Using Tramadol for Osteoarthritis Pain Is Associated with Excess Mortality

The opioid agonist tramadol often is prescribed for patients with osteoarthritis pain because it is thought to be safer than opioids or nonsteroidal anti-inflammatory drugs (NSAIDs). To assess tramadol's safety, researchers used a U.K. general practice database to identify about 89,000 patients (mean age, 70) with knee, hip, or hand osteoarthritis who were taking tramadol, naproxen, diclofenac, celecoxib, etoricoxib (Arcoxia; not FDA-approved), or codeine. Patients with cancer or histories of opioid-use disorder were excluded. In general, patients taking tramadol were older, weighed more, had longer duration of osteoarthritis, and were more likely to have several comorbidities than were patients taking other analgesics. Five cohorts were cr…