Department of Family Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.
Department of Medicine, Yonsei University Graduate School, Seoul, Republic of Korea.
Sci Rep. 2024 Oct 11;14(1):23850. doi: 10.1038/s41598-024-74817-3.
We aimed to assess the association of tramadol use with the risk of dementia. This population-based retrospective cohort study using the Korean National Health Insurance Service database included a total of 1,865,827 older adult patients aged 60 years or older with common musculoskeletal pain between January 1, 2003, and December 31, 2007. Individuals who were newly dispensed tramadol (N = 41,963) were identified and propensity score-matched with those who were not (N = 41,963). Over a maximum of 14-year follow-up, the incidence rates (events per 1000 person-years) of all-cause dementia were 6.1 for nonusers, 6.2 for those with cumulative tramadol use of 1-14 days, 7.7 for those with 15-90 days of use, and 8.0 for those with > 90 days of use. Longer cumulative duration of tramadol use was associated with an increased risk of all-cause dementia compared with nonuse (1 to 14 days: aHR 1.06, 95% CI 0.96-1.17; 15 to 90 days: aHR 1.14, 95% CI 1.10-1.35; and more than 90 days: aHR 1.18, 95% CI 1.00-1.39; test for trend: P < 0.001). The results showed a similar pattern for Alzheimer's disease and were robust across subgroup and sensitivity analyses, but not for vascular dementia. This study found that exposure to tramadol was associated with an increased risk of dementia. Taking this potential risk into consideration, clinicians should carefully weigh potential benefits and risks when prescribing tramadol to older adults with musculoskeletal pain.
我们旨在评估曲马多使用与痴呆风险的关联。这项基于人群的回顾性队列研究使用韩国国家健康保险服务数据库，共纳入了 2003 年 1 月 1 日至 2007 年 12 月 31 日期间年龄在 60 岁及以上、患有常见肌肉骨骼疼痛的 1865827 名老年患者。确定了新开具曲马多（N=41963）的个体，并与未开具曲马多的个体（N=41963）进行倾向评分匹配。在最长 14 年的随访期间，所有原因痴呆的发生率（每 1000 人年事件数）为：未使用者为 6.1，累积曲马多使用 1-14 天者为 6.2，使用 15-90 天者为 7.7，使用超过 90 天者为 8.0。与未使用者相比，累积使用曲马多时间越长，全因痴呆的风险越高（1-14 天：aHR 1.06，95%CI 0.96-1.17；15-90 天：aHR 1.14，95%CI 1.10-1.35；使用超过 90 天：aHR 1.18，95%CI 1.00-1.39；趋势检验：P<0.001）。对于阿尔茨海默病，结果显示出类似的模式，且在亚组和敏感性分析中均具有稳健性，但对于血管性痴呆则不然。本研究发现，接触曲马多与痴呆风险增加有关。考虑到这种潜在风险，临床医生在为患有肌肉骨骼疼痛的老年患者开具曲马多时，应仔细权衡潜在的益处和风险。
