Zabi Wardak MD

10/18/2025

Tramadol and Opioids in Pain Management — Recent Findings

Over the past month a major evidence review has raised serious questions about the role of tramadol in treating moderate to severe and chronic pain. The review found only small pain-relief benefits from tramadol while identifying increased risks of serious side effects, and concluded that tramadol use should be minimized and guideline recommendations reconsidered.

What the evidence says now

Effectiveness: Tramadol appears to provide limited benefit for many chronic pain conditions such as osteoarthritis, neuropathic pain, fibromyalgia, and chronic low back pain.

Harms: The same analyses link tramadol to higher rates of both serious and non-serious adverse events, including signals for cardiovascular problems and other concerning outcomes.

Net balance: Authors of pooled analyses conclude the potential harms likely outweigh the modest benefits for many patients, prompting calls to reduce routine prescribing of tramadol.

Practical takeaways for patients and caregivers

Ask about alternatives.

If tramadol is prescribed: Use the lowest effective dose for the shortest reasonable time.

For acute severe pain: Opioid decisions should be individualized.

Recent research into chronic pain, which afflicts millions of Americans, has led to a surprising source: the brain. "Sunday Morning" host Jane Pauley talks w...

05/01/2024

Fast Fact: As of 2022, more than 46 million people in the U.S. population (15% of the population) live in a rural area.

Dying early from the five leading causes of death when the death could have been prevented is more common among people living in rural areas than those living in urban areas.

Learn how clinicians and public health professionals can work together to improve the health of people living in rural communities. bit.ly/3w6MUKt

05/01/2024

E. COLI OUTBREAK: If you buy organic walnut halves or pieces from bulk containers at natural food and co-op stores in AK, AR, AZ, CA, CO, HI, ID, KS, LA, MT, NE, NM, NV, OR, SD, TX, UT, WA, or WY, check to see if your store had recalled walnuts. Some stores may repackage walnuts into plastic clamshells or bags.

Check your pantries, refrigerators, and freezers for walnuts. Throw them away or return them to where you bought them. Wash items and surfaces that may have touched the walnuts using hot soapy water or a dishwasher.

If you don’t know if it’s part of the recall, it’s safer not to eat them.

Retailers: Check the outbreak notice to see if you received recalled organic walnut halves or pieces. Do not sell or serve them.

Review the outbreak notice for a full list of stores: https://bit.ly/3UEXQs7

05/01/2024

Here’s frightening reality,

If you don’t have heart disease, chances are you know someone who is affected. Thanks to a century of research, we know that lifestyle changes and treatments, living longer and healthier is possible.

04/14/2024

In this Double Take video from the _New England Journal of Medicine,_ Drs. Schubach, Gravallese, and Firestein review the epidemiology, clinical features, pa...

03/30/2024

As we celebrate , today and every day we thank you for your dedication and commitment to the profession of medicine. http://spr.ly/6181Zlzfl

03/30/2024

Dimension compasses a range of cognitive impairments, Alzheimer’s disease is just one type.
Dementia includes no cognitive deficit, mild cognitive deficit, moderate cognitive deficit, severe cognitive decline, or deficit, and very severe cognitive deficit. Each stage includes various symptoms, personality changes, Behavioral changes and cognitive impairment.
Due each stage, there is different level of care needed. Can givers and families should always remember to seek support, educate themselves, keep in mind that self-care matters, create a structured routine, Adapt to a different level of communication, remember that safety comes first, and always celebrate small victories.

This video from NEJM talks about various stages of dementia and treatment options:


In this Double Take video from the New England Journal of Medicine, Drs. NathanielChin and Stephen Salloway define the stages of dementia and the effect ofea...

02/25/2024

The difference between heart attack and cardiac arrest:

02/14/2024

Chronic Traumatic Encephalitis are common among football players, and the credits go to Dr Omalu Bennet for being the first one to recognize it.

Pathologist Bennet Omalu, MD, MBA, MPH, received the Distinguished Service Award for being the first to recognize brain abnormalities in NFL players.

02/14/2024

10/28/2023

This review summarizes current evidence regarding the diagnosis and treatment of knee osteoarthritis, patellofemoral pain, and meniscal tears.

https://ja.ma/3tCZQ9e

10/18/2023

Keep the Weight OFF, for a better Diabetes Control:

A Randomized controlled double-blind study of Mounjaro (Trizepatide) vs Placebo, after 12 wks of intensive lifestyle intervention with greater than 5% weight loss showed that at 72 wks Mounjaro ( Trizepatide) treated group showed an additional 18.4% reduction in body weight, compared to a 2.5% gain in body weight in placebo group.

read more about it in Nature Medicine

In the SURMOUNT-3 trial, once-weekly treatment with tirzepatide was demonstrated to result in clinically meaningful additional weight loss in adults with overweight or obesity following initial successful weight loss of at least 5% body weight with intensive lifestyle intervention.