Study suggests Tramadol enhances TT performance by ~ 5%

WADA’s reluctance to ban tramadol has come under the spotlight after a study showed that the powerful and highly-addictive painkiller boosted cycling performance during a 20 minute time trial.

The study, published by researchers at the University of Kent and the University of Granada, is yet to be peer reviewed and so must be fully validated. However the results suggest a five percent improvement in performance during the effort, with the 19 male and female riders showing a gain in average power. Those in the placebo group put out 209 watts, with those taking tramadol achieving 220 watts.

And while their rate of perceived exertion was the same, those in the tramadol group also achieved a higher average heart rate. Theirs was 166 bpm, versus 162 bpm in the other group.

Meanwhile a second experiment which combined physical exertion with a mental exercise dampened down the effects, with no significant difference being determined between the two groups. Completing the mental task appeared not to be negatively affected by tramadol use.

The anti-doping group MPCC has repeatedly called on WADA to ban the use of Tramadol. It recently blasted the anti-doping agency as ‘reckless’ when it refused calls to prohibit it and corticosteroids. Despite WADA dragging its heels, the new UCI president David Lappartient has said he wants to try to prevent either substance being used.

https://cyclingtips.com/news/study-suggests-tramadol-enhances-performance/


full report:

https://osf.io/preprints/sportrxiv/8hpxz


Tramadol effects on physical performance and sustained attention during a 20-min indoor cycling time-trial: A randomised controlled trial

Darias Holgado Nuñez Thomas Zandonai Mikel Zabala James Hopker Pandelis Perakakis Antonio Luque-Casado Luis Perez Eduardo Guerra Hernandez Daniel Sanabria

Created on: November 01, 2017 | Last edited: November 01, 2017
 
Jul 16, 2010
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They should ban everyone that abused them. It's a prescription drug yet we know from testimonies that teams like Team Sky gave them freely away to their donkeys.
 
Feb 23, 2010
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18-Valve. (pithy) said:
WADA’s reluctance to ban tramadol has come under the spotlight after a study showed that the powerful and highly-addictive painkiller boosted cycling performance during a 20 minute time trial.

The study, published by researchers at the University of Kent and the University of Granada, is yet to be peer reviewed and so must be fully validated. However the results suggest a five percent improvement in performance during the effort, with the 19 male and female riders showing a gain in average power. Those in the placebo group put out 209 watts, with those taking tramadol achieving 220 watts.

And while their rate of perceived exertion was the same, those in the tramadol group also achieved a higher average heart rate. Theirs was 166 bpm, versus 162 bpm in the other group.

Meanwhile a second experiment which combined physical exertion with a mental exercise dampened down the effects, with no significant difference being determined between the two groups. Completing the mental task appeared not to be negatively affected by tramadol use.

The anti-doping group MPCC has repeatedly called on WADA to ban the use of Tramadol. It recently blasted the anti-doping agency as ‘reckless’ when it refused calls to prohibit it and corticosteroids. Despite WADA dragging its heels, the new UCI president David Lappartient has said he wants to try to prevent either substance being used.

https://cyclingtips.com/news/study-suggests-tramadol-enhances-performance/


full report:

https://osf.io/preprints/sportrxiv/8hpxz


Tramadol effects on physical performance and sustained attention during a 20-min indoor cycling time-trial: A randomised controlled trial

Darias Holgado Nuñez Thomas Zandonai Mikel Zabala James Hopker Pandelis Perakakis Antonio Luque-Casado Luis Perez Eduardo Guerra Hernandez Daniel Sanabria

Created on: November 01, 2017 | Last edited: November 01, 2017
Zabala is a Movistar coach and runs the Cycling Research Center with some of the other guys listed above.
 
Any hypothesis on the cause of this? If it's just use as a painkiller, I would think maybe the effect on professional cyclists is lower than on amateurs since they are more used to dealing with pain.

Anyway, clearly Tramadol should be banned. I'm surprised looking at the Wada list that opioids aren't just banned as group.
 
Sep 15, 2016
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The thing is, this study kinda has the same flaws as the ridiculous EPO study that claimed no performance enhancement, so it should be taken with a grain of salt.
I believe that tramadol should be banned nevertheless, because a) if you need to take an opioid painkiller, you're not fit to race IMO.
b)racing high on opioids is dangerous for everyone, high potential for crashes.
c)I believe that it can indeed be performance enhancing, even for top level athletes.
But this study does not prove it IMO, so while the EPO study was ridiculed here, and rightly so, it screams of double standards to claim that an equally flawed one proves that tramadol is clearly a PED for high levels athletes.
 
