The painkiller tramadol only has a slight effect on chronic pain and its side-effects may outweigh any benefits, research suggests.
The prescription-only drug, which has the brand names Maxitram, Marol, Zydol, Zamadol, Tramulief and Tramquel, is a strong painkiller from the opiates family.
It is used for moderate to severe pain, such as after an operation or a serious injury, but some patients are also on the drug for long-term pain if weaker medicines fail to work.
In a new study, published in BMJ Evidence Based Medicine, experts suggested the drug – which is particularly popular in the US – has limited impact on chronic pain and likely increases the risk of serious side-effects, such as heart disease.
The team assessed 19 published clinical trials involving 6,506 people with chronic pain.
Five trials looked at the impact of tramadol on neuropathic pain; nine focused on osteoarthritis; four looked at chronic low back pain; and one focused on fibromyalgia.
Most people were taking the drug as tablets, and length of treatment ranged from two to 16 weeks.
Pooled data analysis showed that while tramadol eased pain, the effect was small and below what would be considered clinically effective.
Researchers also noted a doubling in the risk of harms associated with tramadol compared with placebo drugs, mainly driven by a higher proportion of things such as chest pain, heart disease and congestive heart failure.
Some patients also suffered nausea, dizziness, constipation and sleepiness.
The researchers concluded: “Approximately 60 million individuals worldwide experience the addictive effects of opioids.
“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…
“Given these trends and the present findings, the use of tramadol and other opioids should be minimised to the greatest extent possible.”
Professor Kamila Hawthorne, chairwoman of the Royal College of GPs, said: ”GPs understand how debilitating chronic pain can be and the serious impact it can have on the lives of our patients.
“We want to be able to provide the most appropriate care to help patients manage their pain.
“In line with this study, tramadol has not been found to be helpful for chronic pain, and patients can suffer from its many side-effects.
“As a result, GPs in the UK have been advised to limit, reduce and preferably stop tramadol prescribing for chronic pain and not to start tramadol for new patients with this condition.
“Treating chronic pain can often be challenging given the underlying reason for the pain is often unclear, making it hard to target treatment.
“As with any condition, GPs will consider the various physical, psychological, and social factors potentially impacting on a patient’s health when coming up with a treatment plan, in conversation with them.
“Part of this process will also involve exploring non-pharmaceutical options to supporting patients manage their pain, but access to interventions that could help, such as pain clinics, is often patchy across the country.”
