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Invited Commentary
February 2015

Tramadol and HypoglycemiaOne More Thing to Worry About

Author Affiliations
  • 1Emergency Medicine, New York University School of Medicine, New York, New York
  • 2General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
JAMA Intern Med. 2015;175(2):194-195. doi:10.1001/jamainternmed.2014.5260

Pain is one of the leading reasons why patients seek medical attention, and over the past 2 decades, clinicians, health care institutions, medical organizations, and regulators have become increasingly attentive to its management. Yet despite the importance of pain as a clinical entity, the well of approved pharmacologic options is shallow, consisting principally of acetaminophen, nonsteroidal anti-inflammatory drugs, and opioids, along with off-label alternatives including certain anticonvulsants, antidepressants, and a smattering of other drugs for some types of pain. However, the expectation that analgesics can significantly reduce or abolish pain is often overly optimistic and can lead to the progressive use of higher doses of stronger analgesics without a reasonable benchmark for success or failure. The subjective nature of pain, which can fluctuate and which lacks the objective quantification that many clinicians are accustomed to, further complicates this assessment. Nonpharmacologic approaches such as physical therapy, meditation, exercise, and weight loss are harder to implement than medication because they are time consuming, labor intensive, and often not covered by insurance, even though each is supported by evidence of safety and effectiveness in selected patients.

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