Effect of Tramadol and Morphine on Pain and Gastrointestinal Motor Function in Patients with Chronic Pancreatitis

Tramadol and morphine were compared fortreatment of severe chronic pancreatitis pain and theirinteraction with gut motor function. Oral tramadol ormorphine doses were titrated double-blinded andrandomized for five days in 25 patients and pain, sideeffects, bowel function, orocecal and colonic transit,anal resting pressure, and rectal distension thresholdswere measured. Pain intensities (mean ± SD, 0 = none, 100 = unbearable) before treatment andon day 4 were 75 ± 19 and 8 ± 13 withtramadol (P < 0.001), and 65 ± 21 and 5± 6 with morphine (P < 0.001). On day 4, 67%of patients with tramadol and 20% with morphine rated their analgesia asexcellent (P < 0.001) with mean respective doses of840 mg (range: 80-1920) and 238 mg (20-1125). Orocecaltransit was unchanged after five days of tramadol, but increased with morphine (P < 0.05). Morepatients had prolonged colonic transit times withmorphine by day 5 (P < 0.05). Rectal distensionthreshold pressures increased only with tramadol (P < 0.01). It is concluded tramadol and morphineare potent analgesics in severe chronic pancreatitispain when individually titrated. Tramadol interferedsignificantly less with gastrointestinal function and was more often rated as an excellent analgesicthan morphine.