Information on the event
According to the pharmaceutical injury report dated 28 March 2023, A (b. 1968) has congenital hemiplegia due to mild brain damage in the left hemisphere, affecting the right side of his body. On 26 October 2022, A was prescribed the drug Tramadol (active substance: tramadol) because of pain in his lower back. A was also prescribed a drug containing ketoprofen. Within 4–5 days from starting the medications, A started to experience memory gaps, confusions, cognitive problems etc. Several times a day, A forgot for 10–30 seconds what he was saying, and when shopping, he couldn’t remember a shopping list of three items. When cooking, A had to consult recipes for meals he had been cooking for 30 years. A could not remember the storylines of books he had just read. Before starting the tramadol, A’s mind functioned normally.
According to the pharmaceutical injury report, A stopped the tramadol in December 2022. A hoped that the memory problems would dissipate after stopping the drug, but unfortunately that did not happen. A underwent blood tests and an MRI scan of the head, which did not produce any findings to explain his symptoms. In March 2023, a doctor suggested that A’s memory issues might be due to “pseudodementia”. The doctor also said that the tramadol/ketoprofen was not the cause of A’s symptoms. This felt insulting to A. He did not find himself depressed. A said he had read that Tramadol is not the best option for patients with brain damage/cerebral palsy/hemiplegia. A questioned why he should have invented memory problems for himself when he already had spatial and learning difficulties due to his congenital condition. A had nevertheless overcome these difficulties. A explained that he was unable to work because of the cognitive issues. In addition to the pharmaceutical injury report, A provided the insurance company with email messages dated 25 September 2023, 1 February 2024 and 19 April 2024, in which he enquired about the processing schedule. A also described e.g. the examinations that he had undergone in order to determine the causes of the memory/cognitive problems.
The insurance company issued its compensation decision in the case on 14 May 2024. The company noted that the literature contains descriptions of changes in the functioning of memory areas and cellular-level changes caused by tramadol in rat experiments conducted under research conditions. However, similar changes have not been described in humans. Instead, humans may experience short-term acute confusion related to the use of medications or memory and information processing symptoms caused by prolonged addiction to tramadol, which dissipate after the use is discontinued or after detoxification. In the patient records, the length of A’s sleep is said to be six hours. The sleep has been intermittent due to the back pain. Sufficient high-quality sleep is key to attentiveness and, through it, to memory function. Prolonged pain symptoms or back pain affect attentiveness and cognitive performance. The back pain has also affected A’s ability to exercise. A’s demanding specialist work involved stress, which was made worse by the pain symptoms. The company considered that A’s memory problems had several potential causes affecting his ability to concentrate. The company said it was unlikely that the short-term use of the drug Tramadol was the most probable cause for the symptoms reported by A. In the company’s view, the memory and concentration difficulties experienced by A were probably not caused by the use of the drug Tramadol, and the symptoms thus had no such probable causal link to the use of the drug as is required by the terms and conditions of the pharmaceutical injury insurance. The company did not pay compensation to A from the pharmaceutical injury insurance.
A informed the insurance company of his dissatisfaction with the company's compensation decision. The Insurance Complaints Board has been provided with several email messages in which A and the insurance company discussed the content and terminology of the compensation decision among other things.
The customer’s complaint
The Insurance Complaints Board has received, in addition to A’s request for a resolution recommendation, further communications written by A or by his representative and dated 30 October 2024, 8 January 2025 and 21 January 2025.
A states his dissatisfaction with the insurance company’s compensation decision and requests a resolution recommendation in the case from the Insurance Complaints Board. After the request for a resolution recommendation was received, A’s case has been handled by his representative. A demands that the Insurance Complaints Board should confirm a causal link between the tramadol medication given to him and the significant cognitive deficiency symptoms he has been found with, entitling him to compensation.
A states that he has a congenital brain injury due to which the right side of his body has always been weaker than the left side. However, A has learned to live with the brain injury from a young age, and he has managed well both physically and cognitively. A has long held demanding specialist positions, is highly educated and has played squash, among other sports, at a high level. A was prescribed the drug Tramadol for back pains on 26 October 2022, and within 4–5 days of starting the treatment, he noticed a clear deterioration of his memory. A’s spouse noticed his memory problems as well. The medication continued for approximately six weeks, but the symptoms did not dissipate after A stopped the drug.
