Association of Tramadol With All-Cause Mortality Among Patients With Osteoarthritis
https://jamanetwork.com/journals/jama/article-abstract/2727448
Question Is tramadol prescription associated with a higher risk of all-cause mortality than other pain relief medications among patients with osteoarthritis?
Findings In this cohort study that included 88 902 patients with osteoarthritis, initial prescription of tramadol was associated with a significantly increased risk of mortality over 1 year compared with initial prescription of naproxen (hazard ratio [HR], 1.71), diclofenac (HR, 1.88), celecoxib (HR, 1.70), and etoricoxib (HR, 2.04), but not compared with codeine (HR, 0.94).
Meaning Tramadol prescription may be associated with increased all-cause mortality compared with commonly prescribed nonsteroidal anti-inflammatory drugs, but further research is needed to determine if this relationship is causal.
Importance An American Academy of Orthopaedic Surgeons guideline recommends tramadol for patients with knee osteoarthritis, and an American College of Rheumatology guideline conditionally recommends tramadol as first-line therapy for patients with knee osteoarthritis, along with nonsteroidal anti-inflammatory drugs.
Objective To examine the association of tramadol prescription with all-cause mortality among patients with osteoarthritis.
Design, Setting, and Participants Sequential, propensity score–matched cohort study at a general practice in the United Kingdom. Individuals aged at least 50 years with a diagnosis of osteoarthritis in the Health Improvement Network database from January 2000 to December 2015, with follow-up to December 2016.
Exposures Initial prescription of tramadol (n = 44 451), naproxen (n = 12 397), diclofenac (n = 6512), celecoxib (n = 5674), etoricoxib (n = 2946), or codeine (n = 16 922).
Main Outcomes and Measures All-cause mortality within 1 year after initial tramadol prescription, compared with 5 other pain relief medications.
Results After propensity score matching, 88 902 patients were included (mean [SD] age, 70.1 [9.5] years; 61.2% were women). During the 1-year follow-up, 278 deaths (23.5/1000 person-years) occurred in the tramadol cohort and 164 (13.8/1000 person-years) occurred in the naproxen cohort (rate difference, 9.7 deaths/1000 person-years [95% CI, 6.3-13.2]; hazard ratio [HR], 1.71 [95% CI, 1.41-2.07]), and mortality was higher for tramadol compared with diclofenac (36.2/1000 vs 19.2/1000 person-years; HR, 1.88 [95% CI, 1.51-2.35]). Tramadol was also associated with a higher all-cause mortality rate compared with celecoxib (31.2/1000 vs 18.4/1000 person-years; HR, 1.70 [95% CI, 1.33-2.17]) and etoricoxib (25.7/1000 vs 12.8/1000 person-years; HR, 2.04 [95% CI, 1.37-3.03]). No statistically significant difference in all-cause mortality was observed between tramadol and codeine (32.2/1000 vs 34.6/1000 person-years; HR, 0.94 [95% CI, 0.83-1.05]).
Conclusions and Relevance Among patients aged 50 years and older with osteoarthritis, initial prescription of tramadol was associated with a significantly higher rate of mortality over 1 year of follow-up compared with commonly prescribed nonsteroidal anti-inflammatory drugs, but not compared with codeine. However, these findings may be susceptible to confounding by indication, and further research is needed to determine if this association is causal.
Filed under: General Problems
Why is pain pills considered the cause of pain . I was told that did not have a condition that need pain pills I have neck surgery back surgery gallbladder surgery Ulcer surgery hysterectomy , I had cancer , but I don’t know why I can not take pain pills.
NSAIDS cause me to have intestinal bleeding Tramadol doesn’t! Been taking it at a low dose for years. diclofenac was useless! A small dose of Tramadol and a small dose of clonazepam with a small dose of Neurontin are what stopped my cluster headaches after suffering from them for 35 years. They took them once and my headaches returned! If I live only a few more years and they kill me, it doesn’t matter. Informed Consent! I would have blown my brains out if they wouldn’t have stopped! I was ready to until they finally were stopped! Pain management and the CDC should consider Harm Reduction before there decisions kill more than they help! Wait, didn’t the overdose death rate increase after the CDC guidelines were implemented? DUH!
I had swallowed tons of it, but had hydrocodone also way back then. But I have a digestion like a great white, nothing I swallow hurts me first. I can’t like it or hate it.