Tramadol can be effective for chronic back pain, especially when other treatments fail, but it's a weak opioid with risks like dependence, nausea, dizziness, and constipation, and its effectiveness for long-term chronic pain is debated, with some studies showing small benefits compared to placebo or NSAIDs, while others highlight its potential for serious side effects. It's generally reserved for when non-opioid options aren't enough, often for short-term relief or alongside other therapies, and requires careful monitoring due to its addictive potential and side effects, notes Spine-health.com and Mayo Clinic.
Immediate-release form of tramadol (Ultram).
It is used for back pain, sciatica, and for postoperative pain following spine surgery. For most adults, the maximum safe dose is 400 mg per day of the immediate-release tablets.
If your back pain becomes more severe, you may benefit from a stronger prescription drug like an opioid. Opioids, such as oxycodone (OxyContin) and an acetaminophen/ hydrocodone combination (Vicodin), interact with receptors on nerve cells in the body and brain to reduce pain.
Tramadol is used to relieve moderate to moderately severe pain, including pain after surgery. It is also used to treat pain severe enough to require opioid treatment and when other pain medicines did not work well enough or cannot be tolerated. The extended-release capsules or tablets are used for chronic ongoing pain.
And it likely increases the risk of serious side effects, including heart disease, the findings indicate, prompting the researchers to conclude that the potential harms of tramadol probably outweigh its benefits, and that its use should be minimised.
It is not usually recommended for the treatment of chronic (long-term) pain.
There's no single "best" pain medication for chronic pain; it's highly individual, often requiring a combination approach with therapies like physical activity, but common starting points include paracetamol, NSAIDs (ibuprofen, diclofenac) for short-term relief, and then progressing to antidepressants (amitriptyline, duloxetine) or anticonvulsants (gabapentin, pregabalin) for nerve pain, with opioids reserved for short periods due to risks, and always under doctor supervision.
Tramadol is a strong painkiller from a group of medicines called opiates, or narcotics. It's used to treat moderate to severe pain, for example after an operation or a serious injury. If you have long term pain, your doctor may also prescribe it if weaker painkillers no longer work.
When chronic pain feels unbearable, focus on immediate coping (pacing, distraction, deep breathing, heat/cold) while urgently contacting your doctor or seeking urgent care for severe flares to adjust medication or get immediate relief, using techniques like mindfulness and light movement as possible, and remembering that a multi-faceted management plan with therapies (PT, psychological) is crucial for long-term control, even if there's no quick cure.
At first, tramadol was a non-controlled medication. This means it could be prescribed by healthcare providers with few restrictions. But some medical experts became concerned about the potential for tramadol dependence and misuse. In 2014, the Drug Enforcement Administration (DEA) made tramadol a controlled substance.
Your provider may recommend home remedies to make you more comfortable, including:
Morphine. Morphine and similar drugs (like oxycodone, fentanyl, buprenorphine) are the strongest painkillers. Some come in patch form, but all work in similar ways and are used for severe pain only.
The "Big 3" for lower back pain, developed by spine biomechanics expert Dr. Stuart McGill, are core-stabilizing exercises: the Curl-Up, Side Plank (Side Bridge), and Bird-Dog, designed to build core strength and endurance without excessive spinal stress, helping reduce pain and improve function. They focus on creating a stable "spine bridge" by engaging abdominals, obliques, and back muscles to protect the spine during movement.
Even much stronger prescription painkillers can have minimal effect. A newly published study* indicates that opioid painkillers, including tramadol and morphine, provide “only modest short-term pain relief” for back pain, and this is only for patients who can tolerate the adverse side effects.
Common side effects
Oxycodone is stronger at relieving pain but also more likely than tramadol to lead to addiction and dependence. Tramadol has mood-boosting properties but a lower risk of respiratory depression than oxycodone. Tramadol also carries the risk of seizure.
Chronic pain can become unmanageable when it begins to interfere significantly with daily activities, sleep, and overall quality of life.
However, vitamin deficiencies in B12, D, and magnesium play a key role in sciatic pain and relief. If you've tried stretches, painkillers, or even therapy and found little to no relief, this could be your answer. A B12 vitamin deficiency, for example, leads to increased nerve pain and sciatica symptoms.
20 most painful conditions
Tramadol 50 mg may be adequate as the initial dose for moderate pain. For moderate to severe pain, 50 - 100 mg as needed for relief, every four to six hours may be administered. Tramadol 100mg is usually more effective as the initial dose for more severe pain. The maximum daily dose should not exceed 400mg per day.
Tapentadol is approximately two to three times more potent than tramadol and two to three times less potent than morphine.
Tramadol extended-release tablets and capsules are used to relieve severe and persistent pain in people who are expected to need an opioid pain medication to relieve pain around-the-clock for a long time and who cannot be treated with other pain medications.
Vertex announces FDA approval of JOURNAVXTM (Suzetrigine), a first-in-class treatment for adults with moderate-to-severe acute pain. Business Wire. January 30, 2025.
Opioids. Opioids include drugs like morphine, oxycodone, hydrocodone, and codeine. They are most often used for acute pain, and may be given right after surgery. These medicines can be safely used for short periods.
It's crucial to seek professional help when chronic pain becomes too much to handle on your own. Persistent pain can lead to a decline in physical function, emotional well-being, and overall quality of life.