ColonelKidneyBeans said:
The thing is, this study kinda has the same flaws as the ridiculous EPO study that claimed no performance enhancement, so it should be taken with a grain of salt.
I believe that tramadol should be banned nevertheless, because a) if you need to take an opioid painkiller, you're not fit to race IMO.
b)racing high on opioids is dangerous for everyone, high potential for crashes.
c)I believe that it can indeed be performance enhancing, even for top level athletes.
But this study does not prove it IMO, so while the EPO study was ridiculed here, and rightly so, it screams of double standards to claim that an equally flawed one proves that tramadol is clearly a PED for high levels athletes.
It amazes me how so many actually belief studies like this or that EPO one when their manifest flaws are so many.
 
ColonelKidneyBeans said:
The thing is, this study kinda has the same flaws as the ridiculous EPO study that claimed no performance enhancement, so it should be taken with a grain of salt.
I believe that tramadol should be banned nevertheless, because a) if you need to take an opioid painkiller, you're not fit to race IMO.
b)racing high on opioids is dangerous for everyone, high potential for crashes.
c)I believe that it can indeed be performance enhancing, even for top level athletes.
But this study does not prove it IMO, so while the EPO study was ridiculed here, and rightly so, it screams of double standards to claim that an equally flawed one proves that tramadol is clearly a PED for high levels athletes.
Yeah it's pretty bad again. Would've been interesting if they'd done the actual experiments with gas analysis too.

Did I read that correctly or did they just not report baseline measurements for the power output and comparison between the two?
 

CTQ

Mar 12, 2016
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Robert5091 said:
From 2013
http://www.cyclingnews.com/news/team-sky-calls-for-tramadol-ban-in-peloton/
Team Sky, who are not a member of the MPCC, has backed a call for the substance to be regulated through the TUE system but added that as a team it has prescribed Tramadol throughout the season, but only in what it calls "appropriate scenarios".
Wondered if Froome's 2014 crashes happened because of "medicine".

in TDF , the 2 guys in front of him are the cause of the crash https://youtu.be/6CEHsxviqOg
 
Some weird things in this study:

1) Both men and women were used, and though some analyses were done separately, the main conclusions follow from analysis of the mixed group. So if I understand this correctly, the mean values for the TT power come from both men and women, though one would expect the values of the women as a group to be lower than those of the men. The same for the V02max measurements that were also performed. In addition, the same total dose of tramadol, 100 mg, was given to both men and women, so the average dose/kg of body mass was of course significantly larger for women than men. Ideally, one would like the same dose/kg not only for men and women, but for each individual man and woman.

2) There are no legends with the figures, at least not with the paper I’m looking at, so I’m not entirely clear about some of the details. It would be simple enough to determine power from the TT performance, but nowhere do I see any description of how this was actually done. A ten minute TT was carried out on the initial visit, but it was apparently used only so subjects could familiarize themselves with the setup, not as a baseline against which to measure the 20 min TT at a later visit. Also, this 10 min TT was done following a ramped V02max test, so of course the riders were somewhat fatigued at the time, though I guess that doesn’t matter if the power/time was not measured and used.

3) A randomization procedure was used to determine which subjects received tramadol, so as in that EPO study we discussed a couple of months ago, one portion of the group is used as baseline against the other, rather than each individual’s having both a baseline and drug performance. There’s an additional twist, though. There were two TT sessions, during the second of which the attention of the subjects was tested by having them identify simple colored squares or circles on a computer screen. If I understand correctly, the drug/placebo assignments for the latter experiment were reversed, with the subjects who received tramadol prior to the first 20 min TT receiving placebo before this second test, and vice-versa. Since the second experiment involved different conditions, and in fact average times were somewhat different, one can’t use the placebo values in this experiment to confirm those in the first.

All that said, of course tramadol should probably be banned. I will say it’s not a typical opioid. Though it does have some affinity for one class of opioid receptors, the mu type, I believe the interaction is somewhat weak, and its antinociceptive action may come more from its effect on serotonin and noradrenaline levels. WADA, as far as I can tell, seems to view it more like aspirin, or a weak opioid like codeine than a more typical opioid like morphine or heroin. But any drug that relieves pain of course has the potential to be performance enhancing. And, I might add, in the worst way, because pain of course is generally the body’s way of warning that tissue damage is occurring.
 
