Tramadol is a synthetic opioid analgesic (painkiller) that is frequently prescribed to manage moderate to severe levels of pain—such as that experienced after surgery or in chronic conditions like arthritis. It is commonly marketed under one of its brand names, Ultram.
People who experience more chronic types of pain may be prescribed an extended-release version of tramadol, which allows them to experience longer lasting pain relief without needing to take the medication as frequently.
Is Tramadol Harmful?
This drug – while somewhat atypical with its activity as an opioid – still elicits its narcotic properties via the brain’s opioid receptors. Similar to other drugs in this class of substances, some people may be at risk for addiction if they:
“My pain typically would occur over two or three days. I took one or two a day until it eased. But I noticed on the days I took tramadol I felt more relaxed and coped with life better. Since the doctor had prescribed so many, at least two or three boxes, I started taking one every day….They had come from a doctor, so I was sure they couldn’t harm me…..I didn’t worry whether they were safe or not, I just needed them.”
- Use it for a long period of time.
- Take larger doses than recommended.
- Take it more frequently than has been prescribed.
- Take it for non-medical purposes.
- Take it concurrently with other substances, such as alcohol, sedatives or other painkillers.
Addiction is characterized by:
- Compulsive drug seeking behavior.
- An inability to limit use on one’s own.
- Difficulty functioning without the drug.
Short-Term Effects of Tramadol
Tramadol works by modifying the processing of pain signals traveling between the nerves and the brain. However, it has several different targets in the nervous system—each imparting contributions to tramadol’s pain relieving and, sometimes, mood altering properties. However, two well-known effects of tramadol are considered to be the most relevant for its ability to relieve pain and encourage abuse.
First, like heroin, codeine, and all other opiate analgesics, tramadol binds to opioid receptors in the brain and spinal cord. These receptors are responsible for both the pain-relieving effects that patients need and, at higher doses, the euphoric effects that abusers seek.
Because tramadol is much less potent than other commonly abused narcotics when it is injected, it was thought to be a safe alternative to other painkillers like morphine. However, when taken by mouth, tramadol is converted into another compound called O-desmethyltramadol, which is a much more potent activator of opioid receptors than tramadol itself. As a result, users may get high on tramadol, even if that was not their intention when they first started taking the drug.
The second important mechanism of tramadol is that it raises the brain levels of the neurotransmitters serotonin and norepinephrine, similar to antidepressant drugs like venlafaxine (Effexor). Ultram’s effects on serotonin and norepinephrine signaling in the brain is thought to be partially responsible for the drug’s ability to reduce depressive and obsessive-compulsive symptoms in patients taking it. These effects on mood may cause some patients, like the women quoted above, to take tramadol in larger doses and more often than prescribed, putting them on a path to dependence.
Short-term effects of tramadol include:
- Lack of pain. Tramadol is a painkiller; it modifies the transmission of pain signals to the brain so that you experience less intense pain while you are taking it.
- Elated mood. Tramadol works in a similar way to many antidepressant medications in that it increases the levels of serotonin and norepinephrine in your brain. This may lead to feelings of euphoria and well-being. For some individuals, these pleasant symptoms serve to reinforce a pattern of continued tramadol use.
- Anxiety reduction. Tramadol helps some users feel relaxed and calm because of the way it changes brain chemistry.
These symptoms and signs can contribute to a developing tramadol addiction, especially if the individual in question is concurrently experiencing depression and/or anxiety issues.
Side Effects of Tramadol
Some potential side effects of tramadol include:
- Difficulty falling asleep.
- Loss of appetite.
- Dry mouth.
People who have a seizure disorder should consult with their doctor prior to taking tramadol. Tramadol’s effects on various neurotransmitter systems are thought to mediate a potential pro-epileptic response—in other words, this medication may cause seizures. This property also makes tramadol especially dangerous for abusers because the probability of convulsions or seizures increases at high doses.
Other serious reported side effects that require medical attention include:
- Hives, blisters, or rash.
- Difficulty swallowing or breathing.
