Tramadol is an opioid medication that works to relieve moderately severe pain by changing the way that the brain and nervous system perceive and respond to pain 1,2. The substance was prescribed more than 43 million times during 2013 according to the Drug Enforcement Administration (DEA) 2. In the U.S., tramadol is marketed under a number of brand names, including:
- Ultram and Ultram ER.
Like other pain medications including codeine, oxycodone, and hydrocodone, tramadol is an opioid painkiller and, like those other drugs, it carries the risk of abuse and dependence, alongside other unwanted effects of use like 1:
- Mood changes.
If you’re struggling with a tramadol dependence and wish to quit, you may find you need help to do so. Quitting may trigger the onset of uncomfortable withdrawal symptoms that make staying off tramadol a significant challenge for many. Call 1-888-744-0069 to find help today.
What Is Tramadol Withdrawal?
To better understand the issue of tramadol withdrawal, it is helpful to understand how the substance triggers the development of tolerance and physical dependence. When used, the substance interacts with opioid receptors, which leads to an alteration in pain perception, but also an accompanying increase in dopamine activity in the brain. Increases in dopamine neurotransmission such as this can lead to feelings of reward that encourage continued use 2,3,4.
When take appropriately, it can be used to safely manage pain. However, when misused, the risks of both physical dangers and addiction increase. The DEA reports that 2:
- In 2012, 3.2 million people reported having abused tramadol at some point in their lifetime.
- In 2011, about 20,000 people presented to emergency departments due to complications related to tramadol misuse.
With time and continued use, the standard dose of tramadol will begin to elicit diminishing subjective effects. This decline in efficacy is explained by a phenomenon known as tolerance. To counteract the development of tolerance, users often begin to take increasingly large doses. With ever-increasing levels of tramadol in the system, the brain grows more accustomed to its availability and begins to depend on the substance to operate normally. At this point, the user is said to have become physically dependent on the opioid 3,4.
When a person that is physically dependent on the substance drastically decreases or abruptly stops use, an unpleasant withdrawal syndrome may occur 5. In the case of an acute withdrawal, the brain reacts to a relative deficit in activity of 2,3:
- Dopamine, a neurotransmitter related to motivation, pleasure, emotion, and movement.
- Serotonin, a neurotransmitter involved in sleep, emotion, and movement.
- Norepinephrine, a neurotransmitter linked to attention, energy, and response to stress.
Note that it is not addiction, but rather the presence of physical dependence, that signals the likelihood of experiencing withdrawal symptoms. You can be addicted and not dependent, and vice versa. In fact, even someone taking it according to a prescription (not abusing it) may become dependent and experience withdrawal upon ending use of the drug 4,5.
The time needed to become dependent on tramadol will vary widely according to factors like duration of use, frequency of use, and dose 5.
Is Tramadol Withdrawal Dangerous
People that withdraw from tramadol will experience withdrawal effects quite similar to those associated with other types of opiate withdrawal. Tramadol withdrawal is often marked by flu-like symptoms and strong cravings for more tramadol 2,6:
Tramadol withdrawal is rarely life-threatening. The most common risk of tramadol withdrawal is the risk of relapse. Because of the severe nature of the withdrawal, it is not uncommon for those attempting to stop using to abandon their efforts in an attempt to stop the discomfort. Avoidance of withdrawal is, in fact, a major perpetuator of addiction.
Additionally, if the cravings become more difficult to resist, the individual may be compelled to resume use with a large dose and, in doing so, increase their risk of overdose.
NOTE: Certain psychological dangers may arise in a small percentage of people going through withdrawal. See “Atypical Withdrawal Symptoms” below for more information.
Signs and Symptoms
In general, 90% of tramadol users will have signs and symptoms that are common to other opioids. The other 10% may experience atypical withdrawal symptoms (described below).
The normal acute withdrawal symptoms will begin within a day or two of last use and continue for approximately 4 to 10 days 8. During this time, the withdrawal symptoms will change and develop.
Early in the process, the individual is likely to experience 5,6,8:
- Muscle aches and pain.
- Poor sleep.
- Runny nose.
- Watery eyes.
- Increased sweating.
- Frequent yawning.
After some time, these effects will give way to later symptoms of tramadol withdrawal like 5,6,8:
- Cramping in the abdomen.
- Dilated pupils.
