This common painkiller may raise your heart disease risk, says study

New findings challenge Tramadol's reputation as a safer opioid, linking it to higher cardiovascular risk and minimal pain benefits.

 

A painkiller trusted by millions may not be as safe or effective as once believed. A new study published in BMJ Evidence Based Medicine has found that tramadol, widely prescribed for pain management, offers limited relief while increasing the risk of heart diseases. Researchers warn that the risks may outweigh the benefits, especially with long-term use.

 

"Tramadol is an opioid, similar to morphine. Along with acting as an analgesic, tramadol increases the levels of both serotonin and norepinephrine in the central nervous system," shared Dr Amod Manocha, pain specialist, International Pain Centre, Delhi. "It is used for pain relief after injuries, operations as well as for nerve and cancer pain." 

 

 

What the study found

 

In the study titled 'Tramadol versus placebo for chronic pain: a systematic review with meta-analysis and trial sequential analysis', researchers analysed data from 19 trials involving more than 6,500 patients.

 

Limited pain relief

 

Researchers reviewed randomised controlled trials involving participants with chronic pain conditions, including osteoarthritis, neuropathic pain, chronic low back pain, and fibromyalgia. They found that while tramadol did reduce pain but the effect was small, often below what is considered clinically meaningful.

 

Elevated risk of heart problems

 

More concerningly, tramadol users faced twice the risk of serious adverse events compared to those on placebo. Among these, cardiac complications—including chest pain, coronary artery disease, and heart failure—were prominent.

 

The study also found frequent mild side effects such as nausea, dizziness, constipation, and drowsiness.

 

“Concentration and focus issues have also been observed. Itching, dry mouth, and headaches are common too,” Dr Manocha said.

 

He added: “If you have epilepsy, tramadol can lower the seizure threshold and raise the risk of fits. Those with breathing problems should take it only under medical supervision. Long-term use can also cause addiction.”

 

Tramadol can also interact with other medications and trigger serotonin syndrome, a potentially dangerous condition marked by hyperactivity, sweating, fever, and confusion.

 

The authors noted that most trials were short-term and carried potential biases, suggesting that harms may be underestimated and benefits overstated.

 

Reassessing tramadol’s role in pain care

 

Tramadol has long been considered a safer opioid alternative, prescribed when other treatments fail. However, with evidence suggesting marginal benefits and heightened risks, experts say many patients may be using it without net gain.

 

For the millions living with chronic pain, the findings may lead to a broader re-evaluation of pain management strategies and stricter prescription practices.

 

Advice for patients:

 

• Do not stop tramadol abruptly; sudden withdrawal can trigger rebound pain.
• Consult your doctor about whether ongoing use is appropriate for your health.
• Explore alternative pain-relief options under medical supervision.

 

“Sudden stoppage of tramadol after prolonged use may cause withdrawal symptoms lasting a few days,” said Dr Manocha. “Always discuss tapering or switching with your doctor to manage withdrawal safely.”

 

Limited benefits, serious risks

 

The findings challenge tramadol’s status as a mild opioid, suggesting that while it offers slight pain reduction, it carries significant cardiovascular risks.

 

This holds particular relevance for India, where tramadol’s regulation was tightened in 2018, when it was classified as a psychotropic substance under the Narcotic Drugs and Psychotropic Substances (NDPS) Act due to concerns over misuse and dependence.

 

For both clinicians and patients, the new evidence underscores the need for cautious, personalised treatment decisions and a renewed focus on safer pain management alternatives.   

 

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This report is for informational purposes only and is not a substitute for professional medical advice.