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Tramadol in addition to NSAIDs for canine osteoarthritis

Clinical Scenario

Billie is a 12 year old female neutered Border Collie with osteoarthritis. She has been on meloxicam, a non-steroidal anti-inflammatory drug (NSAID) for over a year, however recently her arthritis has been getting worse. Her owner has read on a dog owner forum that you can add in tramadol to the treatment regime for dogs who are struggling with their arthritis. You wonder whether there is any evidence that adding in tramadol will lead to greater clinical improvement, compared with NSAIDs alone.

3-Part Question (PICO)

In [dogs with osteoarthritis] does treatment with [tramadol and a NSAID compared to a NSAID alone] lead to [better clinical improvement]?

Search Strategy and Summary of Evidence

Search Strategy

MEDLINE(R) In-Process & Other Non-Indexed Citations and MEDLINE(R) 1946 to Present using the OVID interface

dog.mp. OR dogs.mp. OR canine.mp. OR canines.mp. OR canis.mp. OR exp Dogs/

AND

osteoarthriti$.mp. OR arthriti$.mp. OR joint disease$.mp. OR DJD.mp. OR osteoarthrosis.mp. OR OA.mp. OR exp Osteoarthritis/ OR exp Arthritis/ OR exp Joint Diseases/

AND

tramadol.mp. OR ultram.mp. OR ryzolt.mp. OR NSAID.mp. OR NSAIDs.mp. OR non steroidal.mp. OR non steroidals.mp. OR nonsteroidal.mp. OR nonsteroidals.mp. OR exp Tramadol/ OR exp Anti-inflammatory agents, Non-Steroidal/

CAB Abstracts 1910 to Present using the OVID interface

dog.mp. OR dogs.mp. OR canine.mp. OR canines.mp. OR canis.mp. OR exp dogs/

AND

osteoarthriti$.mp. OR arthriti$.mp. OR joint disease$.mp. OR DJD.mp. OR osteoarthrosis.mp. OR OA.mp. OR exp osteoarthritis/ OR exp arthritis/ OR exp joint diseases/

AND

tramadol.mp. OR ultram.mp. OR ryzolt.mp. OR NSAID.mp. OR NSAIDs.mp. OR non steroidal.mp. OR non steroidals.mp. OR nonsteroidal.mp. OR nonsteroidals.mp. OR exp non-steroidal antiinflammatory agents/

Search Outcome

MEDLINE

  • 314 papers found in MEDLINE search
  • 312 papers excluded as they don't meet the PICO question
  • 0 papers excluded as they are in a foreign language
  • 2 papers excluded as they are review articles/in vitro research/conference proceedings
  • 0 total relevant papers from MEDLINE

CAB Abstracts

  • 308 papers found in CAB search
  • 296 papers excluded as they don't meet the PICO question
  • 0 papers excluded as they are in a foreign language
  • 12 papers excluded as they are review articles/in vitro research/conference proceedings
  • 0 total relevant papers from CAB

Total relevant papers

0 relevant papers from both MEDLINE and CAB Abstracts

Comments

No citations have been included in this BET as none of the papers found directly compared tramadol plus NSAIDs with NSAIDs alone (ie. they did not answer the PICO question) or were review articles, conference proceedings or letters. Therefore, the table of evidence below has been left blank. 

Summary of Evidence

No Summary of Evidence yet.

Comments

Numerous results were found discussing the use of pharmaceuticals such as tramadol in addition to non-steroidal anti-inflammatory drugs for dogs with refractory osteoarthritis, suggesting this is a popular topic of discussion. However all of these results were expert opinion pieces, conference proceedings or letters, and none of the peer-reviewed articles found directly examined the benefits of adding tramadol to the treatment regime in addition to an NSAID.

Narrative reviews and expert opinion pieces, along with other sources such as textbooks and online resources (e.g. Vetstream/Vetlexicon or The Merck Veterinary Manual), can be used when deciding which treatment(s) to use. However, an awareness of the strengths and limitations of all of these evidence sources in relation to decision-making is important.

As tramadol is not licensed for the treatment of canine osteoarthritis in the UK, the prescribing cascade (https://www.gov.uk/guidance/the-cascade-prescribing-unauthorised-medicines) should be considered when making treatment decisions. Internationally, local licensing regulations should be considered. There is a need for further research to directly compare these two treatment choices, in order to improve the strength of the evidence base in this area. 

Bottom line

At the present time there is no peer-reviewed evidence comparing the treatment regimes in this BET. Therefore, when deciding whether to add tramadol to a NSAID treatment regime, practitioners should take into account their own clinical experience and local licensing regulations.

Disclaimer

The BETs on this website are a summary of the evidence found on a topic and are not clinical guidelines. It is the responsibility of the individual veterinary surgeon to ensure appropriate decisions are made based on the specific circumstances of patients under their care, taking into account other factors such as local licensing regulations. Read small print

References

About this BET

First author:
Natalie Robinson
Second author:
Marnie Brennan
Institution:

CEVM, University of Nottingham

Search last performed:
2016-04-28 08:20:37
Original publication date:
2016-04-29 08:20:37
Last updated:
2016-04-29 08:20:37
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