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      A Gas Chromatography-Mass Spectrometry Method to Determine Tramadol Abuse Using Urine Samples

      research-article
      1 , , 2 , 3 , 3
      ,
      Cureus
      Cureus
      abuse, gas chromatograph-mass spectrometry, solid-phase extraction, substance abuse, tramadol

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          Abstract

          Background

          The synthetic opioid tramadol is widely used as a pain reliever. Unlike other opioids, it is used freely worldwide, unaffected by international controls resulting in abuse and accidental intoxication. Analytical methods are necessary to prove tramadol abuse because 30% of the drug is excreted unchanged.

          Methodology

          This study describes a sensitive, precise, and accurate gas chromatograph-mass spectrometry (GC-MS) method for tramadol quantification in biological samples using solid-phase extraction (SPE) for sample preparation.

          Results

          A total of 747 samples were analyzed for suspected tramadol abuse; 15% of samples were above cut-off with a mean of 341.0 ± 215 ng/mL. No interference from other substances was detected. Calibration was linear over the concentration range of 50-1,000 ng/mL with a correlation coefficient of >0.998. Recovery was 92.5% and precision was ≤5% (range = 2.68-5.58%).

          Conclusions

          The effectiveness of the SPE in assessing tramadol abuse was assessed with GC-MS. With good recovery, quick analysis times, simplicity, little matrix effect, and effectiveness, this method is regarded as novel and is capable of identifying abuse.

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          Most cited references20

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          An overview of tramadol and its usage in pain management and future perspective

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            Revisiting Tramadol: A Multi-Modal Agent for Pain Management.

            Tramadol-an atypical opioid analgesic-has a unique pharmacokinetic and pharmacodynamic profile, with opioidergic, noradrenergic, and serotonergic actions. Tramadol has long been used as a well-tolerated alternative to other drugs in moderate pain because of its opioidergic and monoaminergic activities. However, cumulative evidence has been gathered over the last few years that supports other likely mechanisms and uses of tramadol in pain management. Tramadol has modulatory effects on several mediators involved in pain signaling, such as voltage-gated sodium ion channels, transient receptor potential V1 channels, glutamate receptors, α2-adrenoceptors, adenosine receptors, and mechanisms involving substance P, calcitonin gene-related peptide, prostaglandin E2, and proinflammatory cytokines. Tramadol also modifies the crosstalk between neuronal and non-neuronal cells in peripheral and central sites. Through these molecular effects, tramadol could modulate peripheral and central neuronal hyperexcitability. Given the broad spectrum of molecular targets, tramadol as a unimodal analgesic relieves a broad range of pain types, such as postoperative, low back, and neuropathic pain and that associated with labor, osteoarthritis, fibromyalgia, and cancer. Moreover, tramadol has anxiolytic, antidepressant, and anti-shivering activities that could improve pain management outcomes. The aim of this review was to address these issues in the context of maladaptive physiological and psychological processes that are associated with different pain types.
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              Pharmacokinetics, efficacy, and safety of analgesia with a focus on tramadol HCl.

              Chronic pain remains a problem because it is often misdiagnosed and undertreated. Adverse effects and safety concerns associated with many analgesics have limited the use of these agents and contributed to the undertreatment of pain. With regard to the pharmacologic agents most commonly used to manage pain, centrally acting analgesics (e.g., morphine, codeine) are associated with respiratory depression, tolerance, and dependence, and most nonsteroidal anti-inflammatory drugs (NSAIDs) produce adverse gastrointestinal effects. New to the United States, tramadol HCl, which has been prescribed for almost 2 decades in Europe, is a single-entity, centrally acting analgesic that is effective for the management of moderate to moderately severe pain. Although the mechanism of action of this analgesic is not completely understood, animal models suggest that at least two complementary modes of action appear applicable: (1) binding of parent compound and mono-O-desmethyltramadol (M1 metabolite) to the mu-opioid receptor and (2) weak inhibition of norepinephrine and serotonin reuptake. Clinical experience suggests that tramadol appears to have a low potential for abuse or addiction. Results from clinical trials conducted in the United States as well as European postmarketing surveillance studies indicate that tramadol is an effective analgesic that may have a particularly important role in the management of chronic painful conditions.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                9 December 2024
                December 2024
                : 16
                : 12
                : e75424
                Affiliations
                [1 ] Department of Clinical Psychopharmacology and Neurotoxicology, National Institute of Mental Health and Neurosciences, Bangalore, IND
                [2 ] Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, IND
                [3 ] Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, IND
                Author notes
                Priyamvada Sharma ps842010@ 123456gmail.com
                Article
                10.7759/cureus.75424
                11711240
                39791082
                5e5e2286-b89a-42b0-86d0-ca9c7efc994c
                Copyright © 2024, Sharma et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 13 September 2023
                Categories
                Public Health
                Pain Management
                Substance Use and Addiction

                abuse,gas chromatograph-mass spectrometry,solid-phase extraction,substance abuse,tramadol

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