A Basic Guide to Tramadol

Tramadol (also marketed under the brand names ConZip, Qdolo, Ultram, and Ultram ER) is a prescription medication used to help relieve moderate to moderately severe pain for acute and chronic pain. 

Though it helps relieve pain for many people, this medication may sometimes lead to dependencies. Your risk of dependency may increase if you currently have a substance use disorder (overuse or addiction to drugs/alcohol). 

If you or someone you know is struggling with moderate to moderately severe pain, the prescription medication, Tramadol may be able to help. Use the below information as a guide to learn everything you need to know about the prescription drug, Tramadol but always first consult with your healthcare provider to see if this medication could be right for you. 

What is Moderate to Moderately Severe Pain?

Pain levels are subjective because they can vary from person to person, depending on their pain tolerance and threshold as well as a host of other factors. As no tests currently exist to measure exact pain intensity, and no imaging device or instrument can precisely locate pain, there is no official no way to determine how much pain a person is in. However, a person's pain can be more deeply analyzed and understood by assessing where their pain is classified on the pain scale, and how much it interferes with life and daily activities. 

What is the Pain Scale?

The pain scale is a numerical scale used by healthcare professionals to help patients assess their pain by rating it with a pain score. The numerical scale enables patients to verbally evaluate their pain on a scale from 0 to 10 or indicate their pain level by making a mark on a line. 0 indicates the absence of pain, while 10 represents the most extreme or severe level of pain possible. This rating scale allows healthcare providers to designate patients’ levels of pain into three categories; mild, moderate, or severe.

Characteristics of Moderate to Moderately Severe Pain

According to My-MS.org, the pain scale for moderate to severe pain indicates the following characteristics: 

Moderate Pain – Interferes significantly with daily living activities

For the purposes of this article, we will begin with a level 4 on the pain scale as moderate pain starts at a level 4 and continues up from there.

4 - Moderate pain- If you are deeply involved in an activity, the pain can be ignored for some time but it is distracting.

5 - Moderately strong pain- It can't be ignored for more than a few minutes at a time, but with effort, you still can manage to work or participate in some social activities.

6 - Moderately strong pain that interferes with regular daily activities- The pain makes it difficult to concentrate on anything else.

Severe Pain – Disabling & severely interferes with performance of daily living activities

7 - Severe pain that dominates your senses, significantly limits your ability to perform routine daily activities or maintain social relationships. Interferes with sleep.

8 - Intense pain- Physical activity is severely limited. Conversing requires great effort.

9 - Excruciating pain- Unable to converse. Crying out and/or moaning uncontrollably.

10 - Unspeakable pain - Bedridden and possibly delirious. Significantly few people will ever experience this level of pain.

These measures help healthcare providers understand the intensity and the severity of pain and whether treatments for pain can help to make a difference for patients. In addition, many doctors will suggest patients keep a pain journal to record their experiences with pain. A journal will help patients record when, where and how long their pain lasts, write down descriptions of their pain (aching, pulling, sharp, cramping, burning, stabbing), help track what makes their pain potentially better or worse, as well as include the different treatments they have tried to help manage their pain. Doctors can  then use this information to create an appropriate pain treatment plan for patients.

Acute Pain vs. Chronic Pain

Acute pain is usually sharp pain that comes on suddenly. It can be mild and last for a short time, or severe and last for weeks or months. The pain will usually go away after the underlying cause is treated or the affected area heals.

Acute pain can also serve as a warning of disease or a threat to the body and might be caused by many circumstances, including: 

• Surgical Pain

• Traumatic Pain (broken bone, cut, or burn)

• Muscle strain

Chronic pain is defined as pain that lasts longer than three months or past the length of time it takes for normal tissue to heal. Chronic pain, as it is usually more disruptive in life activities due to its longer duration can have various physical and emotional implications and effects. 

These effects include:

• Tense muscles

• Limited mobility

• Lack of energy

• Changes in appetite

• Depression

• Anxiety

• Anger

• Fear of re-injury

What is Tramadol and How does it Work? 

Tramadol belongs to the opiate (narcotic) analgesics class of medications and is used to treat moderate to severe pain. It works by changing the way the brain and nervous system feel and respond to pain, by helping to block pain signals and messages. By intercepting the pain signal, a patient’s experience of pain can be reduced and better managed. 

How Do You Use Tramadol to Treat Moderate to Moderately Severe pain? 

It is essential that you first consult your healthcare provider before starting any new prescription medication. Also, always be sure to carefully follow the recommendations of your health care provider, use the medication as instructed and as per the directions on the prescription label. 

