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Researchers analysed data from multiple trials, finding an elevated risk of heart disease with little benefit to patients suffering chronic pain.
Researchers said tramadol use for pain relief should be ‘minimised to the greatest extent possible’.
A new study published in the BMJ Evidence-Based Medicine journal suggests the opioid painkiller tramadol has only a ‘slight effect on reducing chronic pain’ but doubles the risk of harm compared to placebo – including the risk of heart disease.
The findings were obtained by pooling data from 19 clinical trials, involving 6506 participants with chronic pain, including five trials for neuropathic pain, nine focused on osteoarthritis, four on low back pain; and one on fibromyalgia.
Analysis indicated the increased risks posed by tramadol were mainly driven by a higher proportion of ‘cardiac events’, including chest pain, coronary artery disease and congestive heart failure.
The Danish research team said given their findings use of tramadol should be ‘minimised to the greatest extent possible’.
Chair of RACGP Specific Interests Pain Management Dr Adele Stewart said the findings are concerning but not surprising.
‘[These findings] echo what we see in clinical practice – medications like tramadol offer limited benefit for chronic pain while carrying significant risks,’ she told newsGP.
‘We now understand that chronic pain is rarely due to ongoing tissue damage – it’s more about a sensitised nervous system and altered pain processing.
‘When the drivers include stress physiology and neuroimmune dysregulation, medications that target only nociception can’t bring lasting relief.
‘Our energy is better spent helping patients understand pain as a whole-person experience – and supporting nervous system regulation, lifestyle change, and stress reduction.’
Despite the nation’s growing population, tramadol prescription numbers have remained steady, at around one million per year since 2015.
However, in that time tapentadol prescriptions have risen sharply, from 30,000 in 2015 to more than 150,000 last year, and Dr Stewart warned many of the same concerns apply.
The authors of the new study highlighted that approximately 60 million individuals worldwide experience opioid addiction.
‘In 2019, drug use was responsible for approximately 600,000 deaths, with nearly 80% of these fatalities associated with opioids and approximately 25% resulting from opioid overdose,’ they said in a public release.
Dr Stewart said GPs play a crucial role in the management of chronic pain, and most GPs now understand opioids only have a small place in pain care, such as for relief from acute flareups.
She added that deepening her own understanding of chronic pain had resulted in more satisfying consultations and encouraged GPs to join the RACGP Pain Management Specific Interest group.
‘The gplearning modules provide excellent, practical education and resources for supporting patients living with chronic pain,’ she said.
‘There’s a real sense of partnership and progress when patients start to understand what’s happening in their bodies and a surprise to note that their pain can actually improve with reduction of opioids.’
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