Well, I found exactly ONE article discussing ONE patient (this case study was picked up by several medical publishers) in 2007 that they “guess” may have been suffering from Tramadol augmentation. Pardon my French, but what frickin idiots. They have this woman stop her years and years long use of tramadol and within a day or two she’s RLS free and sleeping like a baby. Anyone out there ever hear of someone stopping a DA after augmenting on it and the next day sleeping like a babe? It’s dumb doctors like that which cause other dumb people to run around claiming the sky is falling and Tramadol is causing augmentation.
The reason that woman was doing so well is because Tramadol (though painful towards the end) had up-regulated her receptors - possibly beyond baseline as I believe Melatonin had done for me.
I was thinking there must be more in the way of publications. We "know" Tramadol can cause augmentation... dont we? But not coming up with much. There is this -
Restless legs syndrome augmentation associated with tramadol
November 2006 Sleep Medicine 7(7):592-3 Christopher J Earley,Richard P Allen
2 big name researchers in RLS - but I dont have the paper or even the abstract. Anyone got it or know how?
It linked me to this -
Pharmacologic and Nonpharmacologic Treatment of Restless Legs Syndrome
2020, Sleep Medicine Clinics
Citation Excerpt :
There was also insufficient evidence (level U) for dihydrocodeine, propoxyphene, and tilidine (2 class IV studies).2 Two studies have reported augmentation after RLS treatment with tramadol, whereas it has not been reported with other opioids.21,22
Which are the same 2 references. And that was a review article.
Following citations of the 2007 article by Vetrugno found this excerpt -
The efficacy of tramadol (50-150 mg/day in an evening dose) has been assessed in an open-label study with a follow-up period of 15-24 months, involving 12 RLS patients, in which 10 patients reported a significant improvement, other slight amelioration and other no effect, and none reported major tolerance problems.199 Several patients under tramadol therapy for RLS showed augmentation.200,201
200 and 201 + the same 2 published papers and must be from the 2006 Earley/Allen paper.
Over 170 citations of these 2 papers. I have asked if this is it on the RLS Curbside forum and will see if we get any response there. I have not got copies of either of these - so if you have maybe PM me and pass them on. Tramadol is back on my list, for now.
Well I purchased the Earley/Allen paper. It was just a letter to the Editor - no not a major scientific undertaking. They had 9 patients total using Tramadol, 2 for arthritis. Of the 7 taking it for RLS 4 developed 'typical' augmentations. They all recovered in 4 - 7 days of ceasing. Well if augmentation could disappear in 1 week I would not be so concerned. But 4 of 7 developing augmentation over periods of 2 - 4 years is a high percentage.
You know what’s interesting, neither of them realized that there is no symptom difference between a person with RLS taking a dopamine antagonist and one augmenting on a dopamine agonist. I guarantee you none of them developed augmentation, just as I can guarantee you that gravity does not pull objects away from earth.
Not sure I understand. There is a difference between a person successfully taking AD's and one augmenting. The 2 biggest names in RLS research and first recognised augmentation got it wrong here? I am always open to looking at the evidence but also recognise that real experts are more often right than those of us laptop experts.
Come on doc, you gotta know that pharmacologically speaking, it’s virtually impossible for Tramadol to cause DA type augmentation. Tramadol is part SNRI. SNRIs are dopamine antagonists, essentially opposite of dopamine agonists. Isn’t it obvious to you that what those patients on Tramadol were experiencing was a tolerance to the pain killing properties and agony due to the dopamine antagonist properties of Tramadol? Have you ever heard anyone’s RLS improve, sans medication, a few days after stopping a DA due to augmentation? People on here have described DA withdrawal due to augmentation as hell on earth for weeks and months. Do Early’s patients that stopped Tramadol remind you of this? Are you pulling my leg or are you being serious?
Dopamine receptors are very complicated things. Unexpected results, such as augmentation occur. Is there evidence that it is virtually impossible? Will up-regulating the receptors cause a decrease in dopamine release and then make it or something else worse? Just assuming is not good enough. We need follow-up studies looking at the long-term effects of Tramadol. I would be happy prescribing it to patients in a study. I would prescribe it to a patient with them understanding what to lookout for in augmentation. But the report of Tramadol augmentation resolving in 4 - 7 days is the kind of augmentation I am not so concerned about causing.
I am serious enough to raise Tramadol on the doctors forum for RLS and see is anyone can justify the worry about augmentation.
Only ever looking for more and better options. Got a reply from John Winkleman I your surname has to start with a W to get anywhere in the academic world of RLS) the administrator of the curbside form (for doctors). He said he feels tramadol is a reasonable option and it is unclear if it causes augentation. It is not long acting like Methadone/Buprenorphine so some may get dose rebound as it wears off.
It was only after his reply that I pointed out that the 'augmentation' lasted less than a week and they just went cold turkey no taper.
Hmmm, I want so much more than just “no augmentation.” I want it to up-regulate our receptors. RestlessInLondon reported feeling and sleeping better than he had in ages just two days after stopping Tramadol and switching to very low dose of Codeine.
I couldn’t agree more. I’ve been taking tramadol for 20+ years and my RLS is a thing of the past. The hardest thing to do is get a doctor who agrees with me.
I don’t know what you think you’d find by looking at a scan. What I know is that five different doctors have given me prescription for Tramadol and for the last 20+ years it’s keep my RLS in check. Seeing how I’m 80 now I expect to keep using for many more years.
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