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ISRN Family Med. 2013 Apr 11;2013:638469. doi: 10.5402/2013/638469. eCollection 2013.

Tramadol/Paracetamol fixed-dose combination for chronic pain management in family practice: a clinical review.

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Centro de Salud Universitario Goya, c/O'Donnell 55, 28009 Madrid, Spain.
Johns Hopkins University, Baltimore, MD 21287, USA ; Association of Chronic Pain Patients, Houston, TX 77515, USA.
Arthritis Center Twente (MST & UT), P.O. Box 50.000, 7500KA Enschede, The Netherlands.
Department of Endocrinology, Diabetology and Osteology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland.
Kansas University Medical Center, Kansas City, KS 66160, USA ; International Clinic Research, Overland Park, KS 66210, USA.
Department of Pain Medicine, Beaumont Hospital, Beaumont, Dublin 9, Ireland.
Service de Médecine Interne et Consultation de la Douleur, Hôpital Dieu, 75004 Paris, France.
Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia, PA 19140, USA.


The family practitioner plays an important role in the prevention, diagnosis, and early management of chronic pain. He/she is generally the first to be consulted, the one most familiar with the patients and their medical history, and is likely the first to be alerted in case of inadequate pain control or safety and tolerability issues. The family practitioner should therefore be at the center of the multidisciplinary team involved in a patient's pain management. The most frequent indications associated with chronic pain in family practice are of musculoskeletal origin, and the pain is often multimechanistic. Fixed-dose combination analgesics combine compounds with different mechanisms of action; their broader analgesic spectrum and potentially synergistic analgesic efficacy and improved benefit/risk ratio might thus be useful. A pain specialist meeting held in November 2010 agreed that the fixed-dose combination tramadol/paracetamol might be a useful pharmacological option for chronic pain management in family practice. The combination is effective in a variety of pain conditions with generally good tolerability. Particularly in elderly patients, it might be considered as an alternative to conventional analgesics such as NSAIDs, which should be used rarely with caution in this population.

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