A major review of clinical trials has found that tramadol, a widely prescribed opioid painkiller, provides only slight relief for chronic pain while significantly increasing the risk of serious side effects, particularly heart-related problems. The analysis, published in BMJ Evidence-Based Medicine, suggests that the risks of tramadol likely outweigh its limited benefits, prompting researchers to call for reduced use in pain management.
Researchers analyzed data from 19 randomized clinical trials involving over 6,500 participants with chronic pain conditions, including osteoarthritis, neuropathic pain, and fibromyalgia. While tramadol did reduce pain slightly, the improvement was too small to be considered clinically meaningful for most patients.
More concerning, the study found that tramadol doubled the risk of serious adverse events compared to a placebo. Most of these were cardiac events, such as chest pain, coronary artery disease, and congestive heart failure. Common but milder side effects, including nausea, dizziness, constipation, and sleepiness, were also more frequent among tramadol users.
Dr. Janus Christian Jakobsen, one of the study authors, noted that tramadol is often perceived as a safer alternative to other opioids. However, this review indicates that its risks have been underestimated, especially regarding heart health.
The research also highlighted broader concerns about opioid use worldwide, noting that opioid-related overdose deaths in the U.S. rose sharply between 2019 and 2022. Given these trends, the authors urge healthcare providers to minimize tramadol prescriptions whenever possible.
This comprehensive review underscores the need for caution when prescribing tramadol for chronic pain. While it may offer minor relief, the associated risks, particularly to cardiovascular health, suggest that alternative pain management strategies should be prioritized. Future studies with longer follow-up periods are needed to further clarify tramadol’s long-term safety profile.