Tramadol is a synthetic opioid analgesic used to treat moderate to moderately severe pain. Although it is efficacious in the treatment of neuropathic pain, its use is limited by its side effects profile.
Morphine is the medication of choice in the most severe manifestations of pain although it does have some side effects and its tolerance-profile can limit its application as long-term treatment.
In any case, long-term pain, originating from any cause, rarely responds to a single analgesic or pain treatment and a multi-modal approach should be employed.
During the years many efforts have been made to prove efficacy of other drugs to be used as add-on to or instead of morphine, both in adults and in children. Even if experimental data support the use of tricyclic antidepressants in neuropathic pain in adults, there is limited evidence of their efficacy in children. In adults the risks associated with overdoses of tricyclic antidepressants are well described and adverse effects with tricyclic antidepressants can be significant and can result in discontinuation of neuropathic pain treatment.
Other antidepressants and antiepileptics, such as carbamazepine and gabapentin, are commonly used in adults but there are no comparative studies to determine their potential in the treatment of children.