Tramadol Linked to Higher Mortality in Osteoarthritis. March 18, 2019

Tramadol (multiple brands) was associated with significantly higher all-cause mortality compared with nonsteroidal anti-inflammatory drugs (NSAIDs) among older patients with osteoarthritis (OA) in an observational study of more than 88,000 patients. The mortality risk with tramadol was similar to that associated with codeine.

Tramadol Linked to Higher Mortality in Osteoarthritis 
by  Janis C. Kelly.
https://www.medscape.com/viewarticle/910232?nlid=128661_381&src=WNL_mdplsnews_190315_mscpedit_wir&uac=164666HZ&spon=17&impID=1909067&faf=1

          So, what is "Tramadol" and for what condition it is prescribed? It is pain relive medicine. But in modern medicine there are a lot of attempt to put patient to weight reducing medicine. Diuretics is one of that kind. Tramadol is another. Tramadol was approved by FDA to treat patient who wish to lose weight. It is widely used by neurologist and by prime doctor to obese patient.  Diabetics type 2 usually obese, the edema all the time accompany diabetics with CVD and diabetics type 2 all do have it as a complication of wrongly treated or not treated diabetes. There is no diabetic without pain. Usually we do have headaches. Osteoarthritis is usually accompany diabetic type 2.
      When I started to take Tromadol I did not know about opiates. I simple followed to doctor's order. As soon as I took Tromadol the severe headache put me in bed. Nausea and vomiting followed. I hardly was able to breath. I do have COPD and Asthma. Cough is one condition I am in all the time. With Tramadol all get so bad, I did not know if I will be alive next morning.
      Then I called to doctor. What doctor said? He does not have any medicine for me. He tried all what he could. All medicine was to treat pain. No medicine to address to the cause of pain. Needless to say, medicine will never work, and pain will go nowhere.
      I do understand when people take this medicine because of they need it. To live with pain is misery. We are all the same, we will do all what is possible to get rid of pain. So, what is important part in treatment patient who is in pain? To set patient on the hook. Just go to Neurology clinic early in the morning. There are many people who sit in lobby awaiting doctor to come. Then one after another they go into doctor's office, and soon they leave. Now it is time to pay attention to the new comers, patients with moderate pain. It is time to re-stock medically dependent patients. We all get Rx to pain medicine, and it is opiates, highly addictive type of medicine. With time it will be no way to separate when pain is result of medical condition, and when pain is medically induced by doctor.
      First what doctor said to me when I come into his clinic:"No More Excedrin!" And it is Excedrin which keep me functional and alive more then 25 years by now. I am very sensitive to medicine, to food, to water. I will not be able to take medicine which bring harm to me. With time I accepted this lesson, and now I do not take any medicine which give me pain or any other side effects.

"Among patients aged 50 years and older with osteoarthritis, initial prescription of tramadol was associated with a significantly higher rate of mortality over 1 year of follow-up compared with commonly prescribed nonsteroidal anti-inflammatory drugs, but not compared with codeine," the authors write. "However, these findings may be susceptible to confounding by indication, and further research is needed to determine if this association is causal."

Just one year, and patient gone. Less then 10 years after being diagnosed with diabetes type 2 diabetic type 2 die, due to diabetes but more often due to all cause mortality. As I do remember doctor did not take a look at why do I have pain. He ordered some tests, and he said that all is well. No one test results was in my hands, why? Patient in condition of having stroke cannot be treated without medicine. But it is not what doctor needs.  Doctor Rx all medicine which is profitable to him or to his business. I got Rx to Botox. He said, it will help me to be headache-free. I had good Health Care Company. They paid all what doctor Rx. There were no pain relieve for me. When I come to office next time doctor said, he already sold the rest of Botox. A little bit for patient, more to the doctor's benefits.

 The authors explain, "participants in the tramadol cohort, in general, were older; had a higher BMI [body mass index]; had a longer duration of osteoarthritis; and had a higher prevalence of comorbidities (eg, peptic ulcer, chronic kidney disease, diabetes, hypertension, and cardiovascular diseases), other prescriptions (eg, other NSAIDs, other opioids, aspirin, statin, antihypertensive medicine, and antidiabetic medicine), and health care utilization than participants in the NSAIDs cohorts before propensity score matching. After matching, the characteristics between the 2 matched cohorts were well balanced, with all standardized differences less than 0.10."

Every diabetic type 2 has:
hypertention;
CVD;
CKD.
Every diabetic type 2 take statin, which never work, but Lipitor is too expensive, it is Brand medicine, not generic. It is working well but never in diabetic type 2 medical box.  
There are a lot of medicine to reduce hypertension. What type of this medicine is right for particular patient? What dose to use? No clue usually. There is some medicine in medical box to deal with high blood pressure, but this medicine does not work because of too low dose, or wrong type of medicine. 
Finally it is antidiabetic medicine. The name of medicine is perfectly answer to the goal of medical care. It is medicine do not help to live but to reduce diabetic type 2 population. It is
antidiabetic medicine! So,why do not add one more to get best result? Tromadol is perfect medicine to Medical Care goal. And very profitable for provider. If in stead of Life style modifications diabetic will use Lantus Solo Star then less painkillers will be needed. Less all cause mortality will be. It is not the goal. No one need old weak population. Every one need strong healthy well looking young. So, caravans of immigrants enter into US. Our time is up. This is why Tromadol approved by FDA as weight loss medicne for obese population. Tromadol will work much better then Metformin or Glipizide. Its effect work withing one year, compare with antidiabetic medicine which need to be taken at least 10 years. For that time diabetic type 2 get educated, stop to take trash medicine, and switch to insulin. Life going on. 

The study cohorts included 44,451 patients in the tramadol group, 2397 in the naproxen group, 5674 in the celecoxib group, 2946 in the etoricoxib group, and 16922 in the codeine group. The mean age of the patients was 70 years, and 61.2% were women.
All-cause mortality was determined for tramadol in comparison with each of the other drugs in matched cohorts during the 1-year follow-up. All-cause mortality per 1000 person-years was 23.5 vs 13.8 for tramadol vs naproxen (hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.41 – 2.07); 36.2 vs 19.2 for tramadol vs diclofenac (HR 1.88; 95% CI, 1.51 – 2.35), 31.2 vs 18.4 for tramadol vs celecoxib (HR, 1.70; 95% CI, 1.33 – 2.17), 25.7 vs 12.8 for tramadol vs etoricoxib (HR, 2.04; 95% CI, 1.37 – 3.03), and 32.2 vs 34.6 for tramadol vs codeine (HR, 0.96; 0.83 – 1.05).

One comment: "Studies consistently show that alternating OTC doses of acetaminophen and NSAIDs provides superior pain relief with fewer side effects than opioids. However, that is more complicated and requires patient education, and most prescribers are unwilling or unable to take that additional 2 minutes with a patient." 
         For the same reason there is no time doctor has to listen to the patient and Rx insulin. No, to Rx life style modification is better, never any responsibility, and no wrong treatment. Who can say that live healthy life style is wrong? No one. It is right all the time. Just come to patient bed, and say, Live Healthy!!!!!!!!!!!!  If patient does not go out of bed, this mean, he/she does not want to live healthy, and it is patient's choice to be ill. Brilliant! We even do not need trash medicine. Just live as doctor ordered.

via Ravenvoron