What Tramadol Is Used For

Tramadol is indicated for the management of moderate to moderately severe pain in adults. 1

Primary Indication

Tramadol is FDA-approved specifically for treating moderate to moderately severe pain in adult patients 1
It functions as a weak mu-opioid receptor agonist (approximately one-tenth the potency of morphine) combined with norepinephrine and serotonin reuptake inhibition 2

Tramadol has demonstrated efficacy in postoperative pain following surgical procedures and oral surgery (impacted molar extractions) 1
Single doses of 100 mg tramadol provided analgesia comparable to codeine sulfate 60 mg in acute pain models 1
It is effective for pain from trauma, renal or biliary colic, and labor 3

Tramadol is used for chronic pain of various origins, including osteoarthritis 4
Average daily doses of approximately 250 mg in divided doses were generally comparable to acetaminophen/codeine combinations in long-term controlled trials 1
However, effectiveness typically plateaus after 30-40 days in cancer patients, limiting its long-term utility 5, 6

Tramadol is classified as a WHO Step 2 "weak" opioid for cancer pain, but is not recommended as first-line treatment for moderate to severe cancer pain 5
The National Comprehensive Cancer Network notes that limited evidence supports tramadol use for cancer pain, and it is likely not as effective as morphine in this setting 2
When tramadol fails to provide adequate cancer pain relief, rapid escalation to strong opioids (morphine, oxycodone) is appropriate rather than increasing tramadol beyond recommended doses 6

Tramadol has demonstrated effectiveness in treating neuropathic pain due to its dual mechanism of action 3
The monoaminergic activity (inhibiting noradrenaline and serotonin reuptake) contributes significantly to its efficacy in neuropathic conditions 7

Immediate-release formulations: Maximum 400 mg/day (typically 50-100 mg every 4-6 hours) 2, 8
Extended-release formulations: Maximum 300 mg/day 2, 8
Reduced dosing required for adults ≥75 years old and those with hepatic or renal dysfunction to minimize seizure risk 2, 8

Tramadol must be used with caution or avoided in patients taking serotonergic medications (SSRIs, TCAs) or MAOIs due to risk of serotonin syndrome 2
It should not be combined with monoamine oxidase inhibitors 7

In head-to-head trials, tramadol produced more adverse effects (vomiting, dizziness, weakness) than hydrocodone and codeine, despite similar analgesic efficacy 2
Tramadol demonstrates no superior analgesic efficacy compared to other weak opioids, and both have ceiling effects limiting dose escalation 5

Tramadol has a lower risk of respiratory depression compared to traditional opioids 9, 4
It produces less constipation and dependence than equianalgesic doses of strong opioids 3
Common adverse effects include dizziness, nausea, sedation, dry mouth, and sweating, which are dose-dependent 9, 7
Tramadol can lower seizure thresholds and should be used cautiously in patients with epilepsy risk 6, 10

Particularly useful in elderly patients with osteoarthritis because it does not aggravate hypertension, congestive heart failure, or cause peptic ulcer disease like NSAIDs 4
However, elderly patients (≥75 years) require lower starting doses and closer monitoring for adverse effects 8, 6

Not appropriate for severe pain requiring strong opioid analgesia 5, 6
Should be avoided in patients with severe hepatic or renal impairment 2
Not recommended for patients taking multiple serotonergic medications due to serotonin syndrome risk 2
Limited utility beyond 30-40 days in cancer pain management, after which strong opioids become necessary 5, 6