Pain management in our daily practice: should we re-evaluate?

Treatment strategies of back pain are variable. We describe an unusual case of polyuria and erectile dysfunction with a short-term tramadol use. A 29-year-old man presented to our clinic with worsening lower back pain. After poor control of his pain on Non steroidal anti-inflammatory drugs, tramadol was prescribed. After 3 days of starting tramadol, he experienced significant polyuria and erectile dysfunction with inability to ejaculate or obtain orgasm. He denied any systemic symptoms. On follow-up, he reported complete resolution of his polyuria and erectile dysfunction within 24 h of stopping tramadol, in addition to satisfactory control of his pain. Polyuria and erectile dysfunction are very uncommon side effects of tramadol, reported in <1% of chronic users. This is the first case report to demonstrate such a rapid and aggressive onset of this combination of rare side effects with the complete resolution after tramadol discontinuation.