The analysis of 19 randomized trials involving 6,506 participants found about double the risk of serious harm versus placebo in chronic pain treatment.
The increased risk was driven mainly by heart-related problems, while cancer signals were deemed questionable because studies lasted only two to 16 weeks and often had high bias risk.
Published in BMJ Evidence-Based Medicine, the review says tramadol’s limited benefits may not justify its harms, challenging its widespread use in chronic pain care amid the broader opioid crisis.
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Long believed to be a safer opioid, is tramadol actually a hidden threat to your heart?