Enrique J. Cobos del Moral
Professor of Pharmacology at the University of Granada and coordinator of the Working Group on Basic Sciences in Pain and Analgesia of the Spanish Pain Society
The study follows a solid methodology, based on a systematic review and meta-analysis of clinical trials, also incorporating trial sequential analysis, which strengthens the statistical validity of the findings. However, as with all studies of this kind, it is important to contextualize the data and interpret the results with caution.
This work provides a global perspective on the use of tramadol for chronic pain, beyond specific indications. The results show that this drug may reduce pain, although with a very small effect size, while increasing the risk of adverse events, and some of them can be severe. The novelty of this study lies in the fact that previous research had not analyzed the balance between the benefits and risks of tramadol in such a comprehensive way.
In clinical practice, these results call for a reconsideration of the role of tramadol in the management of chronic pain, always weighing carefully each patient’s profile and the individual response to this drug. It should not be forgotten that patients with chronic pain have very few safe and effective therapeutic alternatives, and withdrawing them without offering them better options can leave them without useful resources. Perhaps the most important message from this study is the urgent need to strengthen preclinical and clinical research to develop new, more effective and safe analgesics.