Overview

• Published October 7 in BMJ Evidence-Based Medicine, the pooled analysis combined 19 randomized trials with 6,506 adults across osteoarthritis, neuropathic pain, low back pain and fibromyalgia.
• Over 2–16 weeks of treatment, tramadol produced only a small reduction in pain that did not meet clinically meaningful thresholds.
• Serious adverse events were about twice as likely versus placebo, largely driven by more cardiac events such as chest pain, coronary artery disease and congestive heart failure.
• Common side effects including nausea, dizziness, constipation and sleepiness were more frequent, while a possible cancer signal was deemed uncertain due to short follow-up.
• The authors advise minimizing tramadol for chronic pain, and the Royal College of GPs has told doctors not to start it for new patients and to reduce existing prescribing where possible.