This popular painkiller may be causing you more harm than good— new study reveals heart-linked risks
New research suggests that popular and widely prescribed painkiller tramadol may not be as effective or harmless as you may think. An analysis of the available research claimed that tramadol is not that effective at easing chronic pain and likely increases the risk of serious side effects.
The analysis prompted the researchers to conclude that "the potential harms of tramadol probably outweigh its benefits". It also suggested that tramadol's use should be minimised.
The study was published in the BMJ Evidence-Based Medicine in October 2025.
What is Tramadol?
Tramadol, often seen as a " safer painkiller", is a dual-action opioid widely prescribed for the treatment of moderate to severe acute and chronic pain (after an operation or a serious injury). It is a strong painkiller from a group of medicines called opiates, or narcotics, according to the National Health Service (NHS) UK.
Tramadol is sold under brand names such as Maxitram, Marol, Zydol, Zamadol, Tramulief and Tramquel. It is also called by the brand names Invodol, Larapam, Mabron, Maneo, Oldaram, Tilodol, Tradorec and Zeridame.
It is available only by prescription and comes in tablet, capsule, and liquid drop forms. It can also be given by injection, but this is usually only done in hospitals.
Even NHS UK claims that tramadol does not stop the pain completely, “but you will not be able to feel it as much”.
Is tramadol addictive?
The NHS UK says it's possible to become addicted to tramadol. But doctors can explain how to reduce those risks.
“Approximately 60 million individuals worldwide experience the addictive effects of opioids. In 2019, drug use was responsible for approximately 600,000 deaths, with nearly 80% of these fatalities associated with opioids and approximately 25% resulting from opioid overdose," researchers said.
Why study tramadol?
Tramadol became one of the most commonly prescribed opioids in the US, possibly because of its perceived lower risk of side effects.
It's also believed that tramadol is "safer and less addictive than other short-acting opioids," researchers said, as per the official press release by the BMJ Group.
They also pointed to the lack of a comprehensive assessment of tramadol’s efficacy and safety in a range of chronic pain conditions.
To bridge this knowledge gap, the researchers analysed research databases for randomised clinical trials published up to February 2025 that compared tramadol with placebo (dummy treatment) for patients with chronic pain, including cancer pain.
The researchers concluded: “Tramadol may have a slight effect on reducing chronic pain [low certainty of evidence] while likely increasing the risk of both serious [moderate certainty of evidence] and non-serious adverse events [very low certainty of evidence]."
"The potential harms associated with tramadol use for pain management likely outweigh its limited benefits,” they said.
What did the BMJ study show? The side effects
The large analysis of clinical trials found that while tramadol does reduce chronic pain, the relief is modest, so negligible that many patients likely wouldn’t notice much real-world benefit.
Data analysis of the trial results by researchers showed that while tramadol eased pain, the effect was small and below what would be considered “clinically effective”.
The study also revealed a likely increase in the risk of serious side effects, including heart problems such as chest pain and heart failure, along with common issues such as nausea, dizziness, and sleepiness.
Statistical analysis of some trials indicated a "doubling in the risk of harms associated with tramadol...mainly driven by a higher proportion of ' cardiac events,’ such as chest pain, coronary artery disease, and congestive heart failure," the press release stated.
It further suggested that the use of tramadol was associated with a heightened risk of some cancers, “although the follow-up period was short, making this finding 'questionable”, the researchers said.
Tramadol treatment was also associated with a heightened risk of several milder side effects, including nausea, dizziness, constipation, and sleepiness, as revealed following the detailed analysis of all the trial results.
Another study in the BMJ had earlier advised federal governing bodies to consider reclassifying tramadol, and providers should use as much caution when prescribing tramadol in the setting of acute pain as for other short-acting opioids.
‘High risk of bias’ and study limits
The official statement by the BMJ group mentioned that the researchers acknowledged the high risk of bias in the outcome results.
"But this increases the likelihood that the findings overestimate the beneficial effects and underestimate the harmful effects of tramadol," they suggested.
Study methodology
As many as 19 clinical trials involving 6,506 participants with chronic pain were eligible for inclusion in the analysis.
Five looked at the impact of tramadol on neuropathic pain; nine focused on osteoarthritis; four looked at chronic low back pain; and one focused on fibromyalgia.
The average age of the trial participants was 58, but ranged from 47 to 69.
Tablets were the primary formulation used; only one trial included a topical cream. Length of treatment ranged from 2 to 16 weeks, while length of follow-up ranged from 3 to 15 weeks.