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Role of Tramadol
Centrally acting opioid analgesic, binds
to opioid receptors
Inhibits reuptake of NE and serotonin
within pain pathways of CNS
Contribute to enhancing the descending
pain inhibitory pathways
Role of Tramadol
Down regulation of central sensitisation hence
an ideal drug for Neuropathic pain

Enhances descending inhibitory pathways

Excellent Analgesic Efficacy

Tolerated well even in very high dosages
Tramadol Central Sensitization
Binds to Mu opiods
Mimicks the effects
Reduce the effects of
Sub P
Reduce the intensity of
the pain
Pain relief
Enhances descending inhibition
Inhibits reuptake of
Serotonin and NE
More in qty at the
Reduce the effects of
Sub P
Reduce the intensity of
the pain
Pain relief
Which TCA?
TCAs differ little in terms of their analgesic efficacy
(Dworkin et. al 2007).
Amitriptyline is the most widely studied TCA and is
commonly used in neuropathic pain.
Prothiaden being similar to amitriptyline is a good choice
for the management of pain especially as it enjoys a
relatively safer adverse event profile.
Prothiaden is a derivative of amitriptyline namely its thio-analogue.
Amitriptyline Prothaiden
refers to osteoarthritis involving the articular surfaces
(joints and discs)of the spine,often with osteophyte (j ) p , p y
formation and cord or root compression
refers to a separation at the pars articularis, which
permits the vertebrae to slip permits the vertebrae to slip.
Maybe uni or bilateral
May result from bilateral pars defects or degenerative
disc disease.
Defined as the anterior subluxation of the suprajacent
vertebrae, often producing central canal stenosis : it is
th li i f d f t b th t b the slipping forwardofone vertebrae on the vertebrae
Pain in a dermatomal distribution, sensory symptoms along
the same dermatome, weakness in a corresponding the same dermatome, weakness
in a corresponding
myotomal distribution, and absent or depressed reflexes.
Frequency of incidence in order of occurrence :
lumbar > cervical > thoracic
Usually caused by a herniated disk or by spondylosis;
othercausesareinfection neoplasm granuloma cyst and othercausesareinfection,
neoplasm, granuloma, cyst, and