Tramadol (with or without acetaminophen) efficacy and harm: Systematic review and meta-analysis
Abstract
OBJECTIVE: To evaluate the efficacy and safety of tramadol (with or without acetaminophen) in adult pain management compared with nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and acetaminophen alone.
DATA SOURCES: Studies were identified through a search of the entire Ovid MEDLINE database, the Ovid MEDLINE Epub Ahead of Print database, Embase, and Evidence-Based Medicine Reviews (Cochrane Central Register of Controlled Trials) from 1946 to August 19, 2022.
STUDY SELECTION: Included studies comprised double-blind, randomized controlled trials (RCTs) of oral tramadol (with or without acetaminophen) compared with opioids, NSAIDs, or acetaminophen for treatment of acute or chronic pain that reported at least 1 of 11 outcomes: total adverse events (AEs), fatal serious AEs (SAEs), nonfatal SAEs, patient withdrawals from the study due to AEs (WDAEs), total study withdrawals, measures of dependence or addiction, quality of life, functional improvement, 30% or more pain reduction, 50% or more pain reduction, and rescue medication use. Overall, 3184 articles were screened and 37 RCTs (21 opioid, 15 NSAID, 1 acetaminophen; N=7156; length 1 hour to 12 weeks) were included. Trials were critically appraised and assessed using the Cochrane risk of bias tool for randomized trials 1.0. Meta-analyzed outcomes were reported as risk ratios (with 95% confidence intervals [CIs]).
SYNTHESIS: Compared with opioids, tramadol with or without acetaminophen did not significantly differ in…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 7,156 participants or records.
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