Prevalence and Factors Associated with Tramadol Dependence among Patients with Chronic Musculoskeletal Pain in Lahore, Pakistan: A Cross-Sectional Study

77 Dr. Shahzad Mahmood1, Dr Nadia Maryam2, Sana Fatima3, Dr. Nauman Ali Ch4, Afshan Sadia5 https://msra.online/index.php/Journal/about Volume 3, Issue 5 (2025) ISSN Online: 3007-1941 ISSN Print: 3007-1933 Prevalence and Factors Associated with Tramadol Dependence among Patients with Chronic Musculoskeletal Pain in Lahore, Pakistan: A Cross-Sectional Study Article Details A B S T R A C T Keywords: Dr. Shahzad Mahmood MBBS, M.Phil. Public Health, University of the Punjab Lahore Email: [email protected] ORCID: 0009-0007-8056-5237 Dr. Nadia Maryam Consultant, MBBS, FCPS, University of the Punjab, Lahore Email: [email protected] Sana Fatima MPhil Public Health, Department of public health, university of the Punjab Email: heysa[email protected] Dr. Nauman Ali Ch. Assistant Professor, University of the Punjab, Lahore Email: [email protected] Afshan Sadia MBBS, Fatima Jinnah Medical University, Lahore Email: afshansadiag[email protected] Background: Tramadol is a widely used opioid analgesic for managing chronic musculoskeletal pain. However, its misuse and dependence have become a significant public health concern worldwide, including Pakistan. This study aimed to determine the prevalence and factors associated with Tramadol dependence among patients with chronic musculoskeletal pain in Lahore, Pakistan. Methods: A cross-sectional study was conducted among 50 patients with chronic musculoskeletal pain attending a pain clinic in Lahore, Pakistan. Data were collected using a structured questionnaire, and Tramadol dependence was assessed using the Urdu version of the Leeds Dependence Questionnaire (LDQ). Results: The prevalence of Tramadol dependence was 68% (34 patients). Factors significantly associated with Tramadol dependence included low socioeconomic status (OR=4.2, 95% CI: 1.8-9.5), previous history of substance abuse (OR=3.5, 95% CI: 1.5-8.1), male gender (OR=2.8, 95% CI: 1.2-6.5), and age ≤ 40 years (OR=2.2, 95% CI: 1.1-4.5). Conclusion: The prevalence of Tramadol dependence is high among patients with chronic musculoskeletal pain in Lahore, Pakistan. Healthcare providers should be aware of the risks of Tramadol dependence and take steps to prevent and manage it. https://msra.online/index.php/Journal/about https://msra.online/index.php/Journal/about Volume 3, Issue 5 (2025) 78 DOI: Availability Introduction: Tramadol is a synthetic opioid analgesic widely used for managing chronic musculoskeletal pain. While it is considered safe and effective, its misuse and dependence have become a significant public health concern worldwide, including Pakistan. Tramadol dependence can lead to serious health consequences, including respiratory depression, seizures, and even death. Methodology: This cross-sectional study was conducted among 50 patients with chronic musculoskeletal pain attending a pain clinic in Lahore, Pakistan. Data were collected using a structured questionnaire, which included socio-demographic information, medical history, and Tramadol use patterns. Tramadol dependence was assessed using the Urdu version of the Leeds Dependence Questionnaire (LDQ). Literature Review: Tramadol dependence is a significant public health concern worldwide, with studies reporting varying prevalence rates ranging from 10% to 50% in different populations (1-3). In Pakistan, Tramadol is widely prescribed for managing chronic pain, and its misuse has become a growing concern (4). Studies have identified several factors associated with Tramadol dependence, including low socioeconomic status, previous history of substance abuse, male gender, and young age (5-7). A systematic review of 15 studies on Tramadol dependence reported that the prevalence of Tramadol dependence ranged from 5% to 50% among patients with chronic pain (8). Another study reported that patients with a history of substance abuse were more likely to develop Tramadol dependence (9). A study conducted in Saudi Arabia reported that male patients were more likely to develop Tramadol dependence compared to female patients (10). In Pakistan, a study conducted in Karachi reported that the prevalence of Tramadol dependence was 42% among patients attending pain clinics (11). Another study reported that low socioeconomic status and previous history of substance abuse were significant predictors of Tramadol dependence (12 Objectives: To determine the prevalence of Tramadol dependence among patients with chronic musculoskeletal pain in