A new large systematic review published this week has raised important questions about the safety and effectiveness of tramadol, a widely prescribed opioid for chronic pain relief. The study, published online ahead of print in BMJ Evidence-Based Medicine, finds that while tramadol does reduce pain compared with placebo, the benefit is small and may not be clinically meaningful for many patients.
Researchers analyzed data from 19 randomized clinical trials including over 6,500 adults with different types of chronic pain such as osteoarthritis, neuropathic pain, low back pain and fibromyalgia, comparing tramadol to inactive placebo.
The team found that tramadol’s effect on pain scores was statistically significant but below the predefined threshold for what most doctors would consider meaningful pain relief, suggesting many patients may not experience a noticeable improvement.
Even more concerning, the review also showed that tramadol was associated with increased risk of serious adverse events, including cardiac problems such as chest pain and coronary disease, as well as a higher occurrence of milder side effects like nausea, dizziness, constipation and sleepiness.
Study authors note that many of the included trials had high risk of bias, meaning the true benefits might be even smaller and the harms larger than reported. They conclude that, overall, the potential harms of tramadol likely outweigh its limited benefits when used for chronic pain management.
The findings come amid growing concerns about opioid prescribing worldwide, and add to ongoing debates among clinicians about the safest and most effective ways to treat long-term pain.