- Lack of coordination.
- Rapid heartbeat.
Long-Term Effects of Tramadol
An increasing number of practitioners shy away from prescribing Tramadol for long-term use due as knowledge of the undesirable effects that are experienced when this drug is used over a long period of time becomes more common. These effects may vary, but they often include:
- Tolerance: As tramadol works by changing a person’s brain chemistry, there is a risk of developing tolerance to this drug. As the body adapts to tramadol’s presence, users need larger doses of the drug to feel its painkilling and euphoric effects.
- Physical dependence: Along with tolerance, many users experience physical dependence if they use tramadol for a long period of time. Their bodies adapt to the presence of the drug, and soon require tramadol in order to function properly. If a dependent individual stops taking tramadol, they may become physically ill due to the onset of a withdrawal syndrome.
- Cognitive decline: Many opioid drugs are associated with cognitive impairment and slowed reaction times. Complex tasks may become more difficult with long-term use of tramadol, and users may present a danger to themselves or others when driving.
The side effects of tolerance and dependence may ultimately lead to a tramadol addiction. Like other kinds of prescription drug abuse, many individuals struggling with an addiction to tramadol need not obtain their drug from an illicit market to continue their cycle of dependence; they begin taking it as prescribed and then take a larger dose on their own when the medication stops working. People may, at some point resort to methods such as “doctor shopping” or prescription forgery to guarantee an uninterrupted supply of the pharmaceutical they find themselves hooked on.
Those who abuse tramadol for recreational purposes or who have developed tolerance after taking it for some time may take greater doses than recommended and are at increased risk for overdose.
Symptoms of tramadol overdose include:
- Decreased pupil size (pinpoint pupils).
- Slowed breathing.
- Slowed or irregular heartbeat.
- Cold, clammy skin.
Tolerance to the effects of tramadol can develop quite early. At the point that tolerance has occurred, dependency is close to follow. People may experience some degree of physiologic tramadol dependency even if the medication is taken as prescribed. However, the likelihood of a more pronounced dependency increases when taken in doses or on a schedule that deviates from that prescribed.
A tenacious psychological addiction may occur when one begins taking increasing amounts of the medication to overcome tolerance, mitigate the onset of withdrawal or merely using tramadol to get high and otherwise avoid dealing with problems in your life.
Tramadol Withdrawal Treatment
The symptoms of tramadol withdrawal can be very unpleasant and, in extreme cases, even dangerous. Many decide to seek help with discontinuing their use of tramadol by first going to a detox center. The process of detoxification allows patients to withdraw from a drug under medical supervision. Doctors may give you other medications or treatments to help you with the physical discomfort you may experience while you withdraw from tramadol.
Effects of withdrawal from tramadol overlap with both opiate and anti-depressant withdrawal syndromes and include:
- Gastrointestinal pain.
- Numbness in the extremities.
- Ringing in the ears.
Many people experience flu-like symptoms such as vomiting and nausea while withdrawing from tramadol. You may also experience tingling in your hands and feet.
After withdrawal is complete, you may want to attend an inpatient program at a rehab center. These types of programs require you to live at the center with other patients, who are also learning to live a new life in recovery—leaving behind the drugs they’ve been struggling with. During rehab, you usually undergo individual and group therapy sessions to help you learn new coping skills and ways of dealing with your emotions, as well as learn techniques to modify previously maladaptive behaviors that may have contributed to your addiction. Your friends and family may also receive therapy to help them process their feelings about how you behaved while in the throes of addiction. In addition, you probably will have the opportunity to attend support groups, like a 12-step program.
Most rehab programs last 30 to 90 days, although they may last longer. Adhering to an aftercare schedule after the initial period of rehab has concluded is beneficial for relapse prevention and long-lasting recovery. Many people continue with outpatient therapy and regular participation in a support group setting at this point. Outpatient approaches to treatment aren’t just for aftercare, however, as some people opt to complete a period of initial addiction treatment. Outpatient programs allow you to return to your normal daily activities while attending therapy sessions at a treatment center.