What is Pain?1

The International Association for the Study of Pain recently revised its definition of pain in an effort to encourage new ways for doctors to assess pain. Pain is different for every individual, and your doctor will ask you questions about your pain to help determine what treatment options are best for you.

What’s The Difference Between Acute And Chronic Pain?2

QDOLO - man in pain

Acute pain is sharp and is generally caused by something specific, like surgery, an injury, or dental work. Acute pain doesn’t last longer than six months, and it goes away when the underlying cause of the pain is resolved. Once the acute pain is gone, a person can go back to life as usual.

Chronic pain usually lasts longer than six months and may not be caused by injury or damage to tissue. Some examples are headache, arthritis, back pain, and nerve pain. Some people do experience pain months or years after an injury or surgery heals. This is also considered chronic pain.

People who have chronic pain may suffer emotional effects that can interfere with their lives, like depression, anxiety, or anger.

How Prevalent Is Pain In The US?

Nearly 86% of patients having surgery report postoperative pain, which is often moderate to severe in intensity.3 Poorly controlled pain can result in delayed discharge from the hospital, a delay in functional recovery, and an increased risk of chronic pain.4

50 million adults in the United States have chronic daily pain, with 19.6 million adults experiencing high-impact chronic pain that interferes with daily life or work activities. The cost of pain to our nation is estimated at between $560 billion and $635 billion annually.5

How is Pain Treated?

A May, 2019 U.S. Department of Health and Human Services report on pain management best practices emphasized the need for an “individualized, patient-centered” approach for the treatment of pain.6

This approach to pain management emphasizes shared decision-making between individual patients and their doctors to make safer, effective pain management decisions. Ultimately, it’s between you and your doctor to decide what is right for you.


  1. International Association for the Study of Pain. “IASP Announces Revised Definition of Pain.” July 16, 2020. https://www.iasp-pain.org/PublicationsNews/NewsDetail.aspx?ItemNumber=10475
  2. Cleveland Clinic. Acute vs. Chronic Pain. https://my.clevelandclinic.org/health/articles/12051-acute-vs-chronic-pain
  3. Gan TJ, Habib AS, Miller TE, White W, Apfelbaum JL. Incidence, patient satisfaction, and perceptions of post-surgical pain: results from a US national survey. Curr Med Res Opin. 2014;30:149–160. doi: 10.1185/03007995.2013.860019.
  4. Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367:1618–1625. doi: 10.1016/S0140-6736(06)68700-X.
  5. Centers for Disease Control and Prevention. Prevalence of chronic pain and high-impact chronic pain among adults – United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:1001-6.
  6. U.S. Department of Health and Human Services (2019, May). Pain Management Best Practices Inter-Agency Task Force Report: Updates, Gaps, Inconsistencies, and Recommendations. Retrieved from U. S. Department of Health and Human Services website: https://www.hhs.gov/ash/advisory-committees/pain/reports/index.html

QDOLO (tramadol hydrochloride) Oral Solution 5mg/1ml C-IV IMPORTANT SAFETY INFORMATION


  • Ensure accuracy when prescribing, dispensing, and administering QDOLO. Dosing errors due to confusion between mg and mL can result in accidental overdose and death.
  • QDOLO exposes users to the risks of addiction, abuse and misuse, which can lead to overdose and death.
  • The FDA has required a REMS for all opioid analgesics.
  • Serious, life-threatening, or fatal respiratory depression may occur. Monitor closely, especially during initiation or following a dose increase.
  • Accidental ingestion of QDOLO, especially by children, can result in a fatal overdose of tramadol.
  • Life-threatening respiratory depression and death have occurred in children who received tramadol. Some of the reported cases followed tonsillectomy and/or adenoidectomy; in at least one case, the child had evidence of being an ultra-rapid metabolizer of tramadol due to a CYP2D6 polymorphism.
  • QDOLO is contraindicated in children younger than 12 years of age and in children younger than 18 years of age following tonsillectomy and/or adenoidectomy. Avoid the use of QDOLO in adolescents 12 to 18 years of age who have other risk factors that may increase their sensitivity to the respiratory depressant effects of tramadol.
  • Prolonged use of QDOLO, during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life threatening if not recognized and treated. If prolonged opioid use is required in a pregnant woman, advise the patient of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available.
  • The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. Use of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with QDOLO requires careful consideration of the effects on the parent drug, tramadol, and the active metabolite, M1.
  • Concomitant use of opioids with benzodiazepines or other central nervous system depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing for use in patients for whom alternative treatment options are inadequate; limit dosages and durations to the minimum required; and follow patients for signs and symptoms of respiratory depression and sedation.


QDOLO is indicated in adults for the management of pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate.

