Asian Pain Academy

Introduction Tramadol has long been regarded as a “safer opioid,” often prescribed for the management of chronic non-cancer pain. Its dual mechanism — weak μ-opioid receptor agonism and inhibition of serotonin and norepinephrine reuptake — made it a preferred choice for clinicians seeking an alternative to stronger opioids. However, a new systematic review and meta-analysis  published in BMJ Evidence-Based Medicine  (2025) has raised Important questions about tramadol’s true