Department for Health Economics, Health Policy and Outcome Research, Centre for Social Policy Research, University of Bremen, Bremen, Germany.
Pharmacoepidemiol Drug Saf. 2012 Sep;21(9):1013-21. doi: 10.1002/pds.3266. Epub 2012 Jun 6.
Tramadol is a weak opioid according to the World Health Organization pain ladder step II. It is one of the most prescribed analgesic substances in Germany, but tramadol and the step II opioids are very controversially discussed. We analysed patients with filled tramadol prescriptions with special emphasis on high use.
We used data from a German statutory health insurance for the year 2007. Patients older than 17 years with at least one tramadol prescription were analysed concerning demographic data, pain diagnoses, comorbidities, concomitant opioids, physician contacts and number of different prescribed substances. We fitted a logistic regression model to find relevant associations with high use (defined as >180 daily defined doses per year).
From 22 ,946 insurants with filled tramadol prescriptions, 7.9% (n = 1812) are identified as high users; 90.9% of all tramadol patients and 93.1% of the high users have at least one pain diagnosis. The most frequent diagnoses are back pain (78.4% vs 77.1%) and arthritis pain (37.9% vs 41.8%). The results of the logistic regression model show associations between high use of tramadol and rising age, unspecific pain diagnoses, psychiatric co-morbidities, additional prescribed strong opioids and a high number of physician contacts.
Despite some limitations, this study shows the prescriptions of tramadol in Germany in an authentic way. It seems that there are some 'challenging' patients that present a treatment dilemma for some prescribers. This might result in a high use of tramadol.
曲马多属于世界卫生组织疼痛阶梯 II 中的弱阿片类药物。它是德国使用最广泛的处方止痛药之一，但曲马多和 II 类阿片类药物存在很大争议。我们分析了使用曲马多处方的患者，重点关注高用量的患者。
我们使用了德国法定健康保险的数据，对 2007 年至少有一份曲马多处方的 17 岁以上患者进行了分析，内容包括人口统计学数据、疼痛诊断、合并症、同时使用的阿片类药物、医生就诊次数和开处的不同药物数量。我们拟合了一个逻辑回归模型，以寻找与高用量（定义为每年>180 日剂量）相关的因素。
在 22946 名使用过曲马多的被保险者中，有 7.9%（n=1812）被确定为高用量者；90.9%的曲马多患者和 93.1%的高用量者至少有一种疼痛诊断。最常见的诊断是背痛（78.4%对 77.1%）和关节炎疼痛（37.9%对 41.8%）。逻辑回归模型的结果显示，高用量曲马多与年龄增长、非特异性疼痛诊断、精神合并症、同时处方强阿片类药物和就诊次数增加有关。
尽管存在一些局限性，本研究仍以真实的方式展示了德国曲马多的处方情况。似乎存在一些“棘手”的患者，这给一些医生的治疗带来了困境，导致曲马多的高用量。
