A major medical review finds tramadol provides only modest chronic pain relief while significantly increasing the risk of serious side effects, including heart problems. Experts warn its harms may outweigh benefits and urge reduced opioid use.
Tramadol is often prescribed as a “safer” alternative to stronger opioids for chronic pain. But new research suggests that this widely used painkiller may offer little real relief while significantly increasing the risk of dangerous side effects raising serious concerns about its long term use.
Modest Pain Relief That Many Patients May Not Feel
Researchers reviewed data from multiple clinical trials to evaluate how well tramadol works for chronic pain conditions such as osteoarthritis, nerve pain, lower back pain, fibromyalgia, and cancer related pain. While tramadol did reduce pain levels, the improvement was small so minor that many patients would likely not notice meaningful relief in everyday life.
Importantly, the pain reduction fell below the threshold doctors consider “clinically important.” This means that despite being commonly prescribed, tramadol may not deliver the level of benefit patients expect when managing ongoing pain.
Related Articles
The findings were published in BMJ Evidence Based Medicine, adding weight to growing concerns around opioid use for chronic pain.
Higher Risk of Serious and Common Side Effects
Alongside limited benefits, the review found troubling safety signals. Patients taking tramadol were nearly twice as likely to experience serious adverse events compared with those given a placebo. Much of this increased risk came from heart-related problems, including chest pain, coronary artery disease, and heart failure.
Tramadol was also linked to common but disruptive side effects such as nausea, dizziness, constipation, and excessive sleepiness. These symptoms can interfere with daily functioning, especially in older adults who are already more vulnerable to falls and cardiovascular complications.
Although some data suggested a possible link to cancer risk, researchers cautioned that short follow-up periods make this finding uncertain.
What This Means for Pain Treatment
The authors note that tramadol’s reputation as a low risk opioid may have fueled its rapid rise in prescriptions worldwide. However, the new evidence suggests its harms likely outweigh its modest benefits particularly when safer, non-opioid pain treatments are available.
Given the global opioid crisis, researchers argue that tramadol use should be reduced as much as possible. Instead, they recommend prioritizing non drug approaches, physical therapy, lifestyle changes, and non-opioid medications where appropriate.
The study underscores a growing shift in pain medicine: treating chronic pain effectively requires balancing relief with long term safety not relying on medications that offer little benefit at a high cost.
