Question

Which of the following opioids can be used for neuropathic pain since it has a dual mechanism and increases serotonin and norepinephrine levels?

Question 13 options:

a)	Codeine/acetaminophen (Tylenol #3).

b)	Oxycodone (Oxycontin).

c)	Hydrocodone/acetaminophen (Norco).

d)	Tramadol (Ultram).

Answer 1

Tramadol is the opioid can be used for neuropathic pain since it has a dual mechanism and increases serotonin and norepinephrin levels.

Tramadol is a centrally acting analgesic with a multimode of action. It acts on serotonergic and noradrenergic nociception , while its metabolite O- desmethyltremadol acts on the mu opioid receptor.

The racemic mixture of (+) dextro and (-) levo enantiomer of tramadol has synergistic analgesic effect. It acts by various pathways such as a weak MOR ( Mu Opioid Receptor) agonist or as a serotonin and norepinephrine reuptake inhibitors for the nociception. O- desmethyl tramadol metabolite ( M1) of tratramadol also shows analgesic action by acting as weak MOR agonist. The (+) enantiomer of tramadol act as a MOR agonist and by the inhibition of the reuptake of serotonin , whereas (-) enantiomer inhibits noradrenaline reuptake.