Evidence seen, however, for harmful effects from serious adverse events and several nonserious adverse events
By Elana Gotkine HealthDay Reporter
TUESDAY, Oct. 14, 2025 (HealthDay News) — Tramadol may slightly reduce chronic pain but seems to increase the risk for serious and nonserious adverse events, according to a review published online Oct. 7 in BMJ Evidence-Based Medicine.
Jehad Ahmad Barakji, M.D., from the Centre for Clinical Intervention Research in Copenhagen, Denmark, and colleagues conducted a systematic review to examine the benefits and harms of tramadol versus placebo in chronic pain. Data were included from 19 randomized placebo-controlled trials, with 6,506 participants.
The researchers observed evidence of a beneficial effect of tramadol on chronic pain (mean difference numerical rating scale [NRS], −0.93 points) in a meta-analysis and trial sequential analysis, with the effect size below the predefined minimal important difference of 1.0 point on the NRS. There was evidence of a harmful effect of tramadol on serious adverse events (odds ratio, 2.13), which was mainly due to a higher proportion of cardiac events and neoplasms. Due to a lack of data, it was not possible to conduct a meta-analysis on quality of life. The risk for several nonserious adverse events, including nausea, dizziness, constipation, and somnolence, was increased with tramadol (number needed to harm: seven, eight, nine, and 13, respectively).
“In the United States, the number of opioid-related overdose deaths increased from 49,860 in 2019 to 81,806 in 2022,” the authors write. “Given these trends and the present findings, the use of tramadol and other opioids should be minimized to the greatest extent possible.”
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