A new analysis published in BMJ Evidence-Based Medicine suggests that tramadol — one of the most commonly prescribed opioid pain medications — provides only modest pain relief while increasing the risk of significant adverse health effects.
Tramadol has long been viewed as a “safer” or less addictive opioid, a perception that has contributed to its widespread use in treating chronic pain. However, researchers found that its benefits may be far more limited than previously believed.
Dr. Marc Siegel, senior medical analyst for Fox News, noted that clinicians often turn to tramadol to avoid stronger opioids, even though it is still a synthetic opioid. “It is much milder,” he said, but still carries risks.
What the Study Found
The analysis reviewed 19 randomized clinical trials involving 6,506 adults with chronic pain conditions such as osteoarthritis, low back pain, neuropathic pain, and fibromyalgia. Each study compared tramadol to a placebo.
Researchers reported that tramadol produced only a small reduction in pain, falling short of what is typically considered clinically meaningful. At the same time, participants taking tramadol experienced higher rates of both serious and non-serious adverse events.
Pain specialist Dr. Alopi M. Patel, who was not involved in the study, emphasized how striking the findings were: the pain reduction was minimal, yet the risk of serious complications was clearly elevated.
Increased Risk of Heart-Related Problems
Serious adverse events were primarily cardiovascular, including:
- Chest pain
- Coronary artery disease
- Congestive heart failure
The authors concluded that tramadol likely increases the risk of heart-related issues, raising concerns about its safety for long-term use.
Do the Benefits Outweigh the Risks?
Based on the evidence, the researchers stated that tramadol’s benefits for chronic pain are small, while the potential harms may outweigh those benefits. They questioned whether tramadol should continue to be used as a standard treatment for chronic pain conditions.
Study Limitations
The authors acknowledged several limitations:
- Most trials were short-term (2–16 weeks), limiting insight into long-term safety.
- Many outcomes had a high risk of bias, potentially overstating benefits and understating harms.
- The studies included multiple types of chronic pain, but the data were not detailed enough to draw conclusions for specific conditions.
Dr. Patel noted that this lack of specificity makes it difficult to generalize the findings to particular patient groups.
Dr. Siegel also cautioned against overinterpreting certain associations, such as slight increases in cancer or heart disease, because the studies did not control for other contributing factors. He also pointed out that tramadol was not compared with stronger opioids like Percocet.
Important Reminder for Patients
Experts stress that patients should not stop tramadol abruptly, as doing so may trigger withdrawal symptoms. Anyone considering a change in medication should consult their doctor first.
Original reporting from Fox10 Phoenix
