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The Journal of Headache and Pain
Published in: The Journal of Headache and Pain 1/2015

Open Access 01-12-2015 | Research article

Dexketoprofen/tramadol: randomised double-blind trial and confirmation of empirical theory of combination analgesics in acute pain

Authors: R. Andrew Moore, C. Gay-Escoda, R. Figueiredo, Z. Tóth-Bagi, T. Dietrich, S. Milleri, D. Torres-Lagares, C. M. Hill, A. García-García, P. Coulthard, A. Wojtowicz, D. Matenko, M. Peñarrocha-Diago, S. Cuadripani, B. Pizà-Vallespir, C. Guerrero-Bayón, M. Bertolotti, M. P. Contini, S. Scartoni, A. Nizzardo, A. Capriati, C. A. Maggi

Published in: The Journal of Headache and Pain | Issue 1/2015

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Abstract

Background

Combination analgesics are effective in acute pain, and a theoretical framework predicts efficacy for combinations. The combination of dexketoprofen and tramadol is untested, but predicted to be highly effective.

Methods

This was a randomised, double-blind, double-dummy, parallel-group, placebo-controlled, single-dose trial in patients with moderate or severe pain following third molar extraction. There were ten treatment arms, including dexketoprofen trometamol (12.5 mg and 25 mg) and tramadol hydrochloride (37.5 mg and 75 mg), given as four different fixed combinations and single components, with ibuprofen 400 mg as active control as well as a placebo control. The study objective was to evaluate the superior analgesic efficacy and safety of each combination and each single agent versus placebo. The primary outcome was the proportion of patients with at least 50 % max TOTPAR over six hours.

Results

606 patients were randomised and provided at least one post-dose assessment. All combinations were significantly better than placebo. The highest percentage of responders (72 %) was achieved in the dexketoprofen trometamol 25 mg plus tramadol hydrochloride 75 mg group (NNT 1.6, 95 % confidence interval 1.3 to 2.1). Addition of tramadol to dexketoprofen resulted in greater peak pain relief and greater pain relief over the longer term, particularly at times longer than six hours (median duration of 8.1 h). Adverse events were unremarkable.

Conclusions

Dexketoprofen trometamol 25 mg combined with tramadol hydrochloride 75 mg provided good analgesia with rapid onset and long duration in a model of moderate to severe pain. The results of the dose finding study are consistent with pre-trial calculations based on empirical formulae.

Trial registration

EudraCT (2010-022798-32); Clinicaltrials.gov (NCT01307020).
Appendix
Available only for authorised users
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Metadata
Title
Dexketoprofen/tramadol: randomised double-blind trial and confirmation of empirical theory of combination analgesics in acute pain
Authors
R. Andrew Moore
C. Gay-Escoda
R. Figueiredo
Z. Tóth-Bagi
T. Dietrich
S. Milleri
D. Torres-Lagares
C. M. Hill
A. García-García
P. Coulthard
A. Wojtowicz
D. Matenko
M. Peñarrocha-Diago
S. Cuadripani
B. Pizà-Vallespir
C. Guerrero-Bayón
M. Bertolotti
M. P. Contini
S. Scartoni
A. Nizzardo
A. Capriati
C. A. Maggi
Publication date
01-12-2015
Publisher
Springer Milan
Published in
The Journal of Headache and Pain / Issue 1/2015
Print ISSN: 1129-2369
Electronic ISSN: 1129-2377
DOI
https://doi.org/10.1186/s10194-015-0541-5

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