Popular Painkiller Tramadol Provides Minimal Pain Relief, Increases Risk Of Serious Health Complications

A recent study revealed that Tramadol, which is widely known to be a "safer" painkiller, might not be as beneficial. A large analysis of clinical trials found that the painkiller might help reduce pain, however the pain relief is modest, and it is so small that patients might not benefit much from it. While tramadol doesn't provide much relief, it also increases the risk of several health issues such as heart failure, chest pain, sleepiness and dizziness, among others. The study was published online in BMJ Evidence Based Medicine.

The analysis found that the improvement is minimal and falls below levels that are usually considered clinically important. The findings of the study highlight the higher chances of serious side effects, which includes heart disease. The researchers say that the risks of tramadol outweigh its benefits and hence, the use of this painkiller should be reduced.

Tramadol is an opioid that is usually prescribed by doctors to treat moderate to severe acute and chronic pain. Researchers say that it is due to this very reason that tramadol appears in several clinical guidelines for pain management. This medicine is also one of the most frequently used opioids in the United States. They also say that the use of this medicine is also driven by the belief that tramadol has fewer side effects.

For this study, the researchers searched databases for randomised clinical trials published up to February 2025. These studies compared tramadol with placebo in people who suffered from chronic pain. They also included people with cancer-related pain.

The researchers included 19 clinical trials involving 6506 participants in the final analysis. Five of these studies examined neuropathic pain, nine focused on osteoarthritis, four on chronic low back pain, and one on fibromyalgia. The average age of participants in the study was 58 years, with an age range between 47 and 69 years. Most of these studies used tablets and one of them used a topical cream. The treatment period of these studies depended from 2 to 16 weeks, and a follow up ranging from 3 to 15 weeks. The results showed that tramadol did reduce pain, however, it was very little and not enough to meet standards for clinically effective relief.

Among all the trials, eight of these tracked serious side effects during the follow up period. These studies showed that tramadol doubled the risk of harm when compared with placebo. This was also due to more reported "cardiac events," including chest pain, coronary artery disease, and congestive heart failure. Tramadol also increased the risk of certain cancers. However, the researchers say that the short follow up makes this result "questionable."

The researchers say that several of these outcomes were at high risk of bias. They say that this means the benefits of tramadol are overstated while its harms are understated. The authors said, "Approximately 60 million individuals worldwide experience the addictive effects of opioids. In 2019, drug use was responsible for approximately 600,000 deaths, with nearly 80% of these fatalities associated with opioids and approximately 25% resulting from opioid overdose.

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."

The researchers also added, "Tramadol may have a slight effect on reducing chronic pain (low certainty of evidence) while likely increasing the risk of both serious (moderate certainty of evidence) and non- serious adverse events (very low certainty of evidence). The potential harms associated with tramadol use for pain management likely outweigh its limited benefits."

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