The Commonly-Prescribed Painkiller That Barely Works (And Is Dangerous)

We don’t often write about opioids at 10almonds, because generally speaking, they’re the heavy guns that are usually best discussed between yourself and your healthcare provider(s).

It is known that they are addictive and it is known that they can kill. We assume you know these things.

We have some guest articles, such as: I’ve been given opioids after surgery to take at home. What do I need to know?

When we even mention opioids, it’s usually in the context of alternatives, such as:

The Painkilling Power Of Opioids, Without The Harm?

…and the reason we use such as a comparison is precisely because opioids are considered more effective, even if they are also more dangerous, than non-opioid painkillers.

So, opioids have become a sort of “gold standard” of pain relief.

But…

Tramadol or Tramadon’t?

All so recently, a team of researchers in Denmark assessed tramadol (an opioid painkiller) versus placebo for chronic pain across 19 randomized clinical trials involving 6,506 adults.

In terms of safety, the problems were manifold, including especially that tramadol more than doubled the risk of serious adverse events compared with placebo, of which, mainly by cardiac events such as chest pain, coronary artery disease, and congestive heart failure.

So, that’s quite severe. There were more minor common side effects also, including nausea, dizziness, constipation, and somnolence, but the biggest issue was the more serious effects such as heart failure.

About that heart failure risk: odds ratio 2.13 (i.e., you are 2.13x more likely to get it), and p=0.001, i.e. the chance of the scientists getting these results by random happenstance would be 1 in 1,000. For perspective, a p-value of <0.05 is considered significant, so this result is 20x more significant than the usual scientific standard for “this is a significant result”.

You may be wondering: that’s the risk, but what about the benefits?

And by extension: is it at least a good painkiller?

And the answer is: not really, no.

Tramadol reduced pain by an average of 0.93 points on a 0–10 numerical rating scale, which was below the predefined threshold for clinically meaningful improvement.

This is unfortunate, because tramadol is widely prescribed and often viewed as safer and less addictive than other short-acting opioids, a belief which the findings very much do not support.

You can find the paper itself, here: Tramadol versus placebo for chronic pain: a systematic review with meta-analysis and trial sequential analysis

Want to learn more?

If you’re looking for alternatives, we’ve written quite a bit about pain management, including:

• Before You Reach For That Tylenol…
• How To Stop Pain Spreading
• How To Dial Down Your Pain
• Managing Chronic Pain (Realistically!)
• Get The Right Help For Your Pain
• The 7 Approaches To Pain Management
• Science-Based Alternative Pain Relief (When Painkillers Aren’t Helping, These Things Might)

Take care!