Why Is Tramadol Considered a Strong Painkiller?

Tramadol is a potent painkiller used to treat moderate to severe acute or chronic pain. 

Tramadol belongs to a class of ‘opioid agonists’ and helps manage pain in conditions such as osteoarthritis, back pain, postoperative pain and cancer pain. 

You would typically take Tramadol if basic painkillers such as paracetamol or ibuprofen don’t seem to help with your pain anymore. 

When exploring Tramadol as an option for pain relief, it is important to understand Tramadol, its mechanism of action, tramadol strength vs other painkillers and its benefits and risks.

What Is Tramadol?

Tramadol is a synthetic opioid painkiller that is used to treat moderate to severe pain, especially when common painkillers such as paracetamol or ibuprofen haven’t helped.

Tramadol is a widely prescribed pain relief medication used for various conditions such as postoperative pain, osteoarthritis, fibromyalgia, and cancer-associated pain. 

It also comes available as an extended-release form to provide longer-lasting pain relief.

Tramadol pain relief works by two primary mechanisms:

1. It binds to the opioid receptors in your central nervous system (brain and spinal cord) to produce a feeling of euphoria and heightened mood. This reduces the brain’s ability to perceive pain.
2. Tramadol also works to increase the effects of neurotransmitters, serotonin and noradrenaline, in relieving pain. It does this by inhibiting the reuptake of serotonin and noradrenaline, increasing their concentration within the central nervous system so they can mediate their pain-relieving effects. 

Unlike stronger opioids such as morphine or fentanyl, Tramadol is considered less potent. However, Tramadol is still a prescribed medication which must be used with caution due to the risk of opioid addiction and dependence. 

How Tramadol Works for Pain Relief

Tramadol works through two key pathways to relieve pain and give those tramadol strong painkiller effects.

1. Its primary mode of action is as a mu-opioid receptor agonist, meaning it binds to the same kind of receptors that morphine acts upon in the brain and spinal cord. This reduces the perception of pain and promotes feelings of euphoria and well-being.
2. Tramadol’s secondary mechanism is by inhibiting the reuptake of the neurotransmitters, serotonin and noradrenaline, in the brain. These neurotransmitters help modulate pain signals. By preventing their reuptake, their concentration in the central nervous system increases and enhances their pain-relieving effects. This dual-action mechanism makes Tramadol different to traditional opioids and allows it to act as a moderate strength painkiller.

Is Tramadol a Strong Painkiller?

So is tramadol a strong painkiller?

As a moderate opioid agonist, Tramadol is significantly stronger than over-the-counter medications like ibuprofen or paracetamol, but isn’t as strong as other opioid painkillers such as morphine or fentanyl. 

While morphine and fentanyl are more potent opioid painkillers, they also carry a more serious risk of opioid addiction or dependency. 

Tramadol provides effective pain relief for people experiencing chronic pain from conditions such as osteoarthritis or chronic back pain, while carrying a reduced risk of opioid dependence and side effect profile. This is due to the dual action Tramadol offers. 

By targeting the central nervous system’s opioid receptors and inhibiting the reuptake of neurotransmitters, serotonin and noradrenaline, Tramadol can offer effective pain relief and reduce the perception of pain. 

The dual actions also mean its effects are less intense compared to opioid analgesics like morphine.

This makes Tramadol a fine balance between effective pain relief and safety.

It should be noted that Tramadol is a prescription-only opioid agonist and still carries the risk of opioid dependence. Tramadol must be used with caution and according to the instructions of your medical provider.

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How Strong Is Tramadol Compared to Other Painkillers?

When exploring pain management options it is worth exploring how strong is tramadol compared to other painkillers. The following section compares Tramadol to commonly used painkillers including paracetamol, ibuprofen, codeine and morphine.

Tramadol vs Paracetamol and Ibuprofen

Paracetamol and ibuprofen are commonly used over-the-counter medications for more mild causes of pain, such as headaches, fever and muscle pain. They are relatively safe to use and work differently to opioid painkillers. The table below compares paracetamol and ibuprofen to Tramadol.

