I prescribe a dose of healthy scepticism

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I have a few WIP blog posts but I digress briefly, to fulminate*.

On my sh!t list is the G.O.’s skin cancer G.P.

Late in July the G.O. brought to my notice a mark on his ankle that looked funny and wasn’t healing. We figured out he’d had it since early June. He also had a couple of, to use not-so-scientific terms, small skin thingies behind his knees, plus the usual surface skin cancers on his arms & hands courtesy of his occupation and heredity. Me being a modern woman, and the G.O. being a modern man, I left it to him to make a doctor’s appointment to fit in with his schedule.

In mid August, I called and made the latest-in-the-day after work doctor’s appointment I could for the G.O.  No problem. Off he went. The doctor zapped him well and truly ’til his arms & legs resembled leopard skin. Still good.

As the G.O., who is in his 50’s, and has operated heavy earthmoving equipment for more than two thirds of his life, rose from the chair to leave, the diligent doctor noticed his effort in doing so. After questioning the G.O. on the circumstances and history of this discomfort, the doctor provided him with a number of prescriptions for Durotram XR, explaining they were:

  • a natural drug which would assist to reduce the stiffness in his neck and back;
  • a non drowsy medication;
  • expensive but somewhat subsidised for eligible 55+ age group, and;
  • different strengths, and to start with 10 x 100mg, moving to 10 x 200 mg, then 10 x 300 mg, for which he’d provided prescriptions.

The G.O. dutifully brought home and handed the prescriptions to me, along with the doctor’s spiel, knowing I’d want to investigate. “Natural” resonated with the G.O. as I’d recently started him on a daily spoonful of liquid glucosamine + rosehip oil for the same reason, to which his body seemed to be responding. The G.O. dislikes taking tablets but was interested the pain relief the doctor had to offer, so I did my usual pharmaceutical due diligence. The highlights of which were:

  • Once-daily tramadol extended-release (Durotram XR) for pain
  • Tramadol extended-release is available as 100 mg, 200 mg or 300 mg tablets. Authorities for repeats or quantities greater than 10 tablets will only be granted for severe disabling pain that does not respond to non-opioid analgesics.
  • No published randomised trial of tramadol extended-release has studied efficacy or safety for more than 12 weeks.
  • Other analgesics should be considered before tramadol
  • Tramadol is a weak opioid that also inhibits the reuptake of noradrenaline and serotonin.
  • Tramadol extended-release is subsidised for short-term use
  • Tramadol extended-release is PBS subsidised for up to 10 days. Larger quantities of tramadol extended-release can only be prescribed for severely disabling pain that does not respond to non-opioid medications.
  • Adverse effects are common
  • The most common adverse events reported in trials of tramadol extended-release include dizziness/vertigo (10% to 26%), nausea (11% to 33%), constipation (10% to 34%) and drowsiness (7% to 30%).
  • In trials, up to 81% of people taking tramadol extended-release experienced an adverse event. A similar proportion of participants (79%) taking tramadol twice daily experienced an adverse event.
  • Between 8% and 21% of participants receiving tramadol extended-release discontinued treatment because of adverse events. Similar numbers of people taking tramadol once daily and tramadol twice daily discontinued because of adverse events.
  • Adverse events can appear within days of starting tramadol extended-release. 

In a nutshell, the G.P. prescribed the G.O. who works as heavy earthmoving machinery operator a “natural” opioid drug where dizziness/vertigo (10% to 26%) and drowsiness (7% to 30%) have been reported as side effects.

What a quack!


*What a great word!