In A’s view, it should be noted in particular that cognitive symptoms are partly subjective and that for their objective evaluation, no better method has been developed than a neuropsychological examination. The objective neuropsychological deficiencies observed in neuropsychological examinations should therefore be given a high importance when evaluating the symptoms. Moreover, special attention should be paid in A’s case to the fact that his cognitive performance has probably been significantly above average before the pharmaceutical injury took place. In A’s case, even an average result would thus be probable proof of diminished cognitive ability.
A notes that the neurologists who treated him have found no better explanation than tramadol for the memory symptoms. A has been extensively examined, and no progressive memory loss disease has been found. Several of A’s patient reports discuss, reasonably, the possibility that his congenital hemiparesis might make him more susceptible to the adverse effects of tramadol. This should not be considered against A but, on the contrary, should be viewed as a circumstance in support of the causal link and compensability. In view of A’s congenitally abnormal brain structure, a six-week period of using tramadol must be considered a prolonged period of use.
Many of A’s patient records have noted that he finds six hours of sleep per night sufficient. They contain mentions of the effect of back pain on sleep, but in the initial assessment of the neuropsychological evaluation, for example, A said that he feels he still gets enough sleep nevertheless. The need for sleep varies considerably even among completely healthy adults, and six hours is not such a small amount that this alone would explain the significant and rapid change in A’s cognitive performance. This is especially true because A had had the same duties at work for a long time with the same amount of sleep before starting the medication. The neurological examination also finds that A has no strain factors other than the memory problems and the back pain. A had been on prolonged sick leave because of his memory problems, and was subsequently given notice from his job because of his illness.
The connection between tramadol and cognitive symptoms is not previously unknown in medicine. As the insurance company, too, has noted, tramadol’s lasting cognitive effects have been described in animal experiments. It is clear that tramadol often causes temporary cognitive symptoms at the very least. Similar symptoms to those described by A have also been found in persons who have used tramadol for a prolonged period. A used the medication for approximately six weeks. Even if that period would probably not be long enough to cause difficult and lasting adverse effects in a normally structured brain, A’s congenital brain injury must be taken into account in this case. An article published in 2018, on the use of tramadol in pain relief, observes that discretion should be used in prescribing it to patients with neurological abnormalities (e.g. epilepsy).
According to the talem qualem principle, the personal qualities of the injured party should not be taken into account in assessing the compensability of the loss. In A’s case this principle is a key one, since his starting point is indisputably different from that of an average person. In A’s case, the only factor relevant to the question of causality is whether A would have been likely to develop the cognitive symptoms leading to work disability irrespective of whether tramadol medication was involved. In the light of the specialist opinions found in the patient records, this interpretation must be considered very unlikely.
A’s representative emphasizes the importance of a legal assessment. In A’s case, it is impossible to reach a certain or even a probable conclusion by medical methods. When assessing A’s case objectively and from a legal viewpoint, a causal link between the tramadol medication and the range of symptoms he developed must be considered likely, also because no individual factor speaking against a causal link in his case has been found. Before the tramadol medication, A had been completely healthy in cognitive terms, he had held demanding specialist positions and led an athletic lifestyle.
In its reply, the insurance company has referred to A’s patient records, which A considers partly erroneous. A points out that to his knowledge, his knee has never been operated on, for instance. One of the patient records claims that he has nocturia twice a night, while in reality he has it only once a night. The nocturia was caused by an intervention performed on A in 2006/2007 in connection with an aortic aneurysm.
Reply by the insurance company
In addition to the reply by the insurance company, the Insurance Complaints Board has also received a further reply dated 21 March 2025.
In its reply, the insurance company summarises the contents of its compensation decision issued on 14 May 2024. The insurance company additionally notes that some of the patient record entries speculate on the use of medication, for example, as an explanation for the unusually significant sudden decline in A’s cognitive capacity considering that his compensation reserve is not optimal due to brain damage and the need to compensate, or on A’s central nervous system being abnormally sensitive to the adverse effects of tramadol due to his cerebral palsy. On the other hand, in many entries, the doctors treating A did not find it likely that A’s prolonged symptoms were caused by the drug used, which is not known to cause prolonged memory symptoms. In addition, the range of symptoms as well as the underlying causes of the findings in the neuropsychologist’s assessment have been thought to be multifactorial. On the basis of the information found in the patient records, it is thus not possible to consider that the use of the drug was the most probable cause of A’s symptoms.
