Tramadol provides minimal pain relief in chronic pain with no clinical significance.
Use of tramadol increases risk of cardiac events and some types of cancer.
Clinicians should consider safer alternatives for chronic pain management.
Context
To evaluate the beneficial and harmful effects of tramadol compared with placebo in adults with any type of chronic pain.
Methods
- 19 studies were used involving over 6,500 adults with chronic pain.
- Each study compared tramadol with a placebo.
- The outcomes assessed were pain level, serious and non-serious adverse events, quality of life, dependence, abuse and depressive symptoms.
- Information was gathered from Cochrane, MEDLINE, Science Citation Index, BIOSIS and Embase.
Results
- Pain Relief: Tramadol reduced pain, but did not reach the threshold for clinical significance.
- Side Effects: Tramadol increases risk of cardiac events and neoplasms.
- Many patients reported nausea, dizziness, constipation and drowsiness.
- Quality of life: No clear evidence was found that this was improved.
- Dependence & Withdrawal: Some evidence of increased dependence symptoms was shown. No significant difference in abuse potential.
- Depression: No major differences in depression symptoms between tramadol and placebo groups was found.
Reference
Barakji, J. A., Maagaard, M., Petersen, J. J., Barakji, Y. A., Ipsen, E. Ø., Gluud, C., Mathiesen, O., & Jakobsen, J. C. (2025). Tramadol versus placebo for chronic pain: A systematic review with meta-analysis and trial sequential analysis. BMJ Evidence-Based Medicine. Advance online publication. https://doi.org/10.1136/bmjebm-2025-114101