Tramadol is available in the form of a tablet, a solution (liquid), an extended-release (long-acting) tablet, and an extended-release (long-acting) capsule, all taken by mouth. 

In regards to both the regular tablet and solution, it is usually recommended to take them with or without food every 4 to 6 hours as needed. The extended-release tablet and extended-release capsule are to be taken once a day. Take the extended-release tablet and the extended-release capsule at about the same time every day with or without food.

Tramadol extended-release is used for around-the-clock pain treatment and is not intended for use on an as-needed basis for pain.

Take Tramadol exactly as directed. Make sure to not take more medication in a single dose or take more doses per day than as prescribed by your doctor, as it is possible to overdose on Tramadol which can lead to dangerous side effects. 

Symptoms of overdose may include the following:

• decreased size of the pupil (the black circle in the center of the eye)

• cold, clammy skin

• difficulty breathing, slow or shallowing breathing

• extreme drowsiness or sleepiness

• unable to respond or wake up

• slowed heartbeat

• muscle weakness

What are Possible Side Effects of Tramadol?

It is possible to experience side effects when using Tramadol. Consult with your physician if any of these below symptoms become severe or do not go away. Common side effects may include, but are not limited to:

• sleepiness

• difficulty falling asleep or staying asleep

• headache

• nervousness

• uncontrollable shaking of a part of the body

• muscle tightness

• changes in mood

• heartburn or indigestion

• dry mouth

Some side effects can be severe and should be reported to your doctor right away, or you should seek immediate emergency medical treatment. These include but are not limited to:

• seizures

• hives

• rash

• blisters

• difficulty swallowing or breathing

• swelling of the eyes, face, throat, tongue, lips, hands, feet, ankles, or lower legs

• hoarseness

• agitation, confusion, and/or hallucinations (seeing things or hearing voices that do not exist)

• fever, sweating, shivering

•  severe muscle stiffness or twitching

• loss of coordination

• nausea, vomiting, diarrhea, loss of appetite, weakness, or dizziness

• inability to get or keep an erection

• irregular menstruation

• decreased sexual desire

• changes in heartbeat/fast heartbeat

• loss of consciousness

• joint pain

• stuffy nose, sore throat

• pain in the arms or legs

Get emergency medical help right away if you have hives, difficulty breathing, swelling of your face, lips, tongue, or throat. This could be a severe allergic reaction to the medication.

Other Complications of Using Tramadol

Since Tramadol is considered an opioid, it can be habit-forming, especially with prolonged use. While taking Tramadol, discuss your pain treatment goals, length of treatment, and other ways you can help manage your pain with your healthcare provider. It is also essential to let your doctor know if you or anyone in your family drinks excessive amounts of alcohol, uses or has ever used street drugs, overused or abused prescription medications, had an overdose, or if you have or has ever had depression or another mental illness.

Drug Interactions with Tramadol

Other drugs can sometimes cause a negative interaction when taken in combination with Tramadol and increase your risk of breathing issues. Therefore it's critical to discuss any medications you are currently on and have recently stopped using, especially:

• Amiodarone (Nexterone, Pacerone)

• Certain antifungal medications including itraconazole (Onmel, Sporanox), ketoconazole (Nizoral), and voriconazole (Vfend)

• Benzodiazepines such as alprazolam (Xanax), diazepam (Diastat, Valium), estazolam, flurazepam, lorazepam (Ativan), and triazolam (Halcion); carbamazepine (Carbatrol, Epitol, Equetro, Tegretol, Teril); erythromycin (Ery-tab, Erythromycin)

• Certain medications for human immunodeficiency virus (HIV), including indinavir (Crixivan), nelfinavir (Viracept), and ritonavir (Norvir, in Kaletra)

• Medications for mental illness, nausea, or pain

• Muscle relaxants; phenytoin (Dilantin, Phenytek), quinidine (in Nuedexta), rifampin (Rifadin, Rimactane, in Rifamate)

• Sedatives, sleeping pills, or tranquilizer

This is not a complete list, so it's critical you let your healthcare provider know of all other prescriptions and over-the-counter medications (including vitamins and supplements) you are taking. 

In conclusion

Tramadol can be an effective way to help manage moderate to severe pain, but should be used with caution. Consult with your doctor about all the potential benefits and risks, as well as other ways to manage pain. 

If you or someone you know is suffering from drug addiction please reach out to the Substance Abuse and Mental Health Services Administration. 

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