For patients with osteoarthritis, tramadol might be associated with higher risk of death

Tramadol prescriptions among patients with osteoarthritis have been increasing since 2000. But a new study published March 12 in JAMA calls into question how safe tramadol really is for patients with osteoarthritis, whose main treatment goal is to control pain while avoiding therapeutic toxicity. Tramadol is thought to be a better alternative to NSAIDs and traditional opioids mostly because it has a lower risk of serious cardiovascular and gastrointestinal adverse effects.

After analyzing records of roughly 88,900 patients from the Health Improvement Network, an electronic medical record database comprised of records from general practitioners in the United Kingdom, the researchers discovered that for patients with osteoarthritis aged 50 and older, an initial prescription for tramadol was associated with a higher risk of all-cause mortality within 1 year of follow-up compared with commonly prescribed NSAIDs.

Codeine was the exception. The study compared patients who received initial tramadol prescriptions with patients who got initial prescriptions for one of the following: naproxen, diclofenac, celecoxib, etoricoxib, or codeine.

“Considering that participants with initial prescription of tramadol had a higher comorbidity burden than those with an initial prescription of NSAIDs before propensity score matching, these results were susceptible to confounding by indication,” the researchers wrote.

The study had other limitations as well. For instance, in 16% to 30% of the cases, the cause of death could not be determined.

Researchers noted that further studies are needed to confirm the study results.