Efficacy and safety of 12 weeks of osteoarthritic pain therapy with once-daily tramadol (Tramadol Contramid OAD).

This placebo-controlled study examined the analgesic efficacy, safety, and clinical benefit of Tramadol Contramid OAD, a once-daily formulation with both immediate- and extended-release components. Five hundred and fifty-two patients with moderate to severe pain due to osteoarthritis (OA) of the knee were randomized into this multicenter, double-blind, parallel arm study. After randomization to Tramadol Contramid OAD 100, 200, or 300 mg, or to placebo, patients' dose was titrated to the fixed randomized dose and maintained for 12 weeks. Efficacy was evaluated with the Patients' Global Rating of Pain Relief (median ratings at maintenance visits), and the Western Ontario and McMaster University (WOMAC) Pain and Physical Function subscales (percent difference, baseline to end of study) as coprimary endpoints. A responder analysis was conducted (percentage of patients who achieved a 30 percent improvement on their baseline WOMAC pain score). The difference from placebo on the median Patient Global Rating of Pain Relief at the four maintenance visits was statistically significant (200 and 300 mg: p < or = 0.001). Treatment was rated effective or very effective by 75 percent and 80 percent of patients randomized to Tramadol Contramid OAD 200 mg and 300 mg, respectively. There was a 46 percent (300-mg dose; p = 0.016) and 43 percent (200-mg dose; p = 0.05) improvement on the WOMAC pain score (baseline to the end of the study) with Tramadol Contramid OAD compared with 32percent for placebo. The responder analysis demonstrated a statistically significant difference in the percentage of patients who achieved a 30 percent improvement in their baseline WOMAC pain score for both Tramadol Contramid OAD 200 mg (65 percent; p = 0.0095) and 300 mg (65 percent; p = 0.0104) compared with placebo (50 percent). The type and incidence of adverse events were typical of tramadol (nausea, dizziness/vertigo, vomiting, somnolence, and constipation) and the intensity was mild to moderate in 87percent of patients who experienced them regardless of dose. This study shows the efficacy and safety of Tramadol Contramid OAD 200 mg and 300 mg in patients with moderate or severe pain of the knee due to OA.

Electromyographic analysis of the supraspinatus and deltoid muscles during 3 common rehabilitation exercises.

CONTEXT: Investigators have observed electromyographic (EMG) activity of the supraspinatus muscle and reported conflicting results. OBJECTIVE: To quantify EMG activity of the supraspinatus, middle deltoid, and posterior deltoid muscles during exercises commonly used in rehabilitation. DESIGN: One-factor, repeated-measures design. SETTING: Controlled laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty-two asymptomatic subjects (15 men, 7 women) with no history of shoulder injury participated. MAIN OUTCOMES MEASURE(S): The dominant shoulder was tested. Fine-wire EMG electrodes were inserted into the supraspinatus, middle deltoid, and posterior deltoid muscles. The EMG data were collected at 960 Hz for analysis during maximal voluntary isometric contraction (MVIC) and 5 repetitions of 3 exercises: standing elevation in the scapular plane ("full can"), standing elevation in the scapular plane with glenohumeral internal rotation ("empty can"), and prone horizontal abduction at 100 degrees with glenohumeral external rotation ("prone full can"). We calculated 1-way repeated-measures analysis of variance (P < .05) and post hoc 2-tailed, paired t tests to detect significant differences in muscle activity among exercises. RESULTS: No statistical difference existed among the exercises for the supraspinatus. The middle deltoid showed significantly greater activity during the empty-can exercise (77 +/- 44% MVIC) and prone full-can exercise (63 +/- 31% MVIC) than during the full-can exercise (52 +/- 27% MVIC) (P = .001 and .017, respectively). The posterior deltoid showed significantly greater activity during the prone full-can exercise (87 +/- 53% MVIC) than during the full-can (P = .001) and the empty-can (P = .005) exercises and significantly greater activity during the empty-can exercise (54 +/- 24% MVIC) than during the full-can exercise (38 +/- 32% MVIC) (P = .012). CONCLUSIONS: While all 3 exercises produced similar amounts of supraspinatus activity, the full-can exercise produced significantly less activity of the deltoid muscles and may be the optimal position to recruit the supraspinatus muscle for rehabilitation and testing. The empty-can exercise may be a good exercise to recruit the middle deltoid muscle, and the prone full-can exercise may be a good exercise to recruit the posterior deltoid muscle.