Overview

• Across 6,506 participants, tramadol’s average pain reduction fell short of commonly accepted thresholds for a meaningful benefit.
• Compared with placebo, the risk of serious adverse events roughly doubled, driven largely by chest pain, coronary artery disease and congestive heart failure.
• Non-serious side effects, including nausea, dizziness, constipation and sleepiness, were more frequent among people taking tramadol.
• Most included trials were short and at high risk of bias, which the authors say likely inflates benefits and understates harms.
• The authors advise minimizing tramadol for chronic pain, echoing clinician guidance to favor non-opioid options as the drug remains widely prescribed in the United States and increasingly restricted in the UK.