The idea that A’s short-term use of tramadol was the probable cause of his observed prolonged symptoms is not supported by the research data on tramadol either. Tramadol is known to cause e.g. amnesia as a relatively rare adverse effect that occurs during use of the drug. In the literature, tramadol has been found to cause changes in the function of memory areas and at cellular level in rats under research conditions. Humans, on the other hand, may experience short-term acute confusion while using the drug or memory and information processing symptoms caused by prolonged addiction to tramadol. These symptoms dissipate after the drug is stopped or after detoxification.
A’s representative writes that A has been found to have a significant cognitive deficiency symptom (including problems with memory and regulation of alertness). The company observes that the neuropsychological examination found A to have mainly mild and partly moderate cognitive symptoms, consisting mainly of variation in attention maintenance and of partly related difficulties with verbal memory. A’s representative also observes that “his cognitive performance has probably been considerably above average before the pharmaceutical injury occurred. [A] has worked a long career in demanding specialist positions. In his case, even an average result would thus be probable proof of a diminished cognitive ability.” The company points out that the statement in question remains speculative in nature because, based on the information received by the company, A had not previously undergone a similar examination with which the results could be compared.
Medical reports
The Insurance Complaints Board has at its disposal A’s medical reports for the period of 26 October 2022 to 16 September 2024.
The reports contain the following background information. As a result of mild congenital brain injury, A has a mild cerebral palsy and a related mild paralysis on the right side (hemiplegia). At age 4, A underwent Achilles tendon lengthening surgery. One of his ankles has been stiffened up. In his childhood, A had epilepsy and because of this, he used epilepsy medication until he was a teenager. He has had no epileptic seizures in years. Every five years, A has a control scan of the prosthesis in his lower aorta. A’s mother tongue is English, and he speaks no Finnish.
According to the patient record dated 26 October 2022, A was prescribed the drugs Tramadol/Paracetamol KRKA and Orudis because of prolonged pain in his lower back. A was given sick leave.
According to the patient record dated 2 November 2022, the worst of the back pain had been alleviated with painkillers. Getting dressed was challenging, and bending over provoked the pain. A explained that the drug Tramadol was causing him concentration problems.
According to the B1 medical statement dated 21 December 2022, section “Ability to function”, A developed pain in his back in early October 2022 when he stumbled during a slight bending and twisting motion. When changing positions, A experienced electric shock-like pain in the neck and both legs, more in the right leg. Changing positions was painful. A walked with a limp. When going up the stairs, for example, A was unable to lift his right leg. Sensation was weaker in the lower right limb because of his congenital injury. The use of the drug Tramadol had caused A drowsiness and memory deterioration. A could not remember the storyline of a book, and he could not remember three items to buy when shopping. On 14 December 2022, it was decided to gradually stop the Tramadol medication. The memory problem was a daily hindrance to functioning. According to a plain X-ray examination report dated 15 December 2022, appended to the medical statement, a 9-mm olisthesis of A’s L5 vertebra and S1 vertebra was observed at the L5/S1 interspace, corresponding to the MRI scan performed in October 2022. The anterior parts of the endplates showed degenerative osteophytes. The interspace had shrunk markedly, almost to the level of bone-on-bone contact. The L2/3, L3/4 and L4/5 interspaces had shrunk slightly. The L3 and L4 vertebrae showed slight osteophytes, especially in the anterior parts of the upper endplates.
According to the neurologist’s text dated 11 January 2023, A still had pain in the lower back. A came to see the neurologist because of memory issues, which he said had started when he used a combination of the drug Tramadol and the anti-inflammatory drug Keto for six weeks. A described his mental capacity as having always been good. He had had no memory issues before October 2022. A had had an excessive nocturnal need to urinate (nocturia) twice a night for several years. During the medication, the nocturia had stopped. The medication had had no effect on the pain. The medication had been discontinued three weeks earlier. A had now been using the drug Burana, as well as the drug Norflex at night, but these had had no effect on the pain. The pain woke A up during the night, and he also had to visit the bathroom twice a night again. A felt that his short-term memory problems still persisted. In the neurologist’s opinion, the memory problems experienced by A could be explained by his financial anxieties, the persisting pain, the current pain becoming chronic in a way consistent with a change in the pain threshold, and the broken sleep. During the NSAID medication, A had had no memory problems, and because the weak opiate tramadol had already been stopped, it did not explain this symptom. In the neurologist’s opinion, the sudden onset of the memory problem was inconsistent with an internal medical cause, and A did not describe any symptoms of a cerebrovascular disturbance either. A was prescribed the drug Gabapentin Actavis and the drug Venlafaxin Krka.
