The use of tramadol for cancer-associated pain-a systematic review

Tramadol has been used for cancer pain and reported in the literature with varying relative effects compared to other analgesics. To our knowledge, there is no comprehensive systematic review documenting the efficacy/effectiveness and safety of tramadol for cancer-associated pain. The aim of this review is to report on the efficacy/effectiveness and safety of tramadol for cancer-associated pain.

Ovid MEDLINE, Embase, and Cochrane CENTRAL were searched through September 29, 2023. Articles were included if they reported on tramadol in a multi-arm comparative trial, employing either a randomized controlled trial design or an observational study design with a multivariable or propensity-score matched analysis, and reported on efficacy or safety data pertaining to tramadol. A narrative synthesis was conducted to identify common themes across trials of efficacy and safety endpoints.

Eleven studies with 2582 patients were included. Two were cohort studies and nine were randomized controlled trials. There were 20 efficacy endpoints; tramadol was superior in 3, inferior in 4, and neither in 13. There were 80 safety endpoints; tramadol was superior in 9, inferior in 12, and neither in 59.

Relative to other analgesics, tramadol is neither superior nor inferior. There may exist a different safety profile and therefore an opportunity to provide individualized patient-centered treatment strategies focused on safety and quality of life.