Tramadol, one of the most prescribed drugs in Catalonia, is not as effective as previously thought against chronic pain.

BarcelonaTramadol is a powerful analgesic that is prescribed for the treatment of moderate to severe acute and chronic pain, and its use has increased a lot in recent yearsIn fact, in Catalonia, this opioid considered weak It is one of the twenty most consumed medications. Experts believe that one of the reasons behind this increase is the low perception of risk among citizens, who generally believe that it has fewer side effects and is safer and less addictive than other opioids. To clear up any doubts, a team of researchers from Denmark has reviewed the scientific literature published to date to narrow down its effectiveness and has concluded that it is not very effective in relieving chronic pain. In fact, they maintain that the risks outweigh the benefits in patients suffering from fibromyalgia or osteoarthritis, increasing the risk of serious adverse effects, such as developing cardiovascular disease.

"Tramadol may have a slight effect on reducing chronic pain, but it probably increases the risk of both serious and minor adverse events," warn the authors of the study, published this Tuesday in the scientific journal BMJ Evidence Based MedicineTo reach this conclusion, the researchers reviewed a total of 19 clinical trials involving more than 6,500 people, including patients with fibromyalgia, osteoarthritis, neuropathic pain, and chronic low back pain. Until now, no study had provided a comprehensive assessment of the efficacy and safety of tramadol for different types of chronic pain, and the results of the review are overwhelming: it does relieve pain, but the effect is small and below what would be considered clinically effective.

"High risk of bias"

Regarding potential adverse effects, the authors state that the main risk for these patients is the possibility of developing heart disease, such as chest pain, coronary artery disease, or congestive heart failure. They have also associated its use with mild adverse effects such as nausea, dizziness, constipation, and drowsiness.

Even so, the researchers warn that these results present a "high risk of bias" since the patient follow-up period was short, so they should be interpreted with caution. One of the most questionable aspects of the study is that tramadol use is also associated with an increased risk of some types of cancer, something the researchers have already warned is "questionable" and that further studies are needed to confirm it.

Alicia Alonso, coordinator of the Opioid Working Group of the Spanish Pain Society and associate editor of the Journal of the Spanish Pain Society (RESED), which insists that there is no study concluding that tramadol causes cancer. "The trials included in the analysis had a maximum follow-up of 12 weeks, which limits the ability to establish causality. This is too short a period for drug-induced malignancies to develop. The malignancies could have been preexisting, coincidental, or influenced by other factors not controlled for in the studies," the expert argues in a statement.