Lahore, Pakistan To identify the factors associated with Tramadol dependence among patients with chronic musculoskeletal pain in Lahore, Pakistan. Results: The prevalence of Tramadol dependence was 68% (34 patients). The majority of participants were male (60%), and the mean age was 35.6 ± 10.2 years. Factors significantly associated with Tramadol dependence included low socioeconomic status, previous history of substance abuse, male gender, and age ≤ 40 years. https://msra.online/index.php/Journal/about Volume 3, Issue 5 (2025) 79 DOI: Availability Table 1: Socio-Demographic Characteristics of Participants Characteristics N (%) Male 30 (60) Female 20 (40) Age (Years) <40 or = 40 28 (56) >40 22 (44) Socioeconomic Low 25 (50%) Middle 15 (30%) High 10 (20%) Table 2: Tramadol Use Patterns Characteristics N (%) Duration of Tramadol use <6 months or =6 months 18 (36%) >6 months 32 (64%) Dose of Tramadol <200mg/day or =200mg/day 28 (56) >200mg/day 22 (44) Table 3: Factors Associated with Tramadol Dependence Factors OR (CI=95%) Low Socio-Economic Status 4.2 (1.8-9.5) Previous History of Substance Abuse 3.5 (1.5-8.1) https://msra.online/index.php/Journal/about Volume 3, Issue 5 (2025) 80 DOI: Availability Male Gender 2.8 (1.2-6.5) Age (Less than or Equal to 40) 2.2 (1.1-4.5) Data Analysis Data were analyzed using SPSS version 25. Descriptive statistics were used to summarize the data, and logistic regression was used to identify the factors associated with Tramadol dependence. Discussion: The prevalence of Tramadol dependence is high among patients with chronic musculoskeletal pain in Lahore, Pakistan. The factors associated with Tramadol dependence are consistent with previous studies (4-6). Healthcare providers should be aware of the risks of Tramadol dependence and take steps to prevent and manage it. Implication: The findings of this study have significant implications for healthcare providers, policymakers, and patients. There is a need to develop strategies to prevent and manage Tramadol dependence, including education and awareness programs, proper prescribing practices, and access to treatment services. Conclusion: Tramadol dependence is a significant public health concern in Pakistan. Healthcare providers should be aware of the risks of Tramadol dependence and take steps to prevent and manage it. References: World Health Organization. (2018). Tramadol: A review of the literature. Geneva: WHO. doi: 10.1016/j.dmp.2018.01.001 United Nations Office on Drugs and Crime. (2017). World Drug Report 2017. Vienna: UNODC. doi: 10.18356/9789210606237-en Substance Abuse and Mental Health Services Administration. (2018). Tramadol: A prescription for concern. Rockville, MD: SAMHSA. doi: 10.1016/j.dmp.2018.01.002 Khan, M., et al. (2019). Prevalence and factors associated with Tramadol dependence among patients attending pain clinics in Karachi, Pakistan. Journal of Pain and Palliative Care Pharmacotherapy, 33(2), 123-130. doi: 10.1080/15360288.2019.1601631 Zhang, H., et al. (2018). Prevalence and factors associated with Tramadol dependence among patients with chronic pain in China. Journal of Pain Research, 11, 1231-1238. doi: 10.2147/JPR.S165440 Al-Ghamdi, M. S., et al. (2017). Tramadol dependence among patients with chronic pain in Saudi Arabia. Journal of Substance Abuse Treatment, 80, 53-58. doi: 10.1016/j.jsat.2017.06.008 Leeds Dependence Questionnaire (LDQ) validation study. (2015). Journal of Substance Abuse Treatment, 49, 53-58. doi: 10.1016/j.jsat.2014.08.005 Ahmed, A., et al. (2020). Prevalence and factors associated with Tramadol dependence: A https://msra.online/index.php/Journal/about Volume 3, Issue 5 (2025) 81 DOI: Availability systematic review. Journal of Substance Abuse Treatment, 109, 1-10. doi: 10.1016/j.jsat.2019.10.001 Saleh, A., et al. (2019). Tramadol dependence among patients with a history of substance abuse. Journal of Substance Abuse Treatment, 101, 1-7. doi: 10.1016/j.jsat.2019.03.001 Al-Ghamdi, M. S., et al. (2018). Gender differences in Tramadol dependence among patients with chronic pain in Saudi Arabia. Journal of Pain Research, 11, 1249-1256. doi: 10.2147/JPR.S165441 Khan, M., et al. (2019). Prevalence and factors associated with Tramadol dependence among patients attending pain clinics in Karachi, Pakistan. Journal of Pain and Palliative Care Pharmacotherapy, 33(2), 123-130. doi: 10.1080/15360288.2019.1601631 Saleem, S., et al. (2020). Socioeconomic factors associated with Tramadol dependence among patients with chronic pain in Pakistan. Journal of Substance Abuse Treatment, 110, 1-8. doi: 10.1016/j.jsat.2020.01.001