Why Relying on Painkillers Like Tramadol May Do More Harm Than Good

For years, tramadol has been positioned as a “safer” opioid — a go-to prescription for people living with chronic pain. But a growing body of evidence suggests that this confidence may be misplaced.

A recent large-scale analysis published in BMJ Evidence-Based Medicine raises a serious concern: the risks of tramadol likely outweigh its modest pain-relieving benefits for most chronic pain conditions.

A Painkiller With Surprisingly Limited Pain Relief

Tramadol is a dual-action opioid commonly prescribed for moderate to severe pain, including both acute and chronic conditions. Because of this, it appears in many clinical treatment guidelines and is often viewed as a middle ground between non-opioid painkillers and stronger opioids.

However, when researchers looked closely at the data, the results were underwhelming.

The study analyzed 19 randomized controlled trials involving 6,506 patients with chronic pain, including cancer-related pain. The trials covered several common conditions:

• Neuropathic pain (5 studies)
• Osteoarthritis (9 studies)
• Chronic low back pain (4 studies)
• Fibromyalgia (1 study)

Participants had an average age of 58, and most took tramadol orally for periods ranging from 2 to 16 weeks, with follow-up lasting up to 15 weeks.

The key finding:

While tramadol did reduce pain compared to placebo, the improvement was very small — below the threshold considered clinically meaningful. In other words, patients felt only minimal relief that was unlikely to translate into real-world functional improvement.

Elevated Risk of Serious Side Effects

What makes these findings more concerning is what happened on the safety side.

Across the trials, the risk of serious adverse events was roughly twice as high in patients taking tramadol compared to placebo. The most notable increase was seen in cardiovascular complications, including:

• Chest pain
• Coronary artery disease
• Congestive heart failure

Eight of the trials reported serious side effects emerging within 7 to 16 weeks of treatment — a relatively short time frame.

The analysis also found signals suggesting a possible association between tramadol use and certain cancers, although the authors caution that follow-up periods were too short to draw firm conclusions.

Common Side Effects Are Far From Rare

Beyond serious complications, tramadol significantly increased the risk of more common, day-to-day side effects, including:

• Nausea
• Dizziness
• Constipation
• Drowsiness

While often labeled as “mild,” these symptoms can seriously impact quality of life — especially for people already struggling with chronic pain and fatigue.

Why the Risks May Be Underestimated

The researchers openly acknowledged that many of the included trials had a high risk of bias. However, this actually strengthens their warning rather than weakening it.

Bias typically inflates perceived benefits and underreports harm. That means the true effectiveness of tramadol may be even lower, while its real-world risks could be higher than reported.

A Broader Context: The Opioid Crisis

These findings land in the middle of a global opioid crisis.

• An estimated 60 million people worldwide are affected by opioid dependence
• In 2019, drug use caused around 600,000 deaths globally
  • Nearly 80% involved opioids
  • About 25% were due to opioid overdose

In the United States alone, opioid overdose deaths rose from 49,860 in 2019 to 81,806 in 2022 — a staggering increase.

Against this backdrop, the idea that tramadol is a “low-risk” opioid becomes increasingly difficult to defend.

The Bottom Line

Based on the available evidence:

• Pain relief from tramadol is minimal (low-certainty evidence)
• Risk of serious adverse effects is meaningfully higher (moderate-certainty evidence)
• Risk of non-serious side effects is also increased (very low-certainty evidence)

Taken together, the researchers conclude that the potential harms of tramadol likely outweigh its limited benefits for treating chronic pain.

Final Thought

Tramadol is not harmless — and it is not as effective as many assume.

For patients and clinicians alike, these findings reinforce an important message: chronic pain management should prioritize safer, evidence-based alternatives whenever possible, reserving opioids for carefully selected cases where benefits clearly outweigh risks.

Pain relief matters — but not at the cost of long-term health.