Sep 15, 2016
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Merckx index said:
Some weird things in this study:

1) Both men and women were used, and though some analyses were done separately, the main conclusions follow from analysis of the mixed group. So if I understand this correctly, the mean values for the TT power come from both men and women, though one would expect the values of the women as a group to be lower than those of the men. The same for the V02max measurements that were also performed. In addition, the same total dose of tramadol, 100 mg, was given to both men and women, so the average dose/kg of body mass was of course significantly larger for women than men. Ideally, one would like the same dose/kg not only for men and women, but for each individual man and woman.

2) There are no legends with the figures, at least not with the paper I’m looking at, so I’m not entirely clear about some of the details. It would be simple enough to determine power from the TT performance, but nowhere do I see any description of how this was actually done. A ten minute TT was carried out on the initial visit, but it was apparently used only so subjects could familiarize themselves with the setup, not as a baseline against which to measure the 20 min TT at a later visit. Also, this 10 min TT was done following a ramped V02max test, so of course the riders were somewhat fatigued at the time, though I guess that doesn’t matter if the power/time was not measured and used.

3) A randomization procedure was used to determine which subjects received tramadol, so as in that EPO study we discussed a couple of months ago, one portion of the group is used as baseline against the other, rather than each individual’s having both a baseline and drug performance. There’s an additional twist, though. There were two TT sessions, during the second of which the attention of the subjects was tested by having them identify simple colored squares or circles on a computer screen. If I understand correctly, the drug/placebo assignments for the latter experiment were reversed, with the subjects who received tramadol prior to the first 20 min TT receiving placebo before this second test, and vice-versa. Since the second experiment involved different conditions, and in fact average times were somewhat different, one can’t use the placebo values in this experiment to confirm those in the first.

All that said, of course tramadol should probably be banned. I will say it’s not a typical opioid. Though it does have some affinity for one class of opioid receptors, the mu type, I believe the interaction is somewhat weak, and its antinociceptive action may come more from its effect on serotonin and noradrenaline levels. WADA, as far as I can tell, seems to view it more like aspirin, or a weak opioid like codeine than a more typical opioid like morphine or heroin. But any drug that relieves pain of course has the potential to be performance enhancing. And, I might add, in the worst way, because pain of course is generally the body’s way of warning that tissue damage is occurring.
Tramadol itself is a relatively weak agonist of the mu opioid receptor, yes, but its metabolite O-desmethyltramadol is far more potent and might actually be responsible for the majority of its analgesic effects, as suggested by the fact that poor metabolisers seems to get less pain relief from it. But yes tramadol is a weird drug and not your typical opioid, it affects a wide array of receptors in the brain. Its funny, now i'm thinking that its performance enhancing potential might come more from its NRI effects than from its opioid affinity, but i'm speculating a lot here.
And thank you btw, i didn't have the time nor the courage to articulate what was wrong with the study and couldn't have put it better than you did, there's also the fact that they didn't use pro athletes but amateurs with a "medium to high level of fitness" whatever that means.
At the end of the day, the only conclusion that we can draw from this study is "we need more studies, and then... a meta analysis of those studies" :D
 
ColonelKidneyBeans said:
But yes tramadol is a weird drug and not your typical opioid, it affects a wide array of receptors in the brain. Its funny, now i'm thinking that its performance enhancing potential might come more from its NRI effects than from its opioid affinity, but i'm speculating a lot here.
Absolutely true, took the words out of my mouth before I wrote something to the same effect myself. The binding profile is much broader and different than the various morphine-derivate opioids which have been banned for a long time. The tramadol is more stimulating than sedating, and is accompanied by a sense of well-being, it is euphoric and energizing in a different way.

Disagree with the quote appearing in the article above about tramadol being "highly addictive" - since it's much less-addictive than things like fentanyl or oxycodone... but it definitely has a potential for misuse amongst junkies, and people who are inclined to like opioids in the first place. Some people who are abusing the tramadol by taking hundreds of milligrams can get locked into a nasty habit of addiction. Anyway, tramadol should be banned in competition as an ergogenic/analgesic drug which is performance-enhancing
 
Jul 18, 2010
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No test such as this is complete without the critical third test phase. Everyone gets the placebo and is told they will receive 100 Euro for every additional Watt they can produce compared to their previous efforts. If profit motive outperforms drug then it cannot realistically be considered a PED.
 
5% increase in power (not performance, speed would be ~2% higher) but only in the first experiment, it was not replicated in the second experiment where riders had a minor cognitive task to perform. Also these are low level riders, hardly informative of impacts (or otherwise) on elite athletes.

