Treatment of Pain Due to Postherpetic Neuralgia with Tramadol

Summary

This open pilot study compared the analgesic efficacy and safety of tramadol with a combination of clomipramine/levomepromazine in the treatment of postherpetic neuralgia. The study allowed individualised dose finding at predetermined intervals up to a maximum daily dose of 600mg tramadol and 100mg each of clomipramine/levomepromazine. 21 (60%) of 35 randomised patients were treated with study medication over the 6-week period [tramadol n=10; clomipramine (levomepromazine) n= 11]. After 3 weeks’ treatment the dosage in both groups remained almost constant for the remaining 6-week treatment phase (mean daily dose: tramadol 250 to 290mg; clomipramine 59.1 to 63.6mg). In only 3 patients was a combination with levomepromazine necessary. In correlation with increasing study medication, the average pain level decreased to ‘slight’ after initially being ‘moderate’ to ‘very severe’ in both groups. At the end of the treatment, 9 of 10 patients in the tramadol group and 6 of 11 patients in the clomipramine group retrospectively rated their analgesia as excellent, good or satisfactory. There were no significant differences in the current psychological/physical condition of the patients during tramadol treatment. Sensitivity and depression parameters decreased in the clomipramine group. The incidence of adverse events for all patients was comparable in both groups (tramadol 76.5%; clomipramine/levomepromazine 83.3%). In conclusion, tramadol appears to be an interesting therapeutic alternative for pain relief in postherpetic neuralgia.