02/11/2026    Robert G. Smith DPM, MSc, RPh

PM’s 43rd Annual Survey 2026, Oral Analgesic Responses

As I read, studied, and performed comparative
analyses on the responses provided by the 504
participants of the Podiatry Management’s (PM’s)
43rd Annual Survey 2026, I noticed an interesting
discovery. I began this process in 2010 and
continued over these years comparing and analyzing
the presenting data with known published
references as well as foundational citations. My
initial acknowledge is that over the years a few
readers of PM News have offered criticism that the
annual data is not as robust statistically as
portrayed in meta-analysis studies as well as
citing bias that may creep into data
interpretation.

I do respectfully disagree and believe valuable
data is found in PM’s Annual Survey. Of course,
every investigator would love data that would
withstand rigorous scrutiny to include myself.
From 2009 to the present, I have collected the
prescribing and dispensing data from PM’s 43rd
Annual Survey and performed arithmetic and
comparative analysis on oral analgesics, non-
steroidal anti-inflammatory agents, and topical
agents that I have presented as written and oral
narratives to students, residents, and healthcare
professionals of many disciplines.

One data finding from PM’s 43rd Annual Survey-
Analgesics (Oral) centers on the percentage of
Ultram® (tramadol) prescribed and dispense I found
this finding informative. This data describes the
percentage for 2025 that rose to 5% from 1% in
2024. Moreover, 5% is greater than the previous 4
years, appearing again as 5% in 2020 and the year
2015 presents with 6%, and 2014 revealed 5% for
Ultram® (tramadol) once again as the year 2012
presents as 2% and 2011 presents as 11% for
prescribing and dispensing for Ultram® (tramadol).

Pharmacology and Therapeutic leaders have raised
the question: “Tramadol: Why are we still using it
so often?” Despite serotonin and opioid risks,
tramadol remains a go to analgesic for moderate
pain in emergency departments, urgent care, and
primary care practices. Literature attempts to
explain why it is so frequently prescribed.
Tramadol has legacies of a “gentle” reputation and
the perception it is “weaker” or “safer” than
other opioids. It is time to rethink tramadol’s
role as a go to analgesic. Tramadol has CYP2D
metabolism which contributes to variable pain
relief and is easier to misuse. Common drug
interactions lead to reduce efficiency and
increased toxicity to include an increased
serotonin syndrome risk as well
as a higher seizure potential at therapeutic
doses. Substance use disorder research has
documented that tramadol has a high abuse
potential because it is popular in Appalachia and
other parts of the United States and an increasing
threat in Africa. The World Health Organization
(WHO) has noted that tramadol is a rising public
health threat.

I suggest the architects of the Podiatry
Management’s (PM’s) 44th Annual Survey-2026 that
they include suzetrigine to its analgesic (oral)
products for respondents to select. Because
suzetrigine is indicated for the treatment of
moderate to severe acute pain in adults. It is a
sodium channel blocker that works by reducing pain
signals before they reach the brain. Lastly, it
can be utilized as an opioid sparing therapeutic
as part of a multimodal analgesic regimen for
podiatric physicians.

Robert G. Smith DPM., MSc, RPh, Ormond Beach, FL

Other messages in this thread:

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02/11/2026    Robert G. Smith DPM, MSc, RPh

PM’s 43rd Annual Survey 2026, Oral Analgesic Responses

As I read, studied, and performed comparative
analyses on the responses provided by the 504
participants of the Podiatry Management’s (PM’s)
43rd Annual Survey 2026, I noticed an interesting
discovery. I began this process in 2010 and
continued over these years comparing and analyzing
the presenting data with known published
references as well as foundational citations. My
initial acknowledge is that over the years a few
readers of PM News have offered criticism that the
annual data is not as robust statistically as
portrayed in meta-analysis studies as well as
citing bias that may creep into data
interpretation.

I do respectfully disagree and believe valuable
data is found in PM’s Annual Survey. Of course,
every investigator would love data that would
withstand rigorous scrutiny to include myself.
From 2009 to the present, I have collected the
prescribing and dispensing data from PM’s 43rd
Annual Survey and performed arithmetic and
comparative analysis on oral analgesics, non-
steroidal anti-inflammatory agents, and topical
agents that I have presented as written and oral
narratives to students, residents, and healthcare
professionals of many disciplines.

One data finding from PM’s 43rd Annual Survey-
Analgesics (Oral) centers on the percentage of
Ultram® (tramadol) prescribed and dispense I found
this finding informative. This data describes the
percentage for 2025 that rose to 5% from 1% in
2024. Moreover, 5% is greater than the previous 4
years, appearing again as 5% in 2020 and the year
2015 presents with 6%, and 2014 revealed 5% for
Ultram® (tramadol) once again as the year 2012
presents as 2% and 2011 presents as 11% for
prescribing and dispensing for Ultram® (tramadol).

Pharmacology and Therapeutic leaders have raised
the question: “Tramadol: Why are we still using it
so often?” Despite serotonin and opioid risks,
tramadol remains a go to analgesic for moderate
pain in emergency departments, urgent care, and
primary care practices. Literature attempts to
explain why it is so frequently prescribed.
Tramadol has legacies of a “gentle” reputation and
the perception it is “weaker” or “safer” than
other opioids. It is time to rethink tramadol’s
role as a go to analgesic. Tramadol has CYP2D
metabolism which contributes to variable pain
relief and is easier to misuse. Common drug
interactions lead to reduce efficiency and
increased toxicity to include an increased
serotonin syndrome risk as well
as a higher seizure potential at therapeutic
doses. Substance use disorder research has
documented that tramadol has a high abuse
potential because it is popular in Appalachia and
other parts of the United States and an increasing
threat in Africa. The World Health Organization
(WHO) has noted that tramadol is a rising public
health threat.

I suggest the architects of the Podiatry
Management’s (PM’s) 44th Annual Survey-2026 that
they include suzetrigine to its analgesic (oral)
products for respondents to select. Because
suzetrigine is indicated for the treatment of
moderate to severe acute pain in adults. It is a
sodium channel blocker that works by reducing pain
signals before they reach the brain. Lastly, it
can be utilized as an opioid sparing therapeutic
as part of a multimodal analgesic regimen for
podiatric physicians.

Robert G. Smith DPM., MSc, RPh, Ormond Beach, FL