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‘Safe’ opioid isn’t so safe after all

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Tramadol—marketed as Tramal—has been seen as the safer painkiller.  But it isn’t so safe after all, and reactions can include heart-related problems like chest pain and heart failure.

Not only is it dangerous, it’s also not that effective, a major new review has concluded.

Its painkilling abilities are ‘modest’, and some people won’t notice any improvement at all to their chronic pain, say BMJ Group researchers.

Despite this, prescription for the opioid have increased dramatically in the past few years as doctors have seen it as safer and less addictive.  It’s understandable: around 60 million people around the world are addicted to an opioid, and of the 600,000 deaths related to a prescription drug in 2019, 80 percent were down to opioid addiction.

Although it’s ‘safer’, tramadol is still an opioid, and with the discovery of a range of side effects that hadn’t been recorded before, the researchers say any benefits are outweighed by the risks the drug represents.

For the study, the researchers analysed 19 clinical trials involving 6,506 participants, who were taking the drug for neuropathic pain, osteoarthritis, chronic low back pain, and fibromyalgia.

As well as causing serious heart problems, the drug was also responsible for a host of milder reactions, such as nausea, dizziness, constipation, and sleepiness.

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References
BMJ Evidence-Based Medicine, 2025; bmjebm-2025-114101; doi: 10.1136/bmjebm-2025-114101
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