WASHINGTON (dpa-AFX) - A large review of previous studies found that tramadol, a strong painkiller often prescribed for long-term pain, provides only small pain relief for the conditions it is usually used to treat.
The review, published in BMJ Evidence-Based Medicine, also found that tramadol is linked to a higher risk of serious side effects, including heart problems.
To evaluate how well tramadol really works, the researchers reviewed randomized clinical trials published up to February 2025. These studies compared tramadol with a placebo in people with chronic pain, including cancer-related pain.
The final review included 19 trials involving more than 6,500 people. Of the total, five studies looked at nerve pain, nine focused on osteoarthritis, four examined chronic lower back pain, and one studied fibromyalgia. Participants were around 58 years old on average, and most took tramadol as tablets during the treatment, which lasted between two and 16 weeks.
When the results were combined, the researchers noted that tramadol did reduce pain slightly, but the improvement was too small to be considered meaningful in real-world treatment. Some studies showed that people taking tramadol had about twice the risk of serious harm compared with those taking a placebo. Most of this increase was due to heart-related problems such as chest pain, coronary artery disease, and heart failure.
Tramadol was also linked to a higher risk of certain cancers, though the researchers say this finding is uncertain because the studies followed patients for a short time. Moreover, tramadol users were more likely to experience common side effects like nausea, dizziness, constipation, and drowsiness.
'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,' the authors concluded.
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