Although the popular opioid, tramadol, may reduce chronic pain, it also significantly increases risk of serious side effects from chest pain to heart failure. The corresponding study was published in BMJ Evidence-Based Medicine.
Prescriptions for tramadol have risen in recent years, making it among the most commonly used opioids in the US. While previous systematic reviews have investigated the drug, none have evaluated its efficacy and safety against different types of chronic pain. In light of this, the researchers behind the current study set out to assess the benefits and harms of tramadol compared to a placebo in adults with chronic pain.
To do so, they analyzed 19 clinical trials investigating conditions ranging from neuropathic pain to osteoarthritis and chronic low back pain with a total of 6506 participants. Patients were an average of 58 years old. Most studies used tablets, with one using a cream. Treatment periods spanned 2 to 16 weeks, with follow-ups ranging between 3 and 15 weeks.
While tramadol was found to reduce pain, the reductions were slight and did not meet clinical standards for effective pain relief. Furthermore, eight of the trials reported serious side effects during follow-up periods of 7 to 16 weeks. Tramadol was linked to a significantly higher risk of harm compared to placebo, mostly from cardiac events including chest pain, coronary artery disease, and congestive heart failure. Evidence for this, wrote the researchers, was of ‘moderate certainty’.
Across all trials, tramadol was also linked to a greater risk of milder side effects, including nausea, dizziness, constipation, and sleepiness, although the researchers noted that these findings were based on ‘very low certainty of evidence’. They noted that all outcome results included in their analysis were at a ‘high risk of bias’.
“Tramadol may have a slight effect on reducing chronic pain levels while likely increasing the risk of both serious and non-serious adverse events,” wrote the researchers in their study.
“The potential harms associated with tramadol use for pain management likely outweigh its limited benefits,” they concluded.
Sources: Science Daily, BMJ Evidence-Based Medicine
