When traditional painkillers don't work, Tramadol tends to be prescribed. But as health expert Helen Cowan explains, this pill should always be used with caution.

What is tramadol?

Tramadol is effective at treating moderate to severe pain including postoperative pain, trauma, burns, labour pain and cancer pain. Tramadol is prescribed when paracetamol, aspirin or ibuprofen are not adequate and strong opioids such as morphine are not yet warranted or available.

It is similar in strength to codeine although unlike codeine, which was originally derived from the poppy head, tramadol was until recently thought to be entirely man-made. Rumours abound that it might also be found in the roots of an African tree—perhaps nature got there first again.

 

How tramadol works

Tramadol, codeine and morphine all target pain by binding to the same receptors in the brain (morphine being the most powerful as it produces the strongest bind). Tramadol, however, beats other painkillers by having twin tactics; it also reduces pain by affecting brain chemicals such as serotonin—essential in how most modern antidepressants work.

Does that mean that tramadol might also be useful as an antidepressant? Perhaps. With its dual mechanism of action, tramadol is also tantalising as a possible treatment for diabetic nerve pain, shingles pain, premature ejaculation and even obsessive compulsive disorder.

 

Trick or treat?

Surveying the aftermath of some Halloween tricks gone wrong, Keith Williams from Buckinghamshire Fire and Rescue Service said “We don’t want to stop people enjoying Halloween but we do want them to celebrate safely.” In a similar way, tramadol can be a valuable medicine, but it must be used safely.

Those who are extra sensitive, or when taken in combination with alcohol, some antidepressants, and/or sleeping tablets, it can cause trouble. Tremors, terrors, trips (involving hallucinations and dizziness), trouble sleeping, tiredness, tolerance, tummy trouble and even tragedy can result.

Surprisingly, seizures can also be induced by tramadol, though Dr Justin Barber of South Carolina University acknowledges that this is usually only at high doses or when taken at the same time as other medicines which may cause fits.

 

Tramadol abuse

Because of its psychiatric effects, tramadol is sometimes a drug of misuse. According to the World Health Organization, “Abuse of tramadol is reported by Egypt, Gaza, Jordan, Lebanon, Libya, Mauritius, Saudi Arabia and Togo.” One study showed that 40% of hospital cleaners in Zagazig, Egypt and 10% of teenage students used tramadol for non-medical reasons.

Abuse of tramadol is also well documented in Iran, where experts observe that it is sometimes the first drug used after starting tobacco smoking, and represents a ‘gateway drug’ in the development of substance abuse.

Because the trips can be toxic, terrifying and tragic, the Home Office reclassified tramadol as a controlled class C drug in 2014, tightening rules regarding its prescribing. Given its invaluable use in more than 100 countries worldwide, such legislation, if copied elsewhere, might help to keep tramadol as the treasure that it can be when used appropriately.

 

Helen Cowan completed a PhD in cardiac pharmacology at Oxford in 2002. She is a qualified nurse and has written for the British Journal of Cardiac Nursing, and worked as a columnist in the Nursing Times. Read more from Helen here.

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