- Goose bumps.
- Nausea and vomiting.
- Muscle spasms.
Even when these acute symptoms of withdrawal fade, the individual is at risk of enduring protracted withdrawal 8, which is also known as post-acute withdrawal syndrome (PAWS), or extended withdrawal.
Protracted withdrawal involves symptoms that continue for a period longer than the expected timeframe. Protracted withdrawal symptoms can grow, change, and develop for weeks or months after the acute withdrawal period has ended. Protracted withdrawal symptoms associated with tramadol discontinuation include 8:
- Poor sleep.
- Emotional blunting.
- Poor focus and concentration.
Tramadol is unlike other opioid painkillers such as oxycodone, in that it relieves pain by way of two different mechanisms: 1) by stimulating opioid receptors and 2) inhibiting serotonin and norepinephrine reuptake. temporarily raising the activity of those neurotransmitters in the brain. Due to the fact that it is atypical in this way, some users will actually experience a whole set of symptoms not normally seen in opioid withdrawal.
This atypical withdrawal syndrome include a range of psychological symptoms marked by 2,7:
- Intense paranoia.
- High anxiety and panic.
- Confusion and disorientation.
- Unusual sensory experiences including numbness and prickling in the hands and feet.
Again, these symptoms might not be dangerous themselves, but they can lead to dangerous situations. People that are experiencing visual or auditory hallucinations, paranoia, and delusions can make poor choices—particularly so if these psychotic symptoms have a theme of persecution 7. The user’s safety and those around them may be at risk in these situations.
The body has a natural ability to process and remove harmful toxins. This method is called detoxification. In terms of substance abuse treatments and procedures, detoxification is a group of strategies used to manage intoxication and withdrawal. The primary goal of detoxification is to minimize the harm caused by the substance. It is accomplished through 4:
- Evaluation. In this stage, medical, psychological, and social factors are evaluated to determine the best course of action.
- Stabilization. During this stage, the individual will receive medical supervision and psychological support to achieve a drug-free state.
- Encouraging further treatment. Because detox is not a complete treatment for substance abuse, further treatment is recommended for sustained recovery.
Detox can take place in a number of settings, from inpatient hospitalization to regular visits in a treatment center. The appropriate setting will depend on factors like the individual’s 4:
- Level of dependence.
- How much support the recovering user has.
- Living conditions.
- Risk of violence and suicide.
What Happens After Detox?
Tips to Handle Cravings
Since cravings are an expected part of tramadol withdrawal and recovery, you will need strong strategies to manage cravings like 10:
- Delay, distract, and decide when faced with the choice to use, rather than making impulse decisions.
- Speak positively to yourself about your ability to manage these cravings.
- Use relaxation and imagery techniques to build a sense of calm and control over unwanted thoughts.
Beneficial treatment styles to support recovery include 4:
- Cognitive Behavioral Therapy (CBT) – A treatment that investigates the connectedness of thoughts, feelings, and behaviors to understand triggers of use and methods to prevent relapse.
- Motivational Interviewing (MI) – A style that strives to increase the person’s own internal motivation for change.
- Contingency Management (CM) – A method that provides immediate, tangible rewards to people in recovery for completing recovery-focused activities and behaviors.
- Family Therapy—A general term that applies to the inclusion of family members and significant others in treatment to reinforce healthy habits.
If you need help quitting tramadol, don’t wait. Treatment programs are available to help you end your use for good. Call 1-888-744-0069 to learn more.
- S. National Library of Medicine: MedlinePlus. (2016). Tramadol.
- Drug Enforcement Administration. (2014). Tramadol.
- National Institute on Drug Abuse. (2014). Research Report Series: Prescription Drug Abuse.
- National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide.
- S. National Library of Medicine: MedlinePlus. (2016). Opiate and Opioid Withdrawal.
- Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment.
- Rajabizadeh, G., Kheradmand, A., & Nasirian, M. (2009). Psychosis following Tramadol Withdrawal. Addiction & Health, 1(1), 58–61.
- Substance Abuse and Mental Health Services Administration. (2010). Protracted Withdrawal.
- S. Food and Drug Administration. (2016). FDA Approves First Buprenorphine Implant for Treatment of Opioid Dependence.
- Australian Government: The Department of Health. (2003). Phase 4: Strategies to Cope with Cravings.