Overview

• Researchers pooled 19 randomized trials involving 6,506 adults with neuropathic pain, osteoarthritis, chronic low back pain and fibromyalgia, with treatment lasting 2–16 weeks.
• Tramadol’s average pain reduction was small and fell below commonly accepted thresholds for clinical benefit when compared with placebo.
• Across trials that tracked harms, the risk of serious adverse events was about twice as high on tramadol, driven largely by cardiac events such as chest pain, coronary artery disease and heart failure.
• Milder side effects including nausea, dizziness, constipation and sleepiness were more common, while a possible cancer signal was deemed questionable due to short follow-up.
• Authors judged the evidence low-certainty because of short durations and high risk of bias and recommended minimizing use, with the UK’s Royal College of GPs advising clinicians to limit or stop tramadol for chronic pain.