Opioids and Pain Management

A new meta‑analysis in BMJ Evidence-Based Medicine of 19 randomized trials involving 6,506 adults with chronic pain conditions such as osteoarthritis, low back pain, neuropathic pain and fibromyalgia found that the opioid tramadol produces pain relief below clinically meaningful thresholds while increasing the risk of adverse events, particularly cardiovascular problems like chest pain, coronary artery disease and congestive heart failure. Outside pain specialists said the findings challenge tramadol’s reputation as a safer chronic‑pain opioid and suggest its harms may outweigh its modest benefits, though the authors noted limitations including short trial durations, high risk of bias and lack of head‑to‑head comparisons with other treatments.