The effects of tramadol on pain relief, fast EEG-power spectrum and cognitive function in elderly patients with chronic osteoarthritis (OA)

Pain and cognitive impairment in the elderly patient with osteoarthritis (OA) often is managed inadequately with common NSAIDs. We therefore evaluated the opioid-like agent tramadol, preportedly also acting as a monaminergic reuptake inhibitor. Patients (75 years ± 7S.D.; 17 female, 2 male) with chronic OA of the knee, elbow, shoulder and hip complaining of acute pain were given two 50 mg/70 kg oral doses of tramadol 30 min apart. Before, during and 2 h after medication, the following parameters were measured: 1. Heart rate (HR) and blood pressure (BP). 2. Visual analogue scaling (VAS) of pain associated with movement. 3. Relative changes in the EEG-power spectra (δ, θ, α, β) to control, over a 60 s period. 4. Cognitive function using the Sandoz Clinical Assessment Geriatric scale (SCAG). Patients experienced a significant ( p < 0.01) reduction in VAS assessed pain from 7.8 ± 2.0 to 2.2 ± 0.5. In the EEG, power in δ (0.5–3 Hz) dropped from 50 to 35% ( p < 0.005), α (8–13 Hz) increased from 12 to 25% ( p < 0.001) and β (13–30 Hz) from 23 to 37% ( p < 0.001). There was an improvement ( p < 0.001) in both severities of depression and cognitive function scoring. There were no significant changes in HR or BP. In addition to pain relief, tramadol also improved mood, the ability to perform tasks and reversed disability in cognitively impaired elderly. Subsequent to this pilot trial further studies of tramadol in the elderly are warranted.