Pain Relief Drug Tramadol Associated with Hypoglycemia Interview with:
Ruben Abagyan, Ph.D.

Dr. Abagyan

Professor, University of California, San Diego
Skaggs School of Pharmacy & Pharmaceutical Sciences
San Diego Supercomputer Center  What is the background for this study?  What are the main findings?

Response: The background for this study was concern about unknown side effects of tramadol that became a popular treatment for chronic pain. With our informatics approach and access to millions of the FDA reports we were in a position to look for those adverse effects and we found that hyperglycemia (low blood sugar) is one of those concerns. There have been a few small-scale studies and case reports of tramadol use associated with hypoglycemia and hospitalizations related to it. The dramatic increase in tramadol prescription rates, especially in light of tighter control over hydocodone/acetaminophen (went from schedule III to II), warranted a larger scale postmarketing study of FDA FAERS reports.

As we compared the hypoglycemia side effect between different opioids we found that only one other drug, methadone (used to treat drug abuse and addiction), has a comparable association with hypoglycemia. What should readers take away from your report?

Response: Patients using tramadol should should be aware of hypoglycemia symptoms such as shakiness, dizziness, sweating, hunger, irritability, moodiness, anxiety/nervousness, and headache, or, in severe cases, blurred vision, seizures or loss of consiousness.  The same applies to methadone, also known as Dolophine. What recommendations do you have for future research as a result of this work?

Response: It may be beneficial to perform controlled studies to confirm and understand this association. Our study looked at other drugs with the known pharmacology of tramadol (mu-opioid agonism, serotonin/norepinephrine re-uptake inhibition, and NMDAR antagonism), but did not find an association with hypoglycemia with a specific class.  Would be interesting to learn more about additional/other pharmacology of tramadol and methadone behind the etiology of hypoglycemia. Is there anything else you would like to add?

Response: We think that studies of this nature are beneficial since rare side effects often go unnoticed in clinical trials due to a limited number of participants. Additionally, hypoglycemia effects may often be attributed to other medications and medical conditions, while tramadol or methadone were unlikely to cause suspicion.

Any disclosures?

Non of the authors have any financial or non-financial conflicts of interest to disclose. 


Tigran Makunts, Andrew U, Rabia S. Atayee, Ruben Abagyan. Retrospective analysis reveals significant association of hypoglycemia with tramadol and methadone in contrast to other opioids. Scientific Reports, 2019; 9 (1) DOI: 10.1038/s41598-019-48955-y

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Palliative Care at Home Linked To Greater Pain Relief, Regardless of Illness Interview with:

Dr Yousuf El Mokhallalati  MD, MPH and PhD candidate
Research Assistant, and PhD candidate
Academic Unit of Palliative Care
Leeds Institute of Health Sciences (LIHS)
University of Leeds
Leeds, UK  What is the background for this study?  What are the main findings?

Response: We examined the factors associated with good pain relief at before death, using data which was drawn from responses to the National Bereavement Survey (VOICES) in England between 2011 and 2015, which asked families or close relatives to reflect on the quality of care provided to a person who had died.

Just 10% of patients who died of a non-cancerous disease received palliative care at home, compared to 63% of cancer patients.

 The study revealed that people who accessed palliative care at home were 2.7 times more likely to have experienced good pain relief compared to those who did not receive palliative care.

The association between good pain relief and palliative care at home occurred regardless of the type of disease that patients had, but access to palliative care was not provided equally.

This research shows that palliative care is associated with significant benefits to people with every kind of progressive disease, but this is not reflected in the spread of people that are being offered palliative care.

The study also suggests that patients who had planned where they wanted to die are nearly twice as likely to experience good pain relief compared to those who had not, showing the value of planning ahead and coordinating the support of healthcare professionals.

Only a quarter of patients were found to have recorded a preferred place of death. Cancer patients were nearly three times more likely to have a preference recorded compared to non-cancer patients (36.6% of cancer patients versus 13.1% of non-cancer patients).

