Warning about widely prescribed opioid that shows minimal pain relief and increased cardiac risk
Despite being perceived as a safer option, the analysis indicates that its effectiveness is not as expected
A study published in BMJ Evidence-Based Medicine has questioned the usefulness of tramadol, a commonly prescribed opioid for chronic pain. Despite being perceived as a safer option, the analysis indicates that its effectiveness is minimal and its risks are significant. “We often use tramadol to avoid more addictive drugs like other opioids, even though tramadol is actually a synthetic opioid. It’s much milder,” notes Dr. Marc Siegel, senior medical analyst, to Fox News Digital. The research encompassed 19 randomized clinical trials with more than 6,500 participants. The results showed that pain reduction after tramadol use was below the clinically relevant threshold, raising concerns about its continued use. Patients who received tramadol had a higher risk of adverse events, including serious cardiovascular problems, compared to the placebo group. The need to reconsider its prescription due to these risks was highlighted. Study Limitations and Future Considerations Despite the validity of the analysis, significant limitations are acknowledged. The trials were short-term, making it difficult to assess long-term effects and compare them with other treatments. Experts caution that medication changes should be made under medical supervision to avoid withdrawal symptoms. It is suggested that both clinicians and patients engage in informed decision-making, considering the limited benefits of tramadol and its associated risks. Tramadol Mechanism of Action: Tramadol acts as an atypical opioid analgesic with a dual or triple mechanism of action, combining activation of μ-opioid receptors with inhibition of serotonin and norepinephrine reuptake in the central nervous system. Tramadol binds weakly to μ-opioid receptors.While its active metabolite O-desmethyltramadol (M1) does so with greater affinity, contributing to analgesia. Furthermore, it inhibits the reuptake of norepinephrine and serotonin, blocking pain transmission in the spinal cord, which explains why naloxone does not completely reverse its effects. Comparison with other analgesics. Unlike pure opioids such as morphine or fentanyl, which act almost exclusively on μ receptors with high affinity, tramadol has lower opioid potency (6000 times less than morphine) but adds synaptic effects similar to antidepressants. In contrast to NSAIDs such as ibuprofen (which inhibit COX peripherally) or paracetamol (which has a non-opioid central mechanism), tramadol is more effective for moderate-to-severe neuropathic pain.
Risk Assessment Before Prescribing Tramadol
A risk-benefit assessment before prescribing tramadol is essential to ensure safe use, as this synthetic opioid carries risks such as addiction, seizures, and respiratory depression. A comprehensive patient assessment should be performed to balance relief of moderate-to-severe pain with potential adverse effects.
Main Risks. Tramadol can cause seizures (especially >400 mg/day), serotonin syndrome with serotonergic drugs, tolerance/dependence, and respiratory depression in overdose or combinations. The risk increases with alcohol, benzodiazepines, or prolonged use, requiring close monitoring.