Disclaimer: None of the information in this article constitutes medical advice, and is just the opinion of the writer(s) and published for informational purposes only. We recommend that patients follow their doctor’s guidance in regard to prescription medication.
Tramadol is a drug in a class called analgesics, which relieve pain. It’s typically prescribed for more severe pain disorders or for recovery post-surgery.
Tramadol is the name for the generic version of the medication, but it’s also sold under branded names such as Ultram and Conzip. These terms all refer to the same active ingredient and we will use them interchangeably throughout this article.
In this article we’ll review the medical research on tramadol to determine if it’s safe and effective for pain relief. We’ll explain how the drug works, highlight its side effects and review dosage information.
Does Tramadol Work?
A medical review of tramadol published in the Pharmacological Reports journal evaluated whether it was effective for reducing pain in patients suffering from chronic pain and in cancer patients. The publication is extremely extensive with 113 citations to existing medical research on the topic.
The researchers found that tramadol was effective for both categories of patients suffering from pain. Patients treated with tramadol reported pain reduction that was “very good” or “good” 89% of the time, and during four hours after the first tramadol dose the pain scores decreased by over 50%.
A separate medical trial examined how effective tramadol was for treating perioperative (during or post-surgery) pain. The drug was found to be effective for both children and adult patients. The efficacy of the drug was similar to morphine, and the study authors concluded that tramadol was effective for “moderate to severe postoperative pain.”
Tramadol has also been studied for its efficacy in treating musculoskeletal pain, which overlaps with conditions like fibromyalgia and chronic fatigue syndrome. The drug was found to be more effective than non-steroidal anti-inflammatory drugs (NSAIDs), which are often used as a first-line treatment for musculoskeletal pain.
We can conclude from the available research that tramadol is effective for a variety of pain disorders. The medication is typically only prescribed for moderate or severe pain, because mild pain may be treated with lifestyle changes.
How Does Tramadol Work?
Tramadol is an opioid, which is one of the most well-studied classes of compounds for pain relief. According to StatPearls, which is the largest free medical database in the U.S., tramadol binds to opioid receptors in the central nervous system and reduces messages to the brain indicating that the body is in pain.
One secondary benefit of tramadol as an analgesic is that it also may improve serotonin levels, which can contribute positively to mood and reduce subjective pain. The StatPearls publication details that tramadol blocks reuptake of serotonin, which increases circulating levels. This is the same mechanism of action of selective serotonin reuptake inhibitor (SSRI) drugs like Prozac which are commonly prescribed for depression.
A more in-depth medical review of tramadol published in the CNS Drugs journal explains that the drug is different from other opioids due to a variety of effects it has on biochemical processes in the body, including its ability to suppress nerve conduction and block voltage-gated sodium ion channels, which contribute to pain.
Tramadol Side Effects
The side effect profile of tramadol will vary based on dosage. Higher doses of the drug are more likely to cause side effects generally, and more likely to cause severe side effects than lower doses of the drug. The side effect profile will also vary depending on whether an immediate-release or extended-release version of the drug is used.
A meta-study of tramadol side effects reports that the most common side effects are dizziness, sleepiness, nausea, headache, constipation and vomiting. The percentage of patients reporting each individual side effect seems to range from around 10-20% of patients based on the linked research review.
A more concerning, though more rare, potential side effect of tramadol is serotonin syndrome, which can be fatal in some cases. Any medication which increases circulating levels of serotonin increases the risk for serotonin syndrome, and as we discussed in the previous section, one of the downstream effects of tramadol use is increased serotonin levels.
A medical review noted the following: “physicians should be aware of tramadol as a potential single-agent cause of serotonin syndrome.” The study authors did not report or predict a percentage of patients that may experience this side effect, but it’s almost certainly low based on the mechanics of the drug.
Due to this risk, we feel strongly that patients on antidepressants should speak with their doctor prior to using tramadol about serotonin syndrome specifically.
Tramadol FDA Restriction
In 2017, the Food and Drug Administration (FDA) in the U.S. issued a notice that tramadol was restricted for use in children and adolescents.
The drug’s label now must carry a warning that the drug should not be used for pain in children under 12 years old. The FDA also warns that tramadol should not be used for pain in children under 18 years old who have undergone tonsil or adenoid surgery.
The notice also recommends that women avoid breastfeeding while taking tramadol because the drug can be absorbed by the infant from breastmilk, and may cause serious adverse effects, as a baby’s body cannot process prescription medication as efficiently as an adult can.
Tramadol is prescribed in various doses, and also in various formats.
According to the StatPearls resource referenced previously, the immediate release dosage of tramadol is 50 milligrams (mg), while the extended release version of the medication comes in three separate doses: 100 mg, 200 mg and 300 mg.
As suggested by its name, the immediate release version is absorbed and utilized quicker by the body, reaching peak concentration in the body in just under two hours. The extended release version doesn’t reach peak concentration for 12 hours.
