RTVS programs = incredible. Saw that at the JCC talk today. As one who stopped remote practice, one reason was not feeling able to manage occasional critical cases with the skills/confidence required. That’s a big barrier to sustaining rural work.

RTVS could (does) make all the difference!!!

Yes. Some are better than others. Many suggest things that conflict with others.

good question...probably not. The mechanism is likely related to neurotransmitters and their post-synaptic receptors being down-regulated.

Our group has done a fair bit of work on this: www.ti.ubc.ca/2025/06/18/1... and www.ti.ubc.ca/2025/07/17/1... are our recent efforts.

. . . particularly in youth. I think tramadol carries a warning (in the USA anyway) of increased risk of suicide. We did not assess that in our paper - but none of the studies reported on it anyway. One has to look at population-level data and there are certainly a number of case reports that fit.

I'm sorry you went through that, it must have been very frightening! Pharmacologically: the molecular structure and mechanism of action of tramadol, besides opioid-effect, is that of an SNRI (similar to venlafaxine). Increased suicidality can be a side effect of SSRI or SNRI antidepressants. . .

tough! In Canada we don’t have “direct to consumer” marketing thankfully. People do see American TV ads but it is more the physicians who follow the myth that tramadol is “safer than opioids” who I suspect drive the prescribing trend. hopefully our article helps a bit

that is a perfect summary! haha that is exactly what we found. Our inclusion of types/durations of pain and the durations of studies etc was perhaps overly broad, but there is so little out there that we decided it would be best to include it all.

Critical thinking skills 101. How do you know something is “true”?

Kids need to be able to reason.