For a long time, one medication has become a quiet default for dealing with chronic pain: tramadol. It’s prescribed in clinics of all sizes and sits in medicine cabinets in homes across the country.
Many doctors have viewed tramadol as a compromise. Stronger than over-the-counter options, yet thought to be easier on the body than other opioids.
That reputation helped it spread fast. But a close look at the science tells a less comforting story.
Tramadol in chronic pain care
A large review of existing research took a hard look at how well tramadol actually works for chronic pain.
The researchers pulled together results from many past studies and compared tramadol to a placebo, a dummy treatment with no active drug.
The team set out to answer a simple question: Does this medication truly help people feel better, and at what cost?
Why tramadol became so common
Tramadol is a dual-action opioid that eases pain through more than one mechanism. Doctors commonly prescribe it for moderate to severe pain, both short-term and chronic.
Because of this, tramadol appears in several pain management guidelines. Over time, prescriptions climbed sharply, making tramadol one of the most frequently used opioids in the United States.
That rise did not happen by accident. Many doctors believed tramadol caused fewer side effects and carried a lower risk of addiction than other short-acting opioids. Patients often felt more comfortable taking it, too.
What earlier studies missed
Tramadol has been studied before, but earlier reviews did not fully answer the big questions. Most focused only on whether the drug reduced pain, not on safety. Others looked at limited types of pain. Important gaps remained.
To fill those gaps, the researchers searched medical databases for randomized clinical trials published up to February 2025.
The trials compared tramadol with placebo in people living with chronic pain, including cancer-related pain.
A closer look at the trials
The final analysis covered 19 clinical trials with 6,506 participants. Five studies looked at nerve pain. Nine focused on osteoarthritis. Four examined chronic low back pain. One studied fibromyalgia.
The average participant was 58 years old, with ages ranging from 47 to 69. Most studies tested tramadol tablets. Only one looked at a topical cream.
Treatment lasted anywhere from 2 to 16 weeks. Follow-up periods ranged from 3 to 15 weeks. That matters because many side effects and long-term risks take time to show up.
Small relief, big risks
When the researchers looked at all the results together, a clear picture emerged. Tramadol did ease pain, but only a little. The change was too small to meet the usual standards for meaningful relief.
People may have noticed some improvement, but it likely didn’t translate into better day-to-day function.
Eight of the trials also followed participants for serious side effects over periods ranging from 7 to 16 weeks. In those studies, tramadol was linked to roughly twice the risk of harm compared with a placebo.
That higher risk was driven largely by heart-related problems, including chest pain, coronary artery disease, and congestive heart failure.
Tramadol use was also linked to a higher risk of certain cancers, though the researchers noted that the short follow-up made this finding “questionable.”
Common side effects
Across all trials, tramadol was tied to more common side effects like nausea, dizziness, constipation, and sleepiness.
These issues may sound mild, but they can make daily life harder, especially for older adults.
The authors also pointed out problems with the studies themselves. Many outcomes were at high risk of bias. That likely means the benefits of tramadol were overstated, while its harms were understated.
Opioids in the bigger picture
The findings land in the middle of a much larger opioid crisis. According to the authors of the study, 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,” wrote the researchers.
“In the United States, the number of opioid-related overdose deaths increased from 49,860 in 2019 to 81,806 in 2022.”
“Given these trends and the present findings, the use of tramadol and other opioids should be minimized to the greatest extent possible.”
Pain relief that comes with a price
After weighing the evidence, the team summed it up plainly. Tramadol may have a slight effect on reducing chronic pain while likely increasing the risk of both serious and non- serious adverse events.
“The potential harms associated with tramadol use for pain management likely outweigh its limited benefits,” noted the researchers.
For a drug so widely used and often trusted, that conclusion carries a lot of weight. It suggests that tramadol’s place in chronic pain care deserves serious rethinking, not because it does nothing, but because what it offers may simply not be worth the risk.
The full study was published in the journal BMJ Evidence-Based Medicine.
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