Limitations of Use: Because of the risks of addiction, abuse, and misuse with opioids, even at recommended doses, reserve QDOLO for use in patients for whom alternative treatment options (e.g., non-opioid analgesics):

  • Have not been tolerated or are not expected to be tolerated.
  • Have not provided adequate analgesia or are not expected to provide adequate analgesia.


  • Ensure accuracy when prescribing, dispensing, and administering QDOLO to avoid dosing errors due to confusion between mg and mL which could result in accidental overdose and death. Ensure the proper dose is communicated and dispensed.
  • When writing prescriptions, include both the total dose in mg and the total dose in volume.
  • Instruct patients on how to measure and take the correct dose of QDOLO and to use extreme caution when measuring the dose.
  • Strongly advise patients to always use a calibrated oral syringe or other oral dosing device, with metric units of measurements (i.e., mL), to correctly measure the prescribed amount of medication.
  • Inform patients that oral dosing devices may be obtained from their pharmacy and to never use household teaspoons or tablespoons to measure QDOLO.
  • Do not use QDOLO concomitantly with other tramadol-containing products.
  • Do not administer QDOLO at a dose exceeding 400 mg (80 mL) per day.
  • Use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals.
  • Initiate the dosing regimen for each patient individually, taking into account the patient’s severity of pain, patient response, prior analgesic treatment experience, and risk factors for addiction, abuse, and misuse.
  • Monitor patients closely for respiratory depression, especially within the first 24–72 hours of initiating therapy and following dosage increases with QDOLO and adjust the dosage accordingly.


  • Acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment
  • Known or suspected gastrointestinal obstruction, including paralytic ileus
  • Hypersensitivity to tramadol, any other component of this product or opioids
  • Concurrent use of monoamine oxidase inhibitors (MAOIs) or use of MAOIs within the last 14 days


  • Serotonin Syndrome: May be life-threatening. Can occur with use of tramadol alone, with concomitant use of serotonergic drugs, with drugs that impair metabolism of serotonin or tramadol.
  • Risk of Seizure: Can occur at the recommended dose of tramadol. Concomitant use with other drugs may increase seizure risk. Risk may increase in patients with epilepsy, a history of seizures, and in patients with a recognized risk for seizures.
  • Risk of Suicide: Do not prescribe for suicidal or addiction-prone patients.
  • Adrenal Insufficiency: If diagnosed, treat with physiologic replacement of corticosteroids, and wean patient off the opioid.
  • Life-Threatening Respiratory Depression in Patients with Chronic Pulmonary Disease or in Elderly, Cachectic, or Debilitated Patients: Monitor closely, particularly during initiation and titration.
  • Severe Hypotension: Monitor during dosage initiation and titration. Avoid use of QDOLO in patients with circulatory shock.
  • Risks of Use in Patients with Increased Intracranial Pressure, Brain Tumors, Head Injury, or Impaired Consciousness: Monitor for sedation and respiratory depression. Avoid use of QDOLO in patients with impaired consciousness or coma.


The most common adverse events (≥15.0%) in patients were dizziness/vertigo, nausea, constipation, headache, somnolence, vomiting and pruritus.

To report SUSPECTED ADVERSE REACTIONS, contact FDA at 1-800-FDA-1088 or www.fda.gov/medwatch or Athena Bioscience, LLC at 1-833-874-2664.

See Full Prescribing Information for all adverse reactions associated with QDOLO.


QDOLO use with Agonist/Antagonist and Partial Agonist Opioid Analgesics should be avoided as it may reduce analgesic effect of QDOLO or precipitate withdrawal symptoms.

See Full Prescribing Information for all drug interactions associated with QDOLO.


Pregnancy and Lactation: May cause fetal harm; breastfeeding is not recommended.

See Full Prescribing Information for use in specific populations associated with QDOLO.

Please see the accompanying Full Prescribing Information


To manage serious risks associated with opioid analgesic products, the Food and Drug Administration (FDA) requires a REMS to ensure the benefits of these products outweigh the risks of addiction, abuse, and misuse. This REMS requires providers of opioid analgesics to offer REMS-compliant education programs for healthcare providers and strongly encourages HCPs to:

  • Complete an FDA REMS-compliant accredited continuing education (CE) program
  • Counsel the safe use, serious risks, storage, and disposal of opioid analgesics with patients and caregivers
  • Emphasize to patients and caregivers the importance of reading the Medication Guide provided by their pharmacist
  • Consider other tools to improve patient, household, and community safety

For further information and a list of accredited REMS CME/CE, call 1-800-503-0784 or visit www.opioidanalgesicrems.com.

For the FDA Blueprint, visit www.fda.gov/OpioidAnalgesicREMSBlueprint.