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Tramadol is a centrally acting analgesic that is not chemically related to opiates, but binds to mu-opioid receptors; it is marketed for treatment of "moderate to moderately severe pain." This randomized six-week trial, sponsored by the manufacturer, examined tramadol's effect in the treatment of painful diabetic neuropathy.
The authors gave 131 patients either escalating doses of tramadol (given 4 times a day) or placebo. Although a maximum of 400 mg daily was permitted, the average tramadol dose was 210 mg. On a scale of 0 to 4, the tramadol group had a significantly greater decrease in mean pain intensity (from 2.5 to 1.4) than did the placebo group (from 2.6 to 2.2). On average, pain relief was rated as "moderate" with tramadol and as "s…