And some of the comparisons like MI said, make little sense. They should compare each individual's before/after power on sprint tests for instance, not group averages.

In any case, this isn't a drug that should be permitted in-competition. If you really need it, you shouldn't be competing.

From a WADA perspective, solid evidence of ergonenicity isn't actually required, so that there is a study showing it has potential ergogenic properties is sufficient (aside from the other WADA criteria).
 
Robert5091 said:
From 2013
http://www.cyclingnews.com/news/team-sky-calls-for-tramadol-ban-in-peloton/
Team Sky, who are not a member of the MPCC, has backed a call for the substance to be regulated through the TUE system but added that as a team it has prescribed Tramadol throughout the season, but only in what it calls "appropriate scenarios".
Wondered if Froome's 2014 crashes happened because of "medicine".
Yeah, taking "medicine" will cause a rider in another team to take out your front wheel :rolleyes: which is what caused his first crash in the TDF and bust his wrists.
 
http://www.cyclingweekly.com/news/latest-news/tramadol-blame-classics-crashes-says-lotto-belisol-doctor-119652
Lotto-Belisol team doctor Jan Mathieu has said that the ongoing use of powerful painkiller Tramadol by some riders is a contributing factor in the recent spate of crashes in the opening classics races of 2014, and has renewed calls to have the drug banned.
Tramadol is an opioid, and like other substances in that group it causes drowsiness as a side-effect. Mathieu says that it’s this that has caused riders to lose concentration and cause crashes, according to an interview published by Belgian website sporza.be.
http://www.cyclingsupportz.com/en/2016/11/23/137-en/
Tramadol could adversely affect the ability to ride due to reduced responsiveness. This side effect of Tramadol is probably one of the reasons for the increased number of crashes.
 
bigcog said:
Robert5091 said:
From 2013
http://www.cyclingnews.com/news/team-sky-calls-for-tramadol-ban-in-peloton/
Team Sky, who are not a member of the MPCC, has backed a call for the substance to be regulated through the TUE system but added that as a team it has prescribed Tramadol throughout the season, but only in what it calls "appropriate scenarios".
Wondered if Froome's 2014 crashes happened because of "medicine".
Yeah, taking "medicine" will cause a rider in another team to take out your front wheel :rolleyes: which is what caused his first crash in the TDF and bust his wrists.
More a Sky fault. They should have been all around Froome in the peloton, not hanging out all across the peloton. Having said that, when someone swerves that way, there's not much you can do.

Bit off topic but do you who the rider was who lost control of the bike and swerved to the right? Was it somebody from OPQS?
 
Robert5091 said:
From 2013
http://www.cyclingnews.com/news/team-sky-calls-for-tramadol-ban-in-peloton/
Team Sky, who are not a member of the MPCC, has backed a call for the substance to be regulated through the TUE system but added that as a team it has prescribed Tramadol throughout the season, but only in what it calls "appropriate scenarios".
Wondered if Froome's 2014 crashes happened because of "medicine".
So we've gone from being able to look at a little bit of video and saying this rider's using to a motor to looking at a little bit of video and saying this guy is using Tramadol? WTAF?
 
silvergrenade said:
bigcog said:
Robert5091 said:
From 2013
http://www.cyclingnews.com/news/team-sky-calls-for-tramadol-ban-in-peloton/
Team Sky, who are not a member of the MPCC, has backed a call for the substance to be regulated through the TUE system but added that as a team it has prescribed Tramadol throughout the season, but only in what it calls "appropriate scenarios".
Wondered if Froome's 2014 crashes happened because of "medicine".
Yeah, taking "medicine" will cause a rider in another team to take out your front wheel :rolleyes: which is what caused his first crash in the TDF and bust his wrists.
More a Sky fault. They should have been all around Froome in the peloton, not hanging out all across the peloton. Having said that, when someone swerves that way, there's not much you can do.

