A large review of research has found that tramadol, a strong painkiller often prescribed for long-term pain, may not be as helpful as many people think.
The study, published in BMJ Evidence Based Medicine, shows that while tramadol does reduce pain, the effect is very small—too small to be considered truly helpful in most cases.
At the same time, the study found that people who take tramadol face a higher risk of serious health problems, including heart disease. Because of this, researchers say the risks of tramadol likely outweigh its benefits. They recommend that doctors and patients try to avoid using it whenever possible.
Tramadol is a commonly used opioid painkiller. Doctors often prescribe it for moderate to severe pain, both short-term and long-term. Many health guidelines include tramadol as a treatment option. In recent years, tramadol prescriptions have increased quickly, making it one of the most used opioids in the U.S.
One reason for this rise may be the belief that tramadol is safer and less addictive than other opioids. However, this study challenges that idea.
Past research has included tramadol, but those studies did not look closely at both how well it works and how safe it is across many different kinds of chronic pain.
To fix this gap, the scientists looked at research databases for clinical trials published up to February 2025. These studies compared tramadol to a placebo (a fake treatment) in people with long-lasting pain, including pain from cancer.
In the end, the researchers found 19 studies involving 6,506 people. The trials focused on different types of chronic pain: nerve pain, arthritis, back pain, and fibromyalgia. Most people in the studies were between 47 and 69 years old. The treatments lasted from 2 to 16 weeks.
The results showed that tramadol reduced pain a little—but not enough to meet the usual standards for meaningful relief. In other words, while some people felt better, the improvement was too small to make a big difference in their daily lives.
Eight of the studies tracked serious health problems during and after treatment. These studies showed that people taking tramadol were about twice as likely to experience serious side effects compared to those taking a placebo. Many of these side effects involved heart issues, such as chest pain, blocked arteries, or heart failure.
The researchers also found a higher number of cancer cases among tramadol users, though they say this finding is uncertain because the studies were not long enough to draw clear conclusions.
In all of the studies, people taking tramadol were also more likely to have milder side effects like nausea, dizziness, constipation, and feeling sleepy.
The researchers noted that many of the trials had problems that could have made tramadol look better than it really is. They believe the actual benefits of tramadol are likely even smaller, and the real risks could be greater.
The study also points to the larger crisis involving opioids. Around 60 million people worldwide struggle with opioid addiction. In 2019, drugs caused about 600,000 deaths, and most of these were linked to opioids. In the U.S. alone, opioid-related overdose deaths rose from nearly 50,000 in 2019 to over 81,000 in 2022.
Because of this, the researchers say tramadol and other opioids should be used as little as possible. Their final message is clear: Tramadol might offer small pain relief, but it probably raises the chance of serious and minor side effects. For many people, the dangers may outweigh the small benefits.
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The study is published in BMJ Evidence-Based Medicine.
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