According to the neurologist’s text dated 22 February 2023, A said that the situation with the memory problems was the same as in December or even worse. A did not feel that the Gabapentin and Venlafaxin medications had helped, so the decision was taken to pause them. A explained that his memory was continuously bad. There was no paroxysmal pattern or variation.
According to the patient record dated 27 February 2023, A felt that he could handle the back pain but the memory problems were an insurmountable handicap. A said he could not remember the storylines of books he read. A had forgotten the names of his children for approximately 10 seconds. When speaking, A could not remember words. A had stopped all medication apart from occasionally using Burana for the back pain. A had been on sick leave since October 2022, and the sick leave was extended further.
The neurologist’s text dated 3 March 2023 contains the report on the head MRI scan that A underwent on 24 February 2023. According to the report, the lateral ventricles of the brain were asymmetrical in shape. Next to the left lateral ventricle, there had probably been some loss of functional brain tissue, and the ventricle had receded in that direction and was therefore larger in its corpus part than the right ventricle. This was consistent with the congenital hemiplegia condition mentioned in the referral. Apart from that, there were no abnormal findings in the scan. In the neurologist’s opinion, no organic internal medical or neurological cause for the memory problems could be determined based on the scan. According to the neurologist, the tramadol used did not explain the memory problems either. A was scheduled to undergo a memory test. The neurologist advised that A should ask the psychologist’s opinion on whether a psychological memory impediment might be involved. The neurologist spoke with A about pseudodementia, in which a masked depression could manifest itself in the form of memory symptoms. The neurologist recommended that A should have a psychiatric consultation.
According to the patient record dated 8 March 2023, A said that he did not feel depressed. A had filled out a lengthy depression questionnaire, in which his result was 3 or 4 points, meaning that the test result did not indicate depression.
According to the patient record dated 13 March 2023, A had decided to undergo a lower back stiffening operation that had been suggested to him earlier, and he received a referral for it.
According to the B1 medical statement dated 31 May 2023, section “Ability to function”, A had been on continuous sick leave since October 2022 because of difficult pain symptoms caused by displacement of a spinal vertebra (spondylolisthesis) and degeneration of the spinal column (spondylosis). A linked the memory problems, which had started in December 2022 and were still ongoing, to the tramadol and ketoprofen he had used earlier; since that time, the decline in his cognitive capacity related to the memory issues had been the primary cause of his inability to work in his cognitively demanding specialist job. A described his memory problems saying that several times a day, he repeatedly experienced situations in which he forgot what he was saying and the discussion was thus interrupted. Situations occurred where A did not know what he was doing. A described this as a “brain freeze”. After such an interruption, 10–15 minutes passed before the mistiness/fogginess had completely disappeared. After this, A’s functional capacity could be nearly normal until the same happened again. Such attacks could occur up to once an hour and, in any case, several times a day. A was able to do difficult sudokus for a moment, and then he suddenly could not complete a simple task. When the outage was completely over, A was often able to complete the interrupted task without problems. At home, he could do normal everyday chores, but clearly at a slower pace than before. When cooking, for example, A repeatedly had to check recipes for meals he had been making for decades without recipe. A did not experience symptoms of depression or anxiety. A did not feel stressed or experience insomnia. A said he slept well and fell asleep easily. A’s nocturnal sleep had always been relatively short, but he did not experience daytime fatigue or exhaustion. At the consultation, A’s mood seemed normal and he did not give an impression of being depressed or anxious. The pain in the lower back affected his movements and changes of position. At night, the back pain woke him up when changing position, but otherwise he had no pain when at rest. The sick leave was extended further.
According to the extensive neuropsychological examination report dated 8 June 2023, section “Summary and conclusions”, the examination showed variation in attention maintenance and a slight difficulty with verbal memory. A’s attention maintenance seemed to vary, and his thinking was occasionally interrupted or got stuck; at these times, he also showed an indicative susceptibility to errors. A also noticed himself when his thinking got stuck and he was not able to immediately remember what he was saying. With verbal memory, a slight qualitative difficulty was observed. In broad subject areas, immediate memory performance was at the lower limit of expected values. A benefited from repetition to some extent. A succeeded in delayed retrieval without clues but had to spend a moment thinking and the retrieval seemed rather laborious, even though the performance was largely similar to immediate retrieval. With unconnected material, learning was strain-inducing, and performance again remained at the lower limit of expected values. Delayed voluntary retrieval was clearly poorer than immediate retrieval, but A recognised the material correctly and there was no forgetting. Verbal short-term memory showed a slight susceptibility to disruption. In addition, verbal fluency was poorer than expected. In conversation during the examination, A was also occasionally observed searching for words. In the view of report’s author, A’s primary cognitive capacity was uneven per se, with verbal reasoning corresponding to average level and visual reasoning slightly above average. Verbal reasoning was now within the limits of the expected level. Visual reasoning was slightly/moderately below expected level for identifying essential elements but corresponded to the expected level otherwise. The examination thus primarily showed variation in attention maintenance and a slight difficulty with verbal memory. No typical indications of memory loss disease were observed.
