Intervention: Tramadol
Trial phase: Phase 3
ATC code: N02AJ13 | N02AJ14 | N02AJ16 | N02AX02
SMILES: COc1cccc(C2(O)CCCCC2CN(C)C)c1
Sex: All
Age groups: Adult
Healthy volunteers: No
Participants at risk: 206
Group description: Participants received 3 doses of tramadol hydrochloride 50 mg over a 24-hour period if they developed acute moderate to severe pain within 4 hours after third molar extraction.

Tramadol 50: Each dose comprised 1 capsule containing 50 mg tramadol hydrochloride and 3 placebo tablets matching the other active treatment groups. Doses were taken 8 hours apart.
Eligibility criteria:
Inclusion Criteria:

The participant has read the informed consent form, has understood the relevant aspects of the clinical study, and grants his/her authorization to participate by signing the informed consent form prior to the inclusion in the clinical study and the performance of any procedure.
Male and female participants above 18 years up to 60 years.
Female participants of childbearing potential must be practicing an acceptable method of birth control and must have a negative urine pregnancy test at enrollment with confirmation at the Allocation Visit.
Participants are in good health, i.e., the medical record, vital signs, physical examination, and laboratory parameter assessments do not show any abnormal deviations impeding the participation in the clinical study.
Participants requiring extraction of 3 or more third molars with 2 mandibular impacted third molars.
Clinical and radiological diagnosis of impacted lower third molars.
Class I and Class II molars according to Pell and Gregory's classification (Gay Escoda et al. 2004).
Participants must be able to swallow the IMPs.

Exclusion Criteria at Enrollment:

Findings in the medical record, vital signs, and/or physical examination demonstrating abnormal conditions of participant's general state of health preventing his/her participation in the clinical study according to the investigator's opinion.
Participant unable to speak, read, or write in Spanish language.
Clinical laboratory parameters exceed the pre-defined alert ranges (i.e., 1 standard deviation above or below the upper/lower limit of the normal ranges).
Known hypersensitivity to the IMPs, the anesthetic to be used during surgery, or to the rescue medication (ibuprofen, ketorolac).
Known alcohol or drug abuse in the last 6 months or any history of seizures. Alcohol abuse is defined as the consumption of more than 3 ounces (about 90 milliliters) of liquor or spirits or 18 ounces (about 530 milliliters) of beer per day, for 5 consecutive days during the 6-month period. Drug abuse is defined as the use of any recreational drug for 5 consecutive days during the 6 month period.
Participants who take analgesic medication for chronic pain, monoamine oxidase inhibitors, tricyclic antidepressants, neuroleptics, or other drugs that reduce the seizure threshold within 4 weeks of enrollment.
Pregnant or lactating women.
Participants who received systemic corticosteroids or opioid analgesics less than 2 weeks before surgery.
Participants with molars linked to the mandibular canal.

Participants requiring immediate dental procedures other than third and fourth molars extraction,

Exclusion Criteria at the Allocation Visit:

Participant received a long-acting non-steroidal anti-inflammatory drug within 24 hours or 5 times the elimination half-life of that drug prior to surgery, whatever the longer.
Participant received any analgesic medication other than short-acting pre-operative or intra-operative anesthetic agents within 24 hours before taking IMPs.
Participant received more than 300 mg of lidocaine in total.
Participant received any analgesic medication other than the IMPs immediately after the oral surgical procedure was completed.
Baseline pain intensity of the participant after oral surgical procedure remains below 5 points on the 11-point NRS.