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New research suggests that the popular and widely prescribed painkiller tramadol may not be as effective or harmless as you might think. An analysis of the available research claims that tramadol is not as effective in reducing chronic pain and has an increased risk of serious side effects.
The analysis led researchers to conclude that “the potential harms of tramadol probably outweigh its benefits”. It also suggested that tramadol be used sparingly.
The study was published in BMJ Evidence-Based Medicine in October 2025.
What is tramadol?
Tramadol, often viewed as a “safe” pain reliever, is a dual-acting opioid widely prescribed to treat moderate to severe acute and chronic pain (including after operation or serious injury). According to the National Health Service (NHS) UK, it is a strong painkiller from a group of medicines called opiates or narcotics.
Tramadol is sold under the brand names Maxitrum, Marol, Zydol, Zamadol, Tramalife, and Tramaquel. It is also called by the brand names Invodol, Larapam, Mabron, Maneo, Oldrum, Tilodol, Tradorec, and Xeridem.
It is available only by prescription and comes in tablet, capsule and liquid drop forms. It can also be given by injection, but this is usually done only in hospitals.
Even the NHS UK claims that tramadol does not completely stop the pain, “but you won’t feel it as much”.
Is Tramadol Addictive?
NHS UK says it is possible to become addicted to tramadol. But doctors can tell you how to reduce those risks.
“Approximately 60 million individuals worldwide experience the effects of opioid addiction. In 2019, opioid use was responsible for approximately 600,000 deaths, with approximately 80% of these deaths linked to opioids and approximately 25% caused by opioid overdose,” the researchers said.
Why study tramadol?
Tramadol has become one of the most commonly prescribed opioids in the US, possibly due to its low risk of side effects.
It is also believed that tramadol is “safer and less addictive than other short-acting opioids,” the researchers said, according to the BMJ Group’s official press release.
They also pointed to the lack of comprehensive evaluation of the efficacy and safety of tramadol in many chronic pain conditions.
To bridge this knowledge gap, researchers analyzed research databases of randomized clinical trials published through February 2025 that compared tramadol with placebo (dummy treatment) for patients with chronic pain, including cancer pain.
The researchers concluded: “Tramadol may have little effect in reducing chronic pain [low certainty of evidence] While both are likely to have an increased risk of becoming serious [moderate certainty of evidence] and non-serious adverse events [very low certainty of evidence],
“The potential harms associated with the use of tramadol for pain management outweigh its limited benefits,” he said.
What did the BMJ study show? side effects
A large analysis of clinical trials found that tramadol reduces chronic pain, but the relief is modest, so negligible that many patients will not see much benefit in the real world.
Data analysis of the trial results by researchers showed that tramadol reduced pain, but the effect was small and would be considered “clinically effective”.
The study also revealed a possible increase in the risk of serious side effects, including heart problems such as chest pain and heart failure, as well as common problems such as nausea, dizziness, and trouble sleeping.
Statistical analysis of some trials indicated that “the risk of harm associated with tramadol doubled… driven primarily by a higher proportion of ‘cardiovascular events’ such as chest pain, coronary artery disease and congestive heart failure,” the press release said.
It further suggested that tramadol use was associated with an increased risk of some cancers, “although the follow-up period was short, making this finding ‘questionable'”, the researchers said.
As revealed after a detailed analysis of all trial results, tramadol treatment was also associated with an increased risk of several mild side effects, including nausea, dizziness, constipation and sleepiness.
Another study in the BMJ previously advised federal governing bodies to consider reclassifying tramadol, and that providers should use the same caution when prescribing tramadol in acute pain conditions as other short-acting opioids.
‘High risk of bias’ and study limitations
The official statement from the BMJ Group noted that the researchers acknowledged the high risk of bias in the results.
“But this raises the possibility that the findings overestimate the beneficial effects and underestimate the harmful effects of tramadol,” he suggested.
study method
19 clinical trials involving 6,506 participants with chronic pain were eligible for inclusion in the analysis.
Five looked at the effect of tramadol on neuropathic pain; nine focused on osteoarthritis; four noted chronic low back pain; and one focused on fibromyalgia.
The average age of trial participants was 58, but ranged from 47 to 69.
The tablets were the primary formulation used; Only one trial involved a topical cream. The treatment duration ranged from 2 to 16 weeks, while the follow-up period ranged from 3 to 15 weeks.
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