There are some studies using daily tramadol doses as high as 800 mg, but this higher dose is shown to cause increased dependence, and we believe that much more safety data is necessary before tramadol can be regularly prescribed at those doses.
Should I Take Generic or Branded Tramadol?
As we discussed in the intro section of this article, tramadol is the generic version of the drug and there are several brand-name versions.
One might assume that brand-name versions are superior since they have backing by major pharmaceutical companies, but medical research shows there is no difference in efficacy on average. A medical review published in the well-respected JAMA journal analyzed whether generic or branded drugs were more effective, and found them to be “clinically equivalent.”
This makes sense, because both branded and generic drugs contain the same active ingredient.
We recommend that patients speak with their doctor about the generic tramadol rather than branded versions like Ultram. Tramadol is likely to be cheaper, and if there’s no improvement in efficacy for a more expensive version it makes no sense to take it.
Is Tramadol Addictive?
Because tramadol is an opioid, it has addictive potential. A medical study examined the potential for tramadol dependence in patients with no history of substance abuse.
The researchers found that addiction to tramadol alone was possible, and suggested that the previously-held notion that only patients with a history of substance abuse were likely to get addicted to tramadol may be false. Of the patients in the study addicted to tramadol, 90% of them were not using any other drugs concurrently, and 87% had no previous history of drug abuse prior to their tramadol addiction.
The sample sizes in this study were small, so we’re not suggesting it’s conclusive. But tramadol does appear to have an addictive potential, which makes logical sense given that it’s an opioid.
Patients with a personal or family history of substance abuse may want to speak with their doctor about potential options for pain management which aren’t opioids.
Is Tramadol More Effective With Tylenol?
The combined effect of tramadol and Tylenol have been studied in medical research. A study on this drug combination found that it was more effective than tramadol or Tylenol alone for pain relief. Interestingly, no increased side effects were noted compared to taking tramadol alone.
Tylenol is fast-acting and tramadol tends to take longer to take effect, so this combination may be the cause of the perceived improvement in pain relief when these medications are used together.
Even though Tylenol is available over-the-counter (OTC), we strongly recommend that patients speak with their doctor about taking Tylenol while using tramadol, as there may be long-term health risks.
Tramadol Vs. Oxycodone
Oxycodone is another commonly-prescribed pain medication, so patients are often curious about which treatment is more effective.
While individual results will vary, a clinical trial from 1999 directly compared the efficacy of the two drugs. Patients received one of the two drugs after completing facial surgery, and the pain relief effects were compared.
Oxycodone was found to be the more effective treatment, because pain relief was similar between both drugs but oxycodone caused significantly less nausea than tramadol (28% vs. 44%).
A more recent clinical trial found similar results: both tramadol and oxycodone were equally effective at reducing pain in breast cancer patients, but in this study there was also no difference in side effect rates.
Based on the available research we will conclude that the two drugs are very similar, and that there’s not enough information to suggest one over the other on a general basis. We recommend that patients speak with their doctor about whether tramadol or oxycodone is a better option for them, because genetics and current medications may make one drug more favorable.
Tramadol User Reviews
Drugs.com is a good resource for patient reviews of medication. Their tramadol reviews page shows an average rating of 5.7 out of 10 for the drug when used for chronic pain, which is a mediocre score.
We cannot verify any of the information on this website, but it’s the only useful resource for patient reviews of medication so we still find it valuable.
The most-liked positive review of tramadol comes from an anonymous user who gave the medication an 8/10 rating and claims that its lack of effects on mental wellbeing is a positive:
“Tramadol is a good medication that can take care of a wide range of pain. This medication is a great sub to addictive meds. A medication that only manages the pain and does not manage your mental state.”
The most-liked negative review of tramadol is written by a user named “Bobby 10” who claims they are suffering from near-constant pain and that tramadol has not been effective:
“Good honest hardworking Americans who deserve a few hours a day without pain. Now I am in pain all the time I don’t have insurance, so I pay for all my meds with cash.”
What Does Tramadol Feel Like?
One of the most popular YouTube reviews comes from a real user who describes the effects of the medication based on their personal use. The channel is called “Veterans With Anxiety” and the creator details their opioid addiction which they allege began with their tramadol use:
Tramadol is an effective medication for managing moderate to severe pain in adults. People considering tramadol for their children should speak with a doctor first, because the FDA has restricted its use for several age ranges in adolescents for safety reasons.
Tramadol is an opioid with a unique set of biochemical effects on the body. It may be addictive, like many opioids are, which is why it’s probably logical to consider this drug as a “last” option and try other treatments without the potential for abuse first.
Using Tylenol in conjunction with tramadol may cause greater pain relief short-term than using either medication alone, but patients should clear this use with their doctor as it may pose additional health risks compared to using either drug alone.
We recommend tramadol over any of the branded versions of the drug, as they all should be similarly effective but tramadol is likely to be much cheaper.