Recent research raises concerns over tramadol use
08 Oct 2025
A new study published in BMJ Evidence-Based Medicine shows that the opioid painkiller tramadol provides only a small benefit for chronic pain while significantly increasing the risk of harm, including heart disease.
The Danish research team analysed data from 19 clinical trials involving 6,506 participants with chronic pain, covering neuropathic pain, osteoarthritis, low back pain, and fibromyalgia. Their findings showed that tramadol doubled the risk of adverse events compared to placebo, with many of these risks linked to heart problems such as chest pain, coronary artery disease, and heart failure.
The researchers concluded that tramadol use should be minimised wherever possible.
Chair of RACGP Specific Interests Pain Management, Dr Adele Stewart, said the findings were concerning but not surprising. She explained that chronic pain is often driven by changes in the nervous system rather than ongoing tissue damage. This means that medications like tramadol, which target pain signals, provide limited relief.
“Chronic pain is a whole-person experience. Supporting patients through nervous system regulation, lifestyle changes, and stress management is far more effective than relying solely on opioids,” Dr Stewart said.
In Australia, tramadol prescriptions have remained steady at about one million per year since 2015. By comparison, prescriptions for tapentadol, another opioid, have risen sharply from 30,000 in 2015 to over 150,000 last year. Dr Stewart warned that similar risks apply to tapentadol.
Globally, the study highlighted that approximately 60 million people are affected by opioid addiction. In 2019, drug use caused around 600,000 deaths worldwide, with nearly 80% linked to opioids, and 25% resulting from opioid overdose.
Dr Stewart emphasised the key role of GPs in managing chronic pain. She noted that opioids should generally be reserved for short-term relief during acute flare-ups, and that understanding chronic pain better can lead to more effective and satisfying consultations.
She encouraged GPs to join the RACGP Pain Management Specific Interest group and utilise the gplearning modules, which offer practical resources for supporting patients living with chronic pain.
“Patients often find their pain improves as opioids are reduced, especially when they understand what is happening in their bodies and how to manage it,” Dr Stewart said.
Source: BMJ Evidence-Based Medicine, newsGP
