The painkiller tramadol provides only a slight effect on chronic pain, whilst its side-effects may outweigh any benefits, according to the most comprehensive study of the drug to date.
The prescription-only drug, which has the brand names Maxitram, Marol, Zydol, Zamadol, Tramulief and Tramquel, is a strong painkiller from the opioid family.
It is used for moderate to severe pain, such as after an operation or a serious injury, but some patients are also prescribed the medication for long-term pain if weaker medicines fail to work.
The study, published in BMJ Evidence Based Medicine, analysed 19 clinical trials involving 6,506 people with chronic pain. Researchers found that whilst tramadol reduced pain levels, the effect was small and below what would be considered clinically meaningful.
Five trials looked at the impact of tramadol on neuropathic pain; nine focused on osteoarthritis; four looked at chronic low back pain; and one focused on fibromyalgia.
Most people were taking the drug as tablets, and the length of treatment ranged from two to 16 weeks.
Pooled data analysis showed that while tramadol eased pain, the effect was small and below what would be considered clinically effective.
Most significantly, the study found a doubling in the risk of serious adverse events associated with tramadol compared with placebo, mainly driven by a higher proportion of chest pain, heart disease and congestive heart failure.
Many patients also suffered nausea, dizziness, constipation and sleepiness.
“Approximately 60 million individuals worldwide experience the addictive effects of opioids,” the researchers said.
“In 2019, drug use was responsible for approximately 600,000 deaths, with nearly 80% of these fatalities associated with opioids and approximately 25% resulting from opioid overdose.
“Given these trends and the present findings, the use of tramadol and other opioids should be minimised to the greatest extent possible.”
Professor Kamila Hawthorne, chairwoman of the Royal College of GPs, said: ”GPs understand how debilitating chronic pain can be and the serious impact it can have on the lives of our patients.
“We want to be able to provide the most appropriate care to help patients manage their pain.
“In line with this study, tramadol has not been found to be helpful for chronic pain, and patients can suffer from its many side-effects.
“As a result, GPs in the UK have been advised to limit, reduce and preferably stop tramadol prescribing for chronic pain and not to start tramadol for new patients with this condition.
“Treating chronic pain can often be challenging given the underlying reason for the pain is often unclear, making it hard to target treatment.
“As with any condition, GPs will consider the various physical, psychological, and social factors potentially impacting on a patient’s health when coming up with a treatment plan, in conversation with them.
“Part of this process will also involve exploring non-pharmaceutical options to supporting patients manage their pain, but access to interventions that could help, such as pain clinics, is often patchy across the country.”
The findings have renewed focus on alternative treatments for chronic pain. Medical cannabis clinics have been treating chronic pain conditions since the drug was legalised on the NHS and via private clinics in 2018. The UK clinic Alternaleaf says around 60% of its patients suffer from chronic pain.
“Chronic pain doesn’t discriminate. It affects people from all walks of life. Too often, patients are prescribed traditional painkillers as a first response, despite well-documented side effects and dependency concerns,” said Nabila Chaudhri, Medical Director of Alternaleaf.
A recent survey of 500 NHS doctors revealed that 71% believe treatment options for chronic pain are too limited, whilst 75% said typical treatments for chronic pain, such as opioids and strong painkillers, have worrying long-term side effects.
Medical cannabis is available on the NHS, but for a limited range of conditions, which do not include common chronic pain conditions such as fibromyalgia or sciatica.
However, the survey found that almost nine in 10 (87%) NHS doctors would be open to prescribing medical cannabis to manage chronic pain if it were part of the NHS toolkit.
“Greater awareness and training around safer, evidence-based alternatives, including medical cannabis, could help broaden care options for patients,” Chaudhri added.
