1. In this retrospective cohort of patients with osteoarthritis, tramadol had a significantly higher risk of mortality over 1 year compared to NSAIDs, though there were many confounding factors precluding determination of a causal relationship.

2. No differences in mortality were found when comparing tramadol and codeine.

Evidence Rating Level: 2 (Good)           

Study Rundown: Tramadol is a weak opioid agonist that is commonly recommended for and prescribed to patients with osteoarthritis. Previous studies have shown that it provides similar pain relief when compared to nonsteroidal anti-inflammatory drugs (NSAIDs), but may be associated with more opioid-related adverse events, such as nausea, dizziness, constipation, and vomiting. In this retrospective cohort study, osteoarthritis patients prescribed tramadol had higher mortality rates at 1 year compared with those who received naproxen, diclofenac, celecoxib, and eterocoxib. No difference in mortality was found when comparing tramadol and codeine.

Overall, this study suggests that tramadol prescriptions in patients with osteoarthritis may be more dangerous compared to commonly prescribed NSAIDs. There are several study limitations, most notably confounding by indication, as patients prescribed tramadol were older, had higher BMI, had osteoarthritis for a longer duration, a higher prevalence of comorbidities, and larger prescription burden compared with patients taking NSAIDs, though groups were balanced by propensity score matching before analysis.

Click to read the study in JAMA

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