Burning questions on…2-4 Pain Management: Part 2

Dr Marcia Schofield Senior Lecturer in Pain Management, CardiffDr Ashish Shetty Consultant in Pain Medicine, University College London HospitalsDr Michael Spencer Consultant Psychiatrist, Cambridge and LondonDr Rajesh Munglani Consultant in Pain Medicine, Cambridge and London The second of a three-part feature comprising expert answers to readers’ questions on managing pain in primary care Q.What are the dangers of long-term tramadol?   A Tramadol is an opioid, hence all the usual risks of long-term opioids apply, including constipation, nausea, dependence, intolerance and endocrine/immune suppression. Like all opioids, they may distort the sleep/wake cycle, causing patients to request “sleeping tablets”. One in