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The fear of using tramadol for pain control (tramadolophobia) among Egyptian patients with cancer

Samy A. Alsirafy, MBBCh, MSc, MD, DipPallMed, Radfan N. Saleh, MBBCh, Radwa Fawzy, MBBCh, Ahmed A. Alnagar, MBBCh, MSc, MD, Ahmed M. Hammad, MBBCh, MSc, Wessam El-Sherief, MBBCh, MSc, MD, Dina E. Farag, MBBCh, MSc, MD, Riham H. Radwan, MBBCh


Objectives: The fear of using tramadol for pain control (tramadolophobia) by Egyptian patients with cancer is a frequent problem in our practice. This study was conducted to explore the prevalence of and the reasons behind tramadolophobia among Egyptian patients with cancer.

Methods: A structured interview including open-ended and closed questions. The study included 178 adult patients with cancer from two cancer centers in Cairo and Sharkia, Egypt.

Results: The source of information about tramadol was a non-healthcare-related source in 168 (94 percent) patients, mainly the media (50 percent). The believed uses of tramadol were abuse related in 94 (53 percent) patients, stimulant (physical, sexual, and to boost alertness) in 59 (33 percent), and analgesic in 55 (31 percent). Twenty-six (15 percent) patients gave history of tramadol use, largely (69 percent) as a stimulant. In case tramadol was prescribed for pain control, 90 (51 percent) patients refused to take it, 59 (33 percent) patients agreed to take it with concern about addiction, and only 29 (16 percent) patients agreed without concerns. Among those who refused taking tramadol for pain, the mentioned reason of refusal was addiction-related fears in 57 percent.

Conclusions: The stigmatization and misconceptions about tramadol may have resulted in tramadolophobia among the majority of Egyptian patients with cancer. This further complicates the barriers to cancer pain control in Egypt. Being the only available World Health Organization step-II analgesic in Egypt, interventions to overcome tramadolophobia should be taken.


cancer, pain, tramadol, abuse, phobia, Egypt

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