Limited benefit of tramadol in osteoarthritis

Limited benefit of tramadol in osteoarthritis

Brian McAvoy
Clinical question

How effective is tramadol or tramadol combined with paracetamol or NSAIDs in people with osteoarthritis?

Bottom line

Based on moderate-quality evidence, tramadol alone or in combination with paracetamol probably had no important benefit over placebo on mean pain intensity (4% absolute improvement) or physical function in people with OA. However, there were slightly more people (5%) in the tramadol group who achieved a clinically important improvement (at least 20%) in pain. Moderate-quality evidence showed that adverse events probably cause substantially more participants to stop taking tramadol. The increase in serious adverse events with tramadol was less certain due to the small number of events. Participants were predominantly women with an average age of 63 and with moderate to severe pain. The length of the studies ranged from 1 week to 3 months.


There was a high risk of selection bias as only 4 trials reported both adequate sequence generation and allocation concealment. The doses of tramadol used in the studies were variable, ranging from 37.5mg to 400mg daily. Most of the trials were funded by the pharmaceutical industry.


Tramadol is often prescribed to treat pain and associated physical disability in OA. Due to the pharmacologic mechanism of tramadol, it may lead to fewer associated adverse effects (ie, gastrointestinal bleeding or renal problems) compared with NSAIDs.

Cochrane Systematic Review

Toupin AK et al. Tramadol for osteoarthritis. Cochrane Reviews, 2019, Issue 5. Art. No.: CD005522. DOI: 10.1002/14651858.CD005522.pub3. This review contains 22 studies involving 6496 participants.