The Dual Challenge of Tramadol: Evaluating Pain Relief Versus Cardiovascular Risks

New findings from a systematic review suggest tramadol offers only modest analgesia while raising concerns about cardiovascular harm.

Pooled randomized comparisons of evidence from short-term studies detected statistically significant but small pain reductions that generally fall below commonly accepted thresholds for clinical importance. Most trials reported modest effect sizes and brief follow-up, limiting the practical analgesic advantage of tramadol.

The randomized trials also reported an increased incidence of cardiac events associated with tramadol, including chest pain and congestive heart failure. Pooled analyses across eight trials suggested roughly a doubled risk for serious cardiovascular harms.

Because long-term outcome data are limited, potential harms may outweigh modest benefits for chronic use. Alternatives — including nonopioid options and multimodal pain-management strategies — may offer a more favorable balance of benefits and risks for many patients.

Key Takeaways:

• Tramadol provides only modest pain relief and is associated with an increased risk of serious cardiac events.
• Patients on long-term tramadol, older adults, and individuals with cardiovascular risk factors face the greatest potential harm from continued use.