Tramadol for Hip or Knee Osteoarthritis?

In a guideline from the American College of Rheumatology, the opioid tramadol is “conditionally recommended” for patients with hip or knee osteoarthritis (OA), when other treatments are ineffective or contraindicated (Arthritis Rheumatol 2020; 72:220). In this meta-analysis, researchers examined the efficacy of tramadol in six placebo-controlled, randomized trials that involved 3600 patients with hip or knee OA. Doses were 100, 200, or 300 mg daily, and trial durations were mostly 12 weeks.

All doses of tramadol were statistically better than placebo for pain relief, but the average difference from placebo (even for the 300-mg dose) was equivalent to less than 1 point on a 10-point scale and was not considered to be clinically important. Onl…