Is Tramadol Increasing the Risk of Death in Arthritis Patients?

By Chris Centeno, MD /

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Tramadol (Ultram) is often prescribed as a pain reliever for patients with arthritis. However, is it safe? What if it were just as bad as a narcotic? Let’s take a look.

Tramadol: A Quasi-Narcotic

Tramadol (e.g., Ultram, Ralivia, Conzip, etc.) is an opioid-like narcotic prescribed for pain. While it may be considered a “safer” choice than opioids, it’s still listed as a controlled substance in the U.S. due to its potential for addiction, abuse, and overdose. Tramadol is often prescribed for arthritis when acetaminophen or nonsteroidal inflammatory drugs (NSAIDs) aren’t effectively relieving pain, though NSAIDs are still often taken in conjunction with tramadol to address the inflammation as tramadol is only a pain reliever.

That being said, we certainly aren’t plugging this combo. First, we’re already well aware of the dangerous, in some cases even deadly, side effects of NSAIDS (more on this below). And what about tramadol? By pushing it as a “safer” narcotic, does that make it a safe choice for arthritis pain relief? A new study chimes in on this one, and the conclusion is disturbing. Let’s review.

Study Suggests Tramadol May Increase Mortality Risk in Arthritis Patients

The new study set out to determine if tramadol increased the risk of all-cause mortality (or death from any cause) when compared to other pain relievers. The cohort study consisted of nearly 89,000 arthritis patients. Pain relievers analyzed in these arthritis patients over a one-year period were tramadol; NSAIDs including naproxen, diclofenac, celecoxib, etoricoxib; and the opioid codeine.

The results? Tramadol was found to have a significantly higher risk of death when compared to all of the NSAIDs, close to or over twice the risk, in fact, in all cases. What about the codeine? Tramadol had only a slightly lower risk of death (.94 risk / for comparison, 1.0 would be an even risk between the two meds) when compared to codeine. This number was so slight, however, that the researchers considered it not a statistically significant difference.

The Dirty-Laundry List of NSAID Risks

While there’s nothing new on this list that we haven’t covered on the blog before, the ugly truth is that study after study on NSAIDs continues to reveal new risks. Let’s review just a few:

The upshot? Tramadol isn’t really all that safe. It’s twice as risky as NSAIDs, which in and of themselves have risks. The answer? Figure out why you hurt rather than covering it up with medications.

Category: Side Effects

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1 thought on “Is Tramadol Increasing the Risk of Death in Arthritis Patients?

  1. Sam

    Very informative – thanks!
    Patients often find tramadol’s side effects too strong, so they are prompted to cut the pill in half to reduce the dosage. The problem is that if the tramadol is of extended-release beads type, cutting it in half would cause immediate release/absorption of high dose tramadol with life threating sequela.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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