Date: 25th January 2026 | By: Dr Lourdes Gaspar
What a New Systematic Review Reveals About Tramadol, Chronic Pain, and Why We Need Better Options.
https://ebm.bmj.com/content/early/2025/09/26/bmjebm-2025-114101.abstract
A major new systematic review and meta-analysis has landed—Tramadol versus placebo for chronic pain—and its findings deserve careful attention from anyone working in pain medicine, living with chronic pain, or supporting someone who does.
The review, led by Barakji et al, pooled 19 randomised placebo‑controlled trials involving 6,506 adults with chronic pain. The authors set out to answer a simple but crucial question:
Does Tramadol meaningfully help chronic pain—and at what cost?
The answer, it turns out, is far more sobering than many expect.
What the Study Found: A Small Benefit That Falls Below Clinical Relevance
across all trials. Even at its best, Tramadol did not reach the threshold for a meaningful improvement in chronic pain.
This aligns with what many clinicians observe in practice: opioids may help short‑term acute pain, but their long‑term benefit in chronic pain is extremely limited.
The Harms: A Concerning Signal for Serious Adverse Events
Where the study becomes especially important is in its analysis of harms. The authors found:
i. A more than two‑fold increase in serious adverse events. These were mainly driven by cardiovascular events and neoplasms.
ii. Non‑serious adverse events were also common:, Nausea (NNH 7), Dizziness (NNH 8). Constipation (NNH 9), Somnolence (NNH 13)
The overall pattern is clear: The potential harms of Tramadol likely outweigh its modest and clinically unimportant benefits for chronic pain. This is especially relevant given the widespread perception that Tramadol is a “safer” opioid. The data suggest otherwise.
This study reinforces what modern pain science has been saying for years: Long‑term opioid therapy is not the solution for chronic pain.
At ACT for PAIN, we focus on evidence‑based, non‑pharmacological strategies that empower people to take back control of their lives.
1. Home Exercise Programs – maintain strength & flexibility
Regular, structured movement:
– Improves mobility
Reduces pain sensitivity
– Enhances cardiovascular health
– Supports mood and sleep
Unlike opioids, exercise has positive side effects
2. Acceptance and Commitment Therapy (ACT)
– ACT is a psychological approach grounded in behavioral science.
– Reduce the struggle with pain, build psychological flexibility.
– Reconnect with meaningful activities, shift from “pain control” to “life control”.
ACT is not about giving up—it’s about moving forward with strength and clarity, even when pain is present.
3. Integrated Self‑Management
Combining movement, pacing, sleep strategies, and psychological flexibility creates a sustainable, long‑term approach to living well with pain.
The Takeaway
This new systematic review adds to a growing body of evidence showing that:
Tramadol offers only a small, clinically unimportant reduction in chronic pain.
It increases the risk of serious cardiovascular and other adverse events.
Relying on opioids for long‑term pain management is neither effective nor safe.