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Mindfulness-Based Stress Reduction & Cognitive Behavioral Therapy for Chronic Pain Relief Interview with:
Eve Ling-Khoo,MSc. OT Candidate, BSc. Hons
Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

"Cognitive Therapy | Fox Valley Institute, Naperville IL (630) 718-0717" by Fox valley Institute is licensed under CC BY 2.0. To view a copy of this license, visit:  What is the background for this study?  What are the main findings?

  • 20% of adults worldwide suffer from chronic pain which impacts all facets of well-being.
  • Cognitive behavioral therapy (CBT) is the current gold standard for psychological intervention, but not everyone responds to it.
  • Mindfulness-based stress reduction (MBSR) is an alternative with the potential to improve the quality of life of patients with chronic pain.
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Neck and Back Pain More Common in Diabetes Interview with:

Manuela L. Ferreira PhD
Institute of Bone and Joint Research
The Kolling Institute, Sydney Medical School

Paulo H. Ferreira PhD
Musculoskeletal Health Research Group
Faculty of Health Sciences
University of Sydney, Sydney, NSW, Australia  What is the background for this study?  What are the main findings?

Response: One in four Australians experience back pain or neck pain. Diabetes is also a worldwide prevalent condition, and currently affects over 382 million people. These two diseases often co-exist and have very similar underlying mechanisms, such as obesity and physical inactivity. We were unsure whether having one condition would lead to developing the other, however.

We have found 11 studies published to date, and assessing the relation between back or neck pain and diabetes. The studies included over 165,000 participants published in the USA, Canada, Finland, Denmark, Iran and Spain.

When we pooled the results of these studies together, we observed that people with type 2 diabetes are 35% more likely to also have low back pain (compared to people without diabetes). The risk of having severe back pain symptoms in people with type 2 diabetes is 63% higher and the risk of having severe neck pain is almost 30% higher, than in people with no diabetes.  We could not identify, however, whether type 2 diabetes can lead to back or neck pain, and it is possible that the two conditions are associated via other underlying mechanisms such as obesity and physical inactivity.

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Opioid-Induced Constipation

Chronic Pain Patients: Opioid Induced Constipation a Serious Concern After Surgery Interview with:

Jonathan Jahr, MD, DABA, FASA

Dr. Jonathan Jahr is an anesthesiologist in Los Angeles, California and is affiliated with multiple hospitals in the area, including UCLA Medical Center and UCLA Medical Center-Santa Monica. He received his medical degree from New York Medical College and has been in practice for more than 20 years.

Dr-Jonathan-Jahr  What is the background for this study?  Why is it important?

Response: I have worked in the hospital setting for the past 25 years and have conducted multiple studies on different opioid and non-opioid strategies for managing both chronic and acute pain. I also co-edited a textbook entitled Essence of Analgesia and Analgesics. My background and the research I’ve done sets the stage for newer pain management protocols that can provide patients with significant pain relief, and improved satisfaction and outcomes due to fewer or avoided opioid related side effects (ORADS) such as opioid-induced constipation (OIC).

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Survey Finds Women Use Weed for Stress, Pain Relief

The “Women and Weed Survey”, conducted online by CVI (Canadian Viewpoint Inc.), on behalf of Van der Pop, found women used cannabis ‘for wellness reasons versus for social experiences’, with many regular users citing their primary reason for doing so was “to manage stress or relieve anxiety, followed by to manage pain or to combat symptoms of a medical condition (27%) and to relax (17%).”

Study Reviews Imitrex Nasal Spray (sumatriptan) for Migraine Pain Relief

This study is systematic review and meta-analysis to evaluate the tolerability and efficacy of intranasal sumatriptan for the treatment of acute migraine attacks.  Taste disturbance was a leading side effect.

Intranasal sumatriptan for acute migraine attacks: a systematic review and meta-analysis.

Menshawy A1,2,3, Ahmed H2,4,5, Ismail A1,2,6, Abushouk AI7,8,9, Ghanem E1,2, Pallanti R1,10, Negida A2,4,5.
Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.