Bit off topic but do you who the rider was who lost control of the bike and swerved to the right? Was it somebody from OPQS?
Not sure who the actual rider was but this is the footage of the crash:

http://www.telegraph.co.uk/sport/othersports/cycling/chris-froome/10953864/Chris-Froome-battered-and-bruised-after-crash-on-stage-four-of-Tour-de-France-which-ripped-cycling-shorts.html
 
silvergrenade said:
bigcog said:
Robert5091 said:
From 2013
http://www.cyclingnews.com/news/team-sky-calls-for-tramadol-ban-in-peloton/
Team Sky, who are not a member of the MPCC, has backed a call for the substance to be regulated through the TUE system but added that as a team it has prescribed Tramadol throughout the season, but only in what it calls "appropriate scenarios".
Wondered if Froome's 2014 crashes happened because of "medicine".
Yeah, taking "medicine" will cause a rider in another team to take out your front wheel :rolleyes: which is what caused his first crash in the TDF and bust his wrists.
More a Sky fault. They should have been all around Froome in the peloton, not hanging out all across the peloton. Having said that, when someone swerves that way, there's not much you can do.

Bit off topic but do you who the rider was who lost control of the bike and swerved to the right? Was it somebody from OPQS?
Froome was riding hard on left hand side of the road close to a ditch, he was poorly positioned. That yearjust prior to the Dauphine was when his Romandie TUE was revealed. He wasn’t the same rider at that time. Then his asthma was revealed. Froome looked like a guy who has just been ‘found out’. Then he crashed out of the Tour.
 
thehog said:
silvergrenade said:
bigcog said:
Robert5091 said:
From 2013
http://www.cyclingnews.com/news/team-sky-calls-for-tramadol-ban-in-peloton/
Team Sky, who are not a member of the MPCC, has backed a call for the substance to be regulated through the TUE system but added that as a team it has prescribed Tramadol throughout the season, but only in what it calls "appropriate scenarios".
Wondered if Froome's 2014 crashes happened because of "medicine".
Yeah, taking "medicine" will cause a rider in another team to take out your front wheel :rolleyes: which is what caused his first crash in the TDF and bust his wrists.
More a Sky fault. They should have been all around Froome in the peloton, not hanging out all across the peloton. Having said that, when someone swerves that way, there's not much you can do.

Bit off topic but do you who the rider was who lost control of the bike and swerved to the right? Was it somebody from OPQS?
Froome was riding hard on left hand side of the road close to a ditch, he was poorly positioned. That yearjust prior to the Dauphine was when his Romandie TUE was revealed. He wasn’t the same rider at that time. Then his asthma was revealed. Froome looked like a guy who has just been ‘found out’. Then he crashed out of the Tour.

Mod hat on:

I'm quoting TheHog but this is directed at everyone. Do not turn this into another Froome thread please.
 
May 21, 2015
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Only time I'd taken Tramadol from a friend for a back pain, I ended up seeing double next freaking day in work, got sent home for health and safety as I was developing paranoia then went straight to the pub to chill out at around 1100 hrs. Never again

Should add that the walk in to work that day was absolutely stunning, it was blue sky, early morning sun and summer heat and I felt amazing, then human interaction brought everything to *** very quickly.
 
bigcog said:
Robert5091 said:
From 2013
http://www.cyclingnews.com/news/team-sky-calls-for-tramadol-ban-in-peloton/
Team Sky, who are not a member of the MPCC, has backed a call for the substance to be regulated through the TUE system but added that as a team it has prescribed Tramadol throughout the season, but only in what it calls "appropriate scenarios".
Wondered if Froome's 2014 crashes happened because of "medicine".
Yeah, taking "medicine" will cause a rider in another team to take out your front wheel :rolleyes: which is what caused his first crash in the TDF and bust his wrists.
It looked more like a touch of shoulders.

Also, could it not be possible that only Froome’s crash on the Arenberg stage may have been caused in part by tramadol? That’s the more likely one IMO, as I’d want some painkillers if I was expected to ride on after that initial crash.
 

CTQ

Mar 12, 2016
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42x16ss said:
bigcog said:
Robert5091 said:
From 2013
http://www.cyclingnews.com/news/team-sky-calls-for-tramadol-ban-in-peloton/
Team Sky, who are not a member of the MPCC, has backed a call for the substance to be regulated through the TUE system but added that as a team it has prescribed Tramadol throughout the season, but only in what it calls "appropriate scenarios".
Wondered if Froome's 2014 crashes happened because of "medicine".
Yeah, taking "medicine" will cause a rider in another team to take out your front wheel :rolleyes: which is what caused his first crash in the TDF and bust his wrists.
It looked more like a touch of shoulders.

Also, could it not be possible that only Froome’s crash on the Arenberg stage may have been caused in part by tramadol? That’s the more likely one IMO, as I’d want some painkillers if I was expected to ride on after that initial crash.
he already had a wrist bandage when he started the stage. the wet roads were his problem. There is another GT contender who has fallen often since 2014 ....
 

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