Tramadol for Chronic Pain: Modest Relief at a High Risk

A major review of existing research suggests that tramadol, a strong opioid commonly prescribed for chronic pain, does not provide much meaningful relief. The analysis, published online in BMJ Evidence Based Medicine, found that while tramadol can reduce pain, the improvement is modest and falls below levels typically considered clinically important. The findings also point to a higher likelihood of serious side effects, including heart disease. Based on these results, the researchers conclude that tramadol's risks likely outweigh its benefits and say its use should be reduced as much as possible.

The Widespread Use and Perception of Tramadol

Tramadol is a dual-action opioid that doctors often prescribe for moderate to severe acute and chronic pain. Because of this, it appears in several clinical guidelines for pain management. Prescriptions for tramadol have risen sharply in recent years, making it one of the most frequently used opioids in the United States. This growth may be driven by the belief that tramadol carries fewer side effects and is safer and less addictive than other short-acting opioids.

Analysis of Clinical Trial Data

To address gaps in previous research, scientists conducted a systematic review and meta-analysis of randomized clinical trials comparing tramadol to a placebo for chronic pain. The final analysis covered 19 clinical trials involving 6506 participants. The studies examined various conditions including neuropathic pain, osteoarthritis, chronic low back pain, and fibromyalgia. Participants had an average age of 58, and treatment periods lasted from 2 to 16 weeks.

Key Findings on Efficacy and Safety

The combined data showed that tramadol did reduce pain, but only slightly and not enough to meet standards for clinically effective relief. This means the relief was so small that many patients likely wouldn't notice a real-world benefit. More concerning were the safety findings. Analysis of eight trials tracking serious side effects showed that tramadol was linked to about double the risk of harm compared with a placebo. This increase was largely due to more reported cardiac events, including chest pain, coronary artery disease, and congestive heart failure.

Understanding the Risks

Across all trials, tramadol was also tied to a greater risk of common, non-serious side effects such as nausea, dizziness, constipation, and sleepiness. The researchers acknowledge that many outcomes in the analyzed studies were at a high risk of bias. They suggest this likely means the benefits of tramadol are overstated while its harms are understated in the existing literature.

The Broader Opioid Crisis Context

The researchers emphasize the wider impact of opioid use, noting that approximately 60 million individuals worldwide experience the addictive effects of opioids. In the United States, the number of opioid-related overdose deaths increased from 49,860 in 2019 to 81,806 in 2022. Given these trends and the present findings, the use of tramadol and other opioids should be minimized to the greatest extent possible.

Conclusions and Recommendations

The research team concludes that tramadol may have a slight effect on reducing chronic pain (with low certainty of evidence) while likely increasing the risk of both serious (moderate certainty of evidence) and non-serious adverse events. The potential harms associated with tramadol use for pain management likely outweigh its limited benefits. This major review, as reported by ScienceDaily, provides crucial evidence that should inform clinical practice and patient-doctor discussions about chronic pain management strategies, steering prescribers toward options with a more favorable risk-benefit profile.