Pain Drug Review: Modest Relief & Major Risks Found

A comprehensive review of existing research indicates that tramadol, a widely prescribed opioid for chronic pain, offers only modest relief while carrying a significantly increased risk of serious side effects, particularly those affecting the heart. The findings, published online in BMJ Evidence Based Medicine, suggest the risks associated with tramadol may outweigh its benefits, prompting calls for reduced use of the medication.

For years, tramadol has been a common choice for managing chronic pain, often positioned as a compromise between over-the-counter pain relievers and stronger opioids. Doctors have frequently viewed it as a potentially safer alternative with a lower risk of addiction. However, the new analysis challenges this perception.

Modest Pain Relief, Significant Risks

Researchers analyzed numerous past studies comparing tramadol to a placebo. The review found that while tramadol does provide some reduction in chronic pain, the improvement is small—so small, in fact, that many patients likely wouldn’t experience a noticeable difference in their daily lives.

Alongside the limited pain relief, the analysis revealed a significantly higher risk of serious side effects. These included heart-related problems such as chest pain and heart failure, as well as more common issues like nausea, dizziness, and sleepiness.

Why Tramadol Became So Prevalent

Tramadol is a dual-action opioid, meaning it eases pain through multiple mechanisms. This has led to its frequent prescription for both short-term and chronic, moderate to severe pain. Tramadol has become one of the most frequently used opioids in the United States and appears in several clinical guidelines for pain management.

The rise in tramadol prescriptions was fueled by a belief among many doctors that it caused fewer side effects and carried a lower risk of addiction compared to other short-acting opioids. Patients also often felt more comfortable taking tramadol, contributing to its widespread adoption.

Filling the Gaps in Previous Research

Previous studies on tramadol often focused solely on its ability to reduce pain, without adequately addressing safety concerns. Others examined limited types of pain, leaving important gaps in the understanding of its overall effects. This new review aimed to address these shortcomings by searching medical databases for randomized clinical trials published up to February 2025.

The researchers sought to answer a fundamental question: Does tramadol truly help people feel better, and at what cost? The findings suggest the answer to the latter part of that question is a significant one, raising concerns about the continued widespread use of the drug.

“Based on these results, the researchers conclude that tramadol’s risks likely outweigh its benefits and say its use should be reduced as much as possible.”

BMJ Group

The review underscores the importance of carefully considering the risks and benefits of all pain medications, and highlights the need for more research into effective and safer alternatives for managing chronic pain. The findings may prompt a reevaluation of current pain management guidelines and a more cautious approach to prescribing tramadol.