Is tramadol good for arthritis pain?

In this article:

• Tramadol for arthritis
• How does tramadol work
• Dosage
• Tramadol vs. NSAIDs
• The bottom line

In this article

• Tramadol for arthritis
• How does tramadol work
• Dosage
• Tramadol vs. NSAIDs
• The bottom line

Arthritis is a joint disease that affects nearly 60 million adults. There are over 100 types of arthritis, but osteoarthritis (OA) is by far the most common type. Symptoms of OA include joint pain, stiffness, swelling, and reduced range of motion in the joints. In severe cases, arthritis can make daily activities such as walking or climbing stairs difficult. While arthritis has no cure, many medications are available that help relieve symptoms, slow down the disease, and improve your quality of life. 

Tramadol is a generic prescription medication that’s used to relieve moderate-to-severe pain that’s unmanaged by other treatments. Often referred to by its brand name Ultram, tramadol is an opioid medication that’s classified as a schedule IV controlled substance due to its potential for physical dependence, abuse, and addiction. While oral and topical nonsteroidal anti-inflammatory drugs (NSAIDs) and steroid injections are usually preferred for short-term OA pain relief, tramadol may be prescribed in certain situations. 

In this article, we’ll discuss the use of tramadol for arthritis pain. 

Does tramadol help with arthritis pain?

While most opioid analgesics should be avoided in OA, healthcare professionals may prescribe tramadol in certain cases. For example, tramadol may be helpful for severe OA pain that isn’t relieved by NSAIDs or Tylenol (acetaminophen). 

As mentioned above, tramadol is an opioid drug. According to the American College of Rheumatology (ACR) and Arthritis Foundation OA guidelines, nontramadol opioids should be avoided due to their side effect profile and risk of dependency. But, as a “low-level opioid,” tramadol is conditionally recommended for short-term pain relief from knee, hand, or hip OA. 

In a 2019 study that reviewed 22 clinical trials, researchers found that slightly more people who took tramadol experienced significant improvement in their pain than those who took a placebo (sugar pill). However, the study also concluded that taking tramadol for up to three months had no significant benefit on pain or physical function. A 2023 study of tramadol for knee or hip OA found that 300 milligrams (mg) of tramadol daily provides minimal improvement in pain and function. The study also noted that this dosage showed a higher risk of digestive and cognitive side effects than placebo. 

How does tramadol work for osteoarthritis?

According to its prescribing information, tramadol works by binding to certain opioid receptors to change the way the brain perceives pain. But, unlike NSAIDs, tramadol does not reduce inflammation or swelling. Tramadol also boosts the levels of serotonin and norepinephrine—chemicals involved in mood, wound healing, blood clotting, and alertness—in your system. Similar to other opioids, tramadol can slow the central nervous system (CNS) and cause side effects such as drowsiness, constipation, and dizziness. In rare cases, tramadol can cause excessive sleepiness and severe respiratory depression (slowed or shallow breathing), especially if it’s combined with benzodiazepines, alcohol, sleep medications, or other drugs known to depress the CNS. 

Tramadol dosage for arthritis

According to its prescribing information, the recommended dosage of immediate-release tramadol for moderate-to-severe pain is 50-100 mg every four to six hours. For the extended-release version, the typical starting dosage is 100 mg once daily. Keep in mind this dosage depends on the severity of the condition being treated. To minimize the risks of adverse effects, addiction, and drug dependence, healthcare providers will prescribe the lowest effective dosage for the shortest amount of time needed. 

Tramadol vs. NSAIDs for osteoarthritis

Because arthritis is characterized by pain, swelling, and inflammation, oral NSAIDs are considered the mainstay of OA treatment. There is considerable evidence that establishes their short-term effectiveness, and the treatment guidelines recommend them as the initial treatment choice for OA regardless of where the OA is located. However, NSAIDs, such as ibuprofen and naproxen, have many potential risks, many of which are particularly dangerous for older adults. These include serious cardiovascular, kidney, and gastrointestinal adverse events. As one of the alternatives to NSAIDs, the ACR and Arthritis Foundation conditionally recommend tramadol for people with hip, hand, or knee OA in situations when NSAIDs aren’t appropriate, other treatments are ineffective, or if surgery isn’t an option. The guidelines note, however, that there are still concerns about potential side effects from tramadol. 

A 2008 randomized controlled trial published in Pain Research and Management compared once-daily tramadol to diclofenac, an oral NSAID, for OA pain. The study found that controlled-release tramadol is just as effective as sustained-release diclofenac for treating pain caused by knee or hip OA, with a lower risk of the serious side effects that may occur with NSAID therapy. 

While tramadol is generally well-tolerated, it’s always important to consult a healthcare provider before use. They can discuss the potential benefits and risks of tramadol treatment. As discussed above, like other opioids, the effects of tramadol can be serious, including respiratory depression, addiction, and drug dependence. In addition, tramadol isn’t recommended for certain people. These include people who:

• Take or have taken monoamine oxidase inhibitors (MAOIs) in the last 14 days
• Have had an allergic reaction to tramadol or any of its ingredients
• Have severe asthma, trouble breathing, or other lung problems 
• Have a bowel blockage or narrowing of the digestive tract

Additionally, tramadol can cause an increased risk of seizures and serotonin syndrome, especially if it’s taken with certain other drugs. Tramadol also has many potential drug interactions. Therefore, discussing your medical history and current medications with your healthcare provider before you start treatment is important. 

The bottom line

According to the ACR and Arthritis Foundation, tramadol may be appropriate in certain situations for people with knee, hip, or hand OA. These include when NSAIDs aren’t appropriate, other treatments aren’t effective, or surgery isn’t an option. Tramadol is an opioid pain medication that’s FDA-approved to treat moderate-to-severe pain that isn’t managed by other treatments. It can help relieve OA pain by changing how the brain perceives pain. However, tramadol can cause serious side effects, such as serotonin syndrome, seizures, and respiratory depression. It also has a risk of drug dependence, abuse, and addiction. Therefore, it’s best to consult a healthcare provider for a personalized pain management plan when living with OA.