Unrecognised long-lasting tramadol-induced delirium in two elderly patients. A case report.

We present the cases of two elderly patients with intermittent long-term tramadol intake against chronic back pain. Over a period of more than two years they experienced fluctuating confusional states and cognitive deficits, reversible only after discontinuation of tramadol. According to the DSM IV-criteria, an unrecognised recurrent tramadol-induced delirium can be diagnosed in both cases. Although tramadol may represent a well established safe therapy for chronic non-malignant pain in the elderly, these cases demonstrate that it should be applied with caution even in healthy subjects.