Tramadol for osteoarthritis

This summary of a Cochrane review presents what we know from research about the effect of tramadol for osteoarthritis. The review shows that:

There is gold level evidence that to treat osteoarthritis, tramadol taken for up to three months may decrease pain, may improve stiffness and function and overall-well being. Tramadol may cause side effects such as nausea, vomiting, dizziness, constipation, tiredness, and headache.

The benefits of tramadol are small and the side effects may cause people to stop taking it which may limit how useful tramadol is to treat osteoarthritis.

What is osteoarthritis and what drugs are used to treat it?
Osteoarthritis (OA) is the most common form of arthritis that can affect the hands, hips, shoulders and knees. In OA, the cartilage that protects the ends of the bones breaks down and causes pain and swelling. There are two main types of drug treatments in OA. Pain relievers (such as acetaminophen/paracetamol and opiods) are used to relieve pain but do not affect swelling. Non-steroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen and cox IIs) are used to decrease pain and swelling. Tramadol is a type of opioid being used more for OA. It does not cause bleeding in the stomach and intestines or kidney problems that may occur with other pain relievers. It also does not affect the cartilage at the end of the bones. But tramadol does not decrease swelling and may not work well after long use. It is therefore important to know the benefits and harms of tramadol.

What are the results of this review?
People in the studies took about 200 mg of tramadol per day or a placebo (fake tablets or powder) or an NSAID or a different pain reliever. People took the drugs for up to one week to three months.

Benefits of tramadol
In people with osteoarthritis:

tramadol may decrease pain more than a placebo

-pain may decrease by 8.5 more points on a scale of 0 to 100 with tramadol

tramadol may improve overall well-being more than placebo

- 50 out of 100 people may improve when taking a placebo
- 69 out of 100 people may improve when taking tramadol

tramadol may slightly decrease stiffness and slightly improve function more than placebo

- function may improve by 0.32 more points on a scale of 0 to10 with tramadol

It is not known whether tramadol improves symptoms of osteoarthritis more than other drugs. It is also not known whether tramadol still works well after long use. This is because the follow -up of the studies was short.

Harms of tramadol
In people with osteoarthritis:

tramadol may cause minor side effects in more people than placebo, such as nausea, vomiting, dizziness, constipation, tiredness, and headache

- 18 out of 100 people may have minor side effects when taking a placebo
- 39 out of 100 people may have minor side effects when taking tramadol

tramadol may cause major side effects that would make people stop taking it

- 8 out of 100 people had major side effects when taking a placebo
- 21 out of 100 people had major side effects when taking tramadol

It is not known whether tramadol causes more side effects than other drugs for osteoarthritis.

Authors' conclusions: 

Tramadol or tramadol/paracetamol decreases pain intensity, produces symptom relief and improves function, but these benefits are small. Adverse events, although reversible and not life threatening, often cause participants to stop taking the medication and could limit tramadol or tramadol plus paracetamol usefulness.

Read the full abstract...
Background: 

Tramadol is increasingly used for the treatment of osteoarthritis because, in contrast to nonsteroidal anti-inflammatory drugs (NSAIDs), tramadol does not produce gastrointestinal bleeding or renal problems, and does not affect articular cartilage.

Objectives: 

We sought to determine the analgesic effectiveness, the effect on physical function, the duration of benefit and the safety of oral tramadol in people with osteoarthritis.

Search strategy: 

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and LILACS databases up to August 2005.

Selection criteria: 

We included randomized controlled trials (RCTs) that evaluated the effect of tramadol or tramadol plus paracetamol on pain levels and/or physical function in people with osteoarthritis. No language restriction was applied.

Data collection and analysis: 

We analyzed separately placebo-controlled and active-controlled studies. We used fixed-effect models for the meta-analyses as the results across studies were similar.

Main results: 

We included eleven RCTs with a total of 1019 participants who received tramadol or tramadol/paracetamol and 920 participants who received placebo or active-control.

The placebo-controlled studies indicated that participants who received tramadol had less pain (-8.5 units on a 0 to 100 scale; 95% confidence interval (CI) -12.0 to -5.0) than patients who received placebo. This represents a 12% relative decrease in pain intensity from baseline. Participants who received tramadol had a 37% increase (95% CI 1.2 to 1.5) in the likelihood of reporting moderate improvement (number needed to treat to benefit = 6; 95% CI 4 to 9). Participants who received tramadol had 2.27 times the risk of developing minor adverse events and 2.6 times the risk of developing major adverse events, compared to participants who received placebo. Of every eight people who receive tramadol or tramadol/paracetamol, one will stop taking the medication because of adverse events, number needed to treat to harm (NNTH)= 8 (95% CI 7 to 12) for major adverse events.

No conclusion could be drawn on how tramadol or tramadol/paracetamol compared with available pharmacological treatments because of the limited number of studies that evaluated such therapies.

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