According to the neurologist’s text dated 29 June 2023, A’s situation was discussed at a multi-professional meeting of the neurological outpatient clinic. A’s neuropsychological profile was uneven, possibly in connection with his congenital brain injury. A’s situation was not typical for memory loss disease, but the meeting recommended follow-up and a neuropsychological control examination one year later at the earliest.
According to the neurologist’s text dated 3 January 2024, A’s memory symptoms were evident in everyday life and made him unable to work. The start of A’s memory symptoms was temporally linked to the start of the tramadol medication. Atypically, there had been no improvement even though the tramadol was discontinued. There had been speculation that A’s central nervous system might be abnormally sensitive to the adverse effects of tramadol due to his cerebral palsy. The neurologist observed that tramadol was known to have a complex mode of action, since it affects not only opioid receptors but also noradrenaline reuptake and serotonin release. The neurologist noted that no better explanation than tramadol had been found for A’s memory problems, even though the causality could not be proved objectively. In October 2023, a sample of A’s cerebrospinal fluid had showed normal results.
The B1 medical statement dated 29 January 2024 looks at the memory and cognitive issues experienced by A. In a clinical examination on 26 January 2024, A was stiff and in pain when starting to move due to his lower back. While sitting, A had to change his position because of the back symptom. During the long consultation, A’s speech was interrupted a few times and he had to search for words and try to remember what he was about to say. Otherwise, his conversation was logical, diverse and comprehensible. A did not give the impression of being depressed, tired, low-spirited or anxious.
According to the extensive neuropsychological examination report dated 19 August 2024, section “Summary and conclusions”, the examination on the whole showed a partly slight, partly moderate range of cognitive symptoms consistent with A’s subjective experience of cognitive difficulties. His manner in functioning was energetic, and processing speed was mainly close to average. Some variation in attention maintenance was observed, appearing as a slight variation in the speed of functioning and occasionally even as an evident freezing of functioning (losing track of what he was talking about, occasionally significant variation in task performance). Partly in connection with the above, immediate verbal memory performance was variable and remained below expected levels, at best slightly and occasionally clearly. Visual memory performance broadly corresponded with expectations. Basic verbal operations and naming were performed effortlessly, but verbal fluency was clearly poor at times. Slight inattentiveness was also observed in counting, for example, increasing A’s susceptibility to errors. Performance at reasoning tasks was largely at expected level, although slight unevenness was observed, as performance varied between low average and clearly above-average. Symptom awareness and self-assessment of functional capacity were realistic and fluent. Mental reactions showed adequate frustration with the difficult situation (at the time, A had lost his job due to prolonged work disability, and the underlying causes of the cognitive situation were unclear). However, no signs of mood problems were observed. According to the report, section “Plan”, in a comparison between the observations of the June 2023 examination and those of the latest examination, neither systematic decline nor improvement in cognition was found. No indication of a progressive degenerative situation was observed in relation to cognition. The cognitive difficulties did not seem to be explained by mood factors, strain factors or the pain situation. A has a slight congenital brain injury and explained that he had compensated for it with different strategies and hard work throughout his life. Until autumn 2022, A said he had done very well at university and at work in his specialist position. According to the report’s author, in the light of A’s earlier brain injury and need for compensation, his compensation reserve was not optimal, which may have explained the unusually significant sudden decline in cognitive capacity in autumn 2022 due to e.g. medication.
Resolution recommendation
Formulation of the question
The case concerns the question of whether the memory and cognitive issues experienced by A are compensable as a pharmaceutical injury caused by the drug Tramadol.
