Tramadol is a low-level
opioid increasingly recommended to treat moderate-to-severe acute and
chronic pain. Although characterized as having fewer
opioid-related adverse events, the longer term safety of
tramadol use among older adults has not been thoroughly documented. Thus, the primary objective was to examine the risk of safety events associated with chronic
tramadol use compared to other chronic
opioid use or no
opioids among older adults with
osteoarthritis. Safety events considered included: ≥3 emergency room (ER) visits, falls/
hip fractures, cardiovascular (CVD) hospitalization, composite safety event hospitalization, and all-cause mortality. The study population included older adults ages ≥65 years diagnosed with
osteoarthritis and classified into new or continuing
tramadol use, new or continuing other
opioid use, or nonuse. Inclusion criteria included: 6-month pre period and up to 33 months post period.
Tramadol, other
opioid, and no
opioid users were 1:1 propensity-matched providing study populations of 25,899 within each category; 72% were new chronic
opioid users. Multiple logistic regression or Cox proportional hazard ratios were used to document risk. Generally,
tramadol users had fewer adverse event risks compared to other
opioid users but higher risks than nonusers. New users of
tramadol or other
opioids had higher risks than continuing users.
Tramadol use was associated with increased risk of multiple ER utilizations, falls/fractures, CVD hospitalizations, safety event hospitalizations, and mortality (new users only) compared to nonuse. Thus, although
tramadol use may be appropriately recommended within a
pain management strategy for older adults with
osteoarthritis, careful monitoring for adverse safety events is warranted.