Washington: Researchers have found a way to identify quickly the 5-10 percent of patients in whom the commonly used painkiller, tramadol, does not work effectively.A simple blood test can produce a result within a few hours, enabling doctors to switch a non-responding patient on to another painkiller, such as morphine, which will be able to work in these patients.Tramadol is a synthetic opioid that is metabolised in the liver via an enzyme called cytochrome P450 2D6 (CYP2D6) to produce a small molecule or “metabolite” called O-demethyltramadol (ODT).ODT is between two and four times better at inducing analgesia than tramadol that is not metabolised successfully. This is because ODT has a 200-fold higher affinity to the opioid receptors in humans than un-metabolised tramadol, meaning that it binds to the receptors more successfully, blocking out the signals for pain.“In our hospital we frequently use tramadol after surgery – about 50-60 percent of patients are treated with it, while the rest are treated with nefopam, which is a non-opioid painkiller,” Dr Laurent Varin, an anaesthesiologist at the Caen Teaching Hospital (Caen, France), said.“However, in about 5-10 percent of Caucasian patients the CYP2D6 enzyme is inefficient and does not produce enough ODT to bind effectively to the opioid receptors; these patients are known as `poor metabolisers` and will have poorly controlled pain unless the problem is identified quickly and they are switched to morphine or nefopam,” he said.
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