The applicable policy terms
According to the terms and conditions of the pharmaceutical injuries insurance (effective from 1 January 2023), clause 4 (Pharmaceutical injury), a pharmaceutical injury means any physical illness, injury or mental disorder that was probably caused by a pharmaceutical used by the injured party. […]
Evaluation of the case
The pharmaceutical injuries insurance covers any personal injuries whose probable cause was a pharmaceutical used by the injured party. This means that the injury may have several possible causes but the use of the pharmaceutical is the most likely cause when all causes are considered as a whole. The assessment of the causal link encompasses the illness or injury treated with the pharmaceutical, any other illnesses and the overall state of health of the compensation claimant, the treatments the claimant received and the pharmaceutical in question as well as any other medication the claimant had used. The causal link is assessed on the basis of medical knowledge and experience. A temporal connection alone, i.e. the fact that the symptoms appeared during or shortly after the use of the pharmaceutical, is not sufficient to prove a probable causal link between the use of the pharmaceutical and the injury.
According to the information available to the Insurance Complaints Board, A has a mild cerebral palsy and a related mild paralysis on the right side (hemiplegia) as a result of mild congenital brain injury. At age 4, A underwent Achilles tendon lengthening surgery. One of his ankles has been stiffened up. As a child, A had epilepsy, and he consequently used epilepsy medication until he was a teenager. He has had no epileptic seizures in years. Every five years, A has control scans of the prosthesis in his lower aorta. A’s mother tongue is English, and he does not speak Finnish. A has worked a long career in demanding specialist positions.
A developed pain in his lower back in a slight bending and twisting motion in early October 2022. On 26 October 2022, A was prescribed the drug Tramadol/Paracetamol KRKA and the drug Orudis for prolonged pain in the lower back. According to his own account, A noticed a deterioration of his memory within 4–5 days from starting the above-mentioned medications. The first patient record entry that mentions A’s account of concentration problems caused by the drug Tramadol is dated 2 November 2022. In October 2022, A had an MRI scan and an X-ray examination of the lumbar spine, which showed a vertebral displacement (spondylolisthesis) and degeneration of the spinal column (spondylosis). In December 2022, the decision was made to discontinue the Tramadol medication because of the cognitive symptoms and memory issues experienced by A. A’s cognitive and memory issues persisted despite the discontinuation of the medication, and in health care this was considered an atypical condition following discontinuation of the drug Tramadol. Health care professionals suspected that the symptoms experienced by A might be due to broken sleep caused by the back pain and having to wake up for bathroom visits, a change in his pain threshold due to the pain becoming chronic, and A’s financial worries. Pseudodementia was also discussed as a possible underlying cause of the symptoms, but based on the information received, A was not observed to be in low spirits or anxious, for example. A is said to have always managed with six hours of sleep per night. A’s descriptions of his symptoms include having several outages per day when he did not remember what he had been doing. A had to search for words and could not remember the storylines of books he had read. While cooking, A had to consult recipes for dishes that he had been making for decades without recipe. A’s back pain is reported to have continued, but at the consultation on 27 February 2023, for example, A said that he felt he could handle the back pain but the memory problems were an insurmountable handicap. Starting from October 2022, A was on sick leave because of the back pain and specifically the cognitive problems, until his employment relationship was terminated in April 2024 due to the prolonged work disability.
A underwent several examinations in order to explain the memory problems, including a head MRI scan and a cerebrospinal fluid analysis. The examinations did not produce any findings to explain the symptoms. There was speculation in health care that A’s central nervous system might be abnormally sensitive to the adverse effects of tramadol due to his cerebral palsy. On 8 June 2023, A underwent a neuropsychological examination which primarily showed variation in attention maintenance and a slight difficulty with verbal memory. A underwent a new neuropsychological examination on 19 August 2024 which showed neither systematic cognitive decline nor improvement compared to the observations of the examination on 8 June 2023.
The Insurance Complaints Board notes that medical literature has described cognitive changes resulting from prolonged misuse of tramadol. The Board observes that A used tramadol at a low dose and for a short period of time. Such use has not been associated with changes of the type described above.
Referring to the medical information concerning A, the Insurance Complaints Board notes that the competing explanations for the memory and cognitive issues presented by A are his chronic pain and consequent broken sleep as well as his challenging situation in life. Medical literature has not described prolonged symptoms persisting after discontinuation of tramadol use such as the symptoms described for A. The Insurance Complaints Board does not find it likely that the memory and cognitive issues developed by A would be linked to his earlier use of tramadol. The Board considers that the drug Tramadol is not the probable cause of A’s memory and cognitive issues.
Final outcome
The Insurance Complaints Board does not recommend a change to the insurance company’s compensation decision.
The Insurance Complaints Board’s decision was unanimous.
INSURANCE COMPLAINTS BOARD
Chair Norio
Secretary Pippola
Members
Jokelainen
Järvinen
Mervaala
Soinila