{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T07:10:32Z","timestamp":1756365032406,"version":"3.44.0"},"reference-count":13,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["DTB"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:p>No single analgesic provides effective pain relief in all patients and increasing the dose of an analgesic may increase its unwanted effects.1 In addition, pain frequently results from multiple mechanisms that may respond to different pharmacological interventions.2 One suggested approach is to combine analgesics with different modes of action, with the aim of delivering better analgesia using lower doses of each drug.1 Skudexa (A. Menarini Farmaceutica Internazionale SRL), a combination of tramadol hydrochloride (a synthetic opioid analgesic that is a partial agonist at the \u03bc, \u03b4 and \u03ba opioid receptors) and dexketoprofen (a NSAID), is licensed for short term treatment of moderate to severe acute pain in adults.1-4 Here, we consider the evidence for this product and how it fits with current guidance on the management of pain.<\/jats:p>","DOI":"10.1136\/dtb.2018.6.0635","type":"journal-article","created":{"date-parts":[[2018,6,14]],"date-time":"2018-06-14T04:24:55Z","timestamp":1528950295000},"page":"66-68","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["What place is there for tramadol\/dexketoprofen?"],"prefix":"10.1136","volume":"56","member":"239","published-online":{"date-parts":[[2018,6,14]]},"reference":[{"key":"2025082723354786000_56.6.66.1","doi-asserted-by":"crossref","unstructured":"Derry S et al. Single fixed-dose oral dexketoprofen plus tramadol for acute postoperative pain in adults. Cochrane Database Syst Rev 2016: CD012232. DOI: 10.1002\/14651858.CD012232.pub2 [Last assessed as up-to-date 31 May 2016].","DOI":"10.1002\/14651858.CD012232"},{"key":"2025082723354786000_56.6.66.2","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1080\/03007995.2017.1310092","article-title":"Multimodal analgesia in moderate-to-severe pain: a role for a new fixed combination of dexketoprofen and tramadol","volume":"33","author":"Varrassi","year":"2017","journal-title":"Curr Med Res Opin"},{"key":"2025082723354786000_56.6.66.3","unstructured":"Skudexa 75 mg\/25 mg film-coated tablets. Summary of product characteristics, UK. Menarini International Operations Luxembourg S.A., April 2017."},{"key":"2025082723354786000_56.6.66.4","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1186\/s10194-015-0541-5","article-title":"Dexketoprofen\/tramadol: randomised double-blind trial and confirmation of empirical theory of combination analgesics in acute pain","volume":"16","author":"Moore","year":"2015","journal-title":"J Headache Pain"},{"key":"2025082723354786000_56.6.66.5","unstructured":"Haute Autorit\u00e9 de Sant\u00e9, 2016. SKUDEXUM 75mg\/25mg, dexketoprofen\/tramadol, fixed NSAID-weak opioid combination [online]. Available: https:\/\/www.has-sante.fr\/portail\/upload\/docs\/application\/pdf\/2017-01\/skudexum_summary_ct15131.pdf [Accessed 23 May 2018]."},{"key":"2025082723354786000_56.6.66.6","unstructured":"National Institute for Health and Care Excellence, 2015. Clinical Knowledge Summaries: analgesia- mild-to-moderate pain [online]. Available: https:\/\/cks.nice.org.uk\/analgesia-mild-to-moderate-pain [Accessed 23 May 2018]."},{"key":"2025082723354786000_56.6.66.7","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s12871-016-0174-5","article-title":"Dexketoprofen\/tramadol 25mg\/75mg: randomised double-blind trial in moderate-to-severe acute pain after abdominal hysterectomy","volume":"16","author":"Moore","year":"2016","journal-title":"BMC Anesthesiol"},{"key":"2025082723354786000_56.6.66.8","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1093\/bja\/aev457","article-title":"Randomized clinical trial of dexketoprofen\/tramadol 25mg\/75mg in moderate-to-severe pain after total hip arthroplasty","volume":"116","author":"McQuay","year":"2016","journal-title":"Br J Anaesth"},{"key":"2025082723354786000_56.6.66.9","unstructured":"European Medicines Agency, 2016. Guideline on the clinical development of medicinal products intended for the treatment of pain. [online]. Available: http:\/\/www.ema.europa.eu\/docs\/en_GB\/document_library\/Scientific_guideline\/2016\/12\/WC500219131.pdf [Accessed 23 May 2018]."},{"key":"2025082723354786000_56.6.66.10","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/j.pain.2008.06.025","article-title":"Analyzing multiple endpoints in clinical trials of pain treatments: IMMPACT recommendations","volume":"139","author":"Turk","year":"2008","journal-title":"Pain"},{"key":"2025082723354786000_56.6.66.11","doi-asserted-by":"crossref","unstructured":"Moore RA et al. Single dose oral analgesics for acute postoperative pain in adults - an overview of Cochrane reviews. Cochrane Database Syst Rev 2015: CD008659. DOI: 10.1002\/14651858.CD008659.pub3 [Last assessed as up-to-date 4 May 2015].","DOI":"10.1002\/14651858.CD008659.pub3"},{"key":"2025082723354786000_56.6.66.12","unstructured":"Australian and New Zealand College of Anaesthetists (ANZCA) Faculty of Pain Medicine, 2013. Guidelines on acute pain management [online]. Available: http:\/\/www.anzca.edu.au\/documents\/ps41-2013-guidelines-on-acute-pain-management [Accessed 23 May 2018]."},{"key":"2025082723354786000_56.6.66.13","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.jpain.2015.12.008","article-title":"Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists\u2019 Committee on Regional Anesthesia, Executive Committee, and Administrative Council","volume":"17","author":"Chou","year":"2016","journal-title":"J Pain"}],"container-title":["Drug and Therapeutics Bulletin"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/dtb.2018.6.0635","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T06:36:07Z","timestamp":1756362967000},"score":1,"resource":{"primary":{"URL":"https:\/\/dtb.bmj.com\/lookup\/doi\/10.1136\/dtb.2018.6.0635"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,6]]},"references-count":13,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2018,6,14]]},"published-print":{"date-parts":[[2018,6]]}},"alternative-id":["10.1136\/dtb.2018.6.0635"],"URL":"https:\/\/doi.org\/10.1136\/dtb.2018.6.0635","relation":{},"ISSN":["0012-6543","1755-5248"],"issn-type":[{"type":"print","value":"0012-6543"},{"type":"electronic","value":"1755-5248"}],"subject":[],"published":{"date-parts":[[2018,6]]}}}