Use of opioids for pain relief while driving: when the patient meets the police

An average visual reaction time of 204 ms (SD 31 milliseconds) DRIVING: WHEN THE PATIENT MEETS THE POLICE was detected with slow release tramadol and 194 milliseconds (SD34 milliseconds) with naloxone/oxycodone, while an auditory reac- tion time of 188 milliseconds (SD 27 milliseconds) was associated The Italian Highway Code does not have an agreement with the with slow release tramadol and 161 milliseconds (SD 29 millisec- scientific evidence when prescribing opioids in pain therapy. This onds) with naloxone/oxycodone. In both cases, the results would leads to considerable legal implications in the clinical practice as allow the subject to drive vehicles exceeding 3500 kg in accordance with the Italian highway code (art. 119). Using a two-tailed t test for A Caucasian 69-year-old male patient suffering from bilateral lower paired samples, auditory responsiveness was greater when the patient back, and leg pain was being treated with slow release tramadol was treated naloxone/oxycodone than when he was treated with (Unitramaâ 200 mg orally once daily). The patient reported acceptable tramadol, (P < 0.0002-Graphpad Instatâ version 5.0). This result is pain relief (numerical rating scale [NRS] 3) as well as notable constipa- consistent with other data,2–5 which indicate tramadol to be less safe tion, dizziness and drowsiness, in particular while driving. This patient for driving than oxycodone (as assessed using the “on the road was subsequently diagnosed for a suspected hernia recurrence, and driving test”; a test used by the company ICADTS6 that shows epidural infiltrations were hence planned to commence within 30 days.
tramadol to impair driving performance to a great extent than The Italian Highway Code forbids driving while under the influence of psychotropic substances (http://www.aci.it/?id=742) (as These results lead us to ask the question: What is the better? listed in a specific table published by Ministry of Health [http:// Prescribing a painkiller that is permitted by law but that increases the www.salute.gov.it/medicinaliSostanze/paginaInternaMedicinali- likelihood of a car crash or a drug that could reduce the likelihood of Sostanze.jsp?id=7&menu=strumenti]) which may cause contextual causing a car crash itself? Is this problem limited to Italy or is it a more impairment of psychophysical status. The list includes all opioids with the exception of tramadol, which was excluded in 2006 (Decretoministeriale 19 giugno 2006, Gazzetta Ufficiale Repubblica Italiana n.147, 27-6-2006, pag 59). Tramadol can thus be used to treat chronic pain and permit patients to drive, even in the case of altered The first goal is to reduce the patient’s side effects, while preserving adequate analgesia until epidural infiltrations could be administered.
*Department of Anesthesia and Intensive Care Medicine, University of We replaced slow release tramadol 200 mg/die (Unitramaâ) with a Udine, P.zza S. M. Misericordia, 15, Udine, 33100, Italy; combination of naloxone/oxycodone (Targinâ 5 mg bis in die †Department of Pain Medicine and Palliative Care, Hospital of –BID-),1 obtaining adequate pain control (NRS 2) and a reduction in constipation, dizziness, and drowsiness. The second goal was to ‡Italian Military Air Force, Rivolto, Udine, Italy investigate the patient’s psychophysical status. To do this in an objective way, we used the TR 2000 Reflex Tester (Sodi Scientifica,Caledon, FI, Italy) to evaluate the patient’s visual and auditoryreaction times (we chose this instrument because it is presently used in Italy in aptitude tests, as stipulated by the Italian Highway Code 1. Hermanns K, Junker U, Nolte T. Prolonged-release oxycodone/naloxone (http://www.aci.it/sezione-istituzionale/al-servizio-del-cittadino/codi- in the treatment of neuropathic pain - results from a large observational study.
cedella-strada/titolo-iv-guida-dei-veicoli-e-conduzione-degli-animali/ Expert Opin Pharmacother. 2012;13:299–311.
art-119-requisiti-fisici-e-psichici-per-il-conseguimento-della-patente-di- 2. Gaertner J, Radbruch L, Giersecke T, et al. Assessing cognition and guida.html), for driving licenses for vehicles exceeding 3500 Kg; psychomotor function under long-term treatment with controlled release successful performance is considered for results exceeding the 4th oxycodone in non-cancer pain patients. Acta Anaesthesiol Scand. 2006;50: Following several days of therapy with slow release tramadol alone 3. Breivik H. Stable long-term opiod medication per se does not always and then following treatment with naloxone/oxycodone association, cause loss of driving ability: the doctor and patient must consider additional risk the patient’s visual and auditory reflexes were assessed in a series of 30 factors for unsafe driving. Acta Anaesthesiol Scand. 2006;50:651–652.
repeated measures, and the results are recorded.
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Source: http://studiomedicosandri.it/pp.pdf