pain scoring system by their owners and tramadol resulted in no significant difference compared to placebo whereas carprofen did yield improvement compared to the other two treatments.
While there are some reasonable critiques of any study and several alternative theories that suggest that tramadol has utility in a pain management regimen, seeing a study like this certainly gives us pause to question some of the recommendations we have made and to ask whether we should make changes to how we practice with respect to pain management.
I am grateful that one of my veterinary colleagues was able to execute a thoughtfully designed study with valuable data.