Tramadol Harms Outweigh Benefits for Chronic Pain
Summary of Research on Tramadol for Chronic Pain
This research review, conducted by Barakji and colleagues, investigates the benefits and harms of tramadol use for chronic pain. Here’s a breakdown of the key findings:
Background:
* Tramadol use has significantly increased in the US and is now a commonly prescribed opioid.
* This rise is attributed to perceptions of a favorable side effect profile and a belief that it’s safer and less addictive than other opioids.
* However, evidence suggests tramadol may carry a comparable or even greater risk of prolonged use compared to other short-acting opioids.
Study Details:
* The researchers analyzed 19 randomized controlled trials (6,506 participants) comparing tramadol to placebo for various chronic pain conditions (neuropathic pain, low back pain, osteoarthritis, fibromyalgia).
* Treatment duration ranged from 2-16 weeks, wiht follow-up periods of 3-15 weeks.
Key Findings:
* Pain Relief: Tramadol showed a small beneficial effect on chronic pain (reduction of 0.93 points on a numerical rating scale), but this evidence was of low certainty and below what is considered a clinically meaningful difference (1 point).
* Serious Adverse Events: Tramadol increased the risk of serious adverse events (OR = 2.13), notably cardiac events and neoplasms (cancers). however, the researchers caution that a causal link between tramadol and new cancers is uncertain due to the short follow-up periods in the trials.
* Milder Adverse Effects: Tramadol significantly increased the risk of common side effects like nausea, vomiting, dry mouth, itchiness, nervousness, and fatigue.
* Bias Concerns: Most of the included trials had a high risk of bias, potentially exaggerating the benefits and underestimating the harms of tramadol.
Overall Conclusion:
The study suggests that while tramadol may offer a small benefit for chronic pain, this benefit is of low certainty and may not be clinically significant.Furthermore, it’s associated with an increased risk of serious and milder adverse events. The researchers highlight the need for caution when prescribing tramadol, considering the potential risks may outweigh the limited benefits.