For people with osteoarthritis, how does tramadol compare with other analgesics?

Abstract

For people with knee or hip osteoarthritis, tramadol was slightly less effective than non‐steroidal anti‐inflammatory drugs (NSAIDs) regarding pain, physical function, and adverse events. Compared with other opioids, tramadol slightly improved physical function but resulted in little to no difference in pain and increased withdrawals due to adverse events.Moderate‐certainty evidence shows that people with hip or knee osteoarthritis had slightly more pain with tramadol than with NSAIDs but reported little to no difference in pain between tramadol and other opioids. Physical function was slightly worse with tramadol than with NSAIDs (low‐certainty evidence), but more people had improved physical function with tramadol than with other opioids (667 vs 505 per 1000 people; all results on average; moderate‐certainty evidence). Moderate‐certainty evidence shows that more people will probably experience an adverse event with tramadol than with NSAIDs (774 vs 591 per 1000 people; based on 128 people), but very low‐certainty evidence suggests little to no difference compared with other opioids. Low‐certainty evidence suggests that more people withdrew from treatment due to an adverse event with tramadol than with NSAIDs or other opioids (186 vs 99 per 1000 people and 246 vs 109 per 1000 people, respectively). The effect of tramadol compared with NSAIDs or other opioids on serious adverse events was uncertain, but event rates were very low in all groups (≤ 3%). Reviewers found little to no difference in symptoms of opioid dependence between tramadol and NSAIDs, but this assessment was based on only 97 participants. No conclusions could be drawn for the comparison of tramadol versus paracetamol, as this was assessed in an RCT with only 20 participants.