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The many risks of the painkiller tramadol

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Tramadol is an increasingly common drug prescribed for pain. Tramadol is a synthetic opioid (manufactured in a lab) that differs somewhat in its chemical structure compared to the natural opioid codeine. Other opioids include morphine and heroin. All opioids have analgesic properties and are extremely addictive.

In a new study based on primary care data from Spain, the risks of a number of side effects and clinical outcomes of tramadol and codeine use were studied. The study included approximately 370 000 patients that had received prescriptions for tramadol and/or codeine.

The results showed that the prescribing of tramadol compared to codeine was more associated with a higher risk of mortality, cardiovascular disease, and fractures. However, the causal relationships were not entirely clear. These results could partially be explained by the fact that the indications for prescribing the two drugs differ slightly.

In general, opioids are not recommended for osteoarthritis pain as their benefits (providing pain relief) do not outweigh their risks (several side effects and the high risk of developing an addiction). However, many opioids are important drugs for the treatment of severe pain, such as pain after surgery or cancer pain.

The study is published in the Journal of the American Medical Association (JAMA) and can be accessed here.