Tramadol vs Codeine

Codeine is a weaker type of opioid painkiller which is often used for moderate pain. Codeine isn’t as strong as Tramadol and is usually formulated in combination with paracetamol or ibuprofen. Codeine is prescribed, however, you can buy the lowest dose strength (8mg/500mg, combined with paracetamol) by a pharmacist. Codeine works similarly to Tramadol by binding to opioid receptors in the brain and spinal cord to reduce pain signals but it is less potent. 

Codeine’s main limitation is its higher risk of causing constipation and its inconsistency in offering pain relief especially when used on its own.

This table compares codeine and Tramadol.

Tramadol vs Morphine

Morphine is a very strong opioid painkiller used to treat severe pain, such as cancer pain or post-surgical pain. Morphine is much stronger than Tramadol, however, it is associated with a greater risk of opioid dependence and addiction. 

This table summarises the differences between Tramadol and Morphine.

Benefits of Tramadol for Pain Relief

As a moderate opioid analgesic (painkiller), Tramadol has multiple key benefits for managing moderate to severe chronic pain.

Effective pain-relief: when common painkillers such as paracetamol or ibuprofen fall short in providing relief from moderate to severe chronic pain, Tramadol offers effective pain relief, and does so without being as intense as other opioid analgesics like morphine. This offers a fine balance between strength and safety while managing chronic pain. 

Dual action mechanism: By working as both 1) an opioid agonist & 2) a serotonin/ noradrenaline uptake inhibitor, Tramadol offers two distinct and effective ways to manage diverse causes of pain. 

Extended release alternative: Available as an extended release version, this can provide long-lasting pain-relief to match your specific health needs.

Lower risk of Opioid dependence/addiction compared to strong opioid agonists: While opioid addiction is a risk of taking Tramadol, it isn’t as great as a risk compared to strong opioid agents such as morphine or fentanyl. This provides a safer, less harsh form of opioids, for those who need a stronger painkiller but are still worried about taking too potent of a painkiller. 

Generally tolerated well by patients: Most patients find Tramadol and its associated side effects rather tolerable since they don’t carry as many severe side effects as strong opioid agents do. For example, gastrointestinal issues (codeine) or severe drowsiness. 

Risks and Side Effects of Tramadol

Although tramadol is considered a safer alternative to stronger opioids, it is not without its risks and side effects. These include:

Serious side effects:

Seek immediate medical attention if you experience any of the following:

• Confusion
• Seizures
• Extreme sleepiness and drowsiness
• Difficulties urinating
• Hallucinations

This isn’t a complete list of side effects. Refer to the medicine’s leaflet for more information and consult your doctor if you have further concerns.

Why Is Tramadol Considered a Strong Painkiller? (Key Factors)

So why is tramadol considered a strong painkiller ? As mentioned, Tramadol belongs to a class of opioid painkillers. Opioid painkillers are much more potent than common painkillers such as paracetamol or ibuprofen.

The following key factors help explain why is tramadol strong at relieving pain.

Dual Mechanism of Action: Tramadol’s ability to both stimulate opioid receptors and inhibit the reuptake of neurotransmitters responsible for mediating pain signals (serotonin and noradrenaline) makes it an effective agent for diverse causes of pain.

Moderate Potency: Tramadol isn’t as strong as morphine or fentanyl (other opioid agonists) which carry a more serious risk of opioid dependence, but Tramadol is still stronger than common painkillers taken over-the-counter. This allows Tramadol to strike a balance between effectiveness and safety, making it suitable for moderate to severe chronic or acute pain.

Widespread Uses: Tramadol is a versatile analgesic, widely prescribed for acute and chronic pain, including conditions such as osteoarthritis, chronic back pain, post-operative pain and cancer pain.

When Tramadol Should Be Used with Caution

Tramadol is suitable for most adults and children aged 12 years and older. 

Consult your doctor or pharmacist if the following applies to you:

• Allergic reaction to Tramadol or adverse reactions to other strong painkillers
• Experience of seizures or fits
• Suffered a head injury 
• Addiction to strong painkillers, alcohol or illicit drugs, or history of substance abuse 
• Breathing difficulties
• Kidney or liver issues
• Pregnancy, breastfeeding or trying to get pregnant
• Certain medications, especially medications targeting serotonin