Authors of tramadol study say further tests needed before recommendations can be made

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The authors of a recent study which showed possible performance-enhancing effects from tramadol have said that it is too soon to make recommendations about the possible banning of the substance.

“We cannot make any recommendation to WADA on the basis of these two experiments,” Daniel Sanabria told CyclingTips.

Sanabria is one of the authors of the research paper which was conducted by researchers at the University of Granada and accepted for publication in the Journal of Science and Medicine in Sport.

“This is the first randomized controlled trial using a double-blind methodology to test the effect of tramadol on cycling performance. We need to accumulate more empirical evidence (e.g., replicating our study) in order to make any formal recommendation regarding the effect of tramadol on physical and cognitive (and brain) performance.”

Tramadol is a powerful painkiller that is reported to have been used by some within the peloton, numbing pain, but also coming with side effects.

These include the danger of becoming hooked on what is a very addictive medication, and also an alleged increase in the number of crashes as a result of disorientation and greater risk taking. Taylor Phinney was one of the first to warn about its use.

“You see so many late-race stupid crashes that I almost wouldn’t be surprised if some or most of those crashes are caused by people taking these hard-hitting painkillers at the end of races,” he said in 2012.

“There is widespread use of finish bottles, which are just bottles of crushed up caffeine pills and painkillers. That stuff can make you pretty loopy, and that is why I have never tried it. I don’t even want to try it as I feel it dangerous.”

Former professional Michael Barry said three years ago that he and some of his team-mates had used tramadol between 2010 and 2012. Another former pro, Jonathan Tiernan-Locke, said last year that former Team Sky doctor Richard Freeman had offered him tramadol while working with the Great Britain team at the 2012 world road championships.

The substance has been on WADA’s monitoring list for several years but, despite calls from the UCI and the anti-doping movement MPCC for the agency to ban it, WADA has resisted doing so. However the pressure to revisit the issue resurfaced this month when the researchers from the University of Granada published a paper showing an increase in power output between subjects using a placebo and the same group taking tramadol.

The results suggested a five percent improvement in performance during the effort, with the 19 male and female riders tested showing a gain in average power. When taking a placebo the group put out an average of 209 watts during a 20 minute time trial; this increased to 220 watts when the same riders were given tramadol.

However, a related test which required the subjects to do a mental exercise during the 20 minute time trial failed to show a difference in power output. This test was intended to test sustained attention, thus examining the anecdotal reports of an increased danger of crashing in races. No difference was found on behavioural performance, although EEG time-frequency analysis showed effects of tramadol on brain functioning related to stimulus processing.

One hypothesis is that the increased concentration required to complete the mental task in those taking tramadol may have cancelled out any power gains. According to Sanabria, this hypothesis needs to be tested in future studies.

He confirmed to CyclingTips that a new study is planned looking at the substance. It is understood that this will likely focus on the effects of tramadol on physical exertion longer than the 20 minute time trial. Road races typically last many hours, and so the effects of tramadol could be quite different to those shown in the shorter test.

Depending on the outcome of that research, it is possible that a recommendation will then be able to be made to WADA in relation to the controversial painkiller and its use in sport.

Click through here to read the results of the study.

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