How Does Tramadol Compare to Other Pain Relief Medications?

Tramadol is different from most pain medications (especially NSAIDs and other over-the-counter painkillers) in the sense that it has a partial effect on the opioid pathway of the brain that, upon stimulation, induce a feeling of euphoria (or pleasure) that gets stronger with continued drug intake. Most people develop physical and psychological dependence on this euphoric effect with prolonged use. However, for acute and infrequent use, tramadol offers absolute pain relief.

Steroids are the most potent drugs that decrease the tissue response to inflammation like pain, redness, swelling, and fever. However, due to the addictive nature of steroids, NSAIDs (non-steroidal anti-inflammatory drugs) are often preferred and are available as over-the-counter pills like acetaminophen, Tylenol, and ibuprofen. These agents act as painkillers and anti-inflammatory pills to decrease swelling, fever, and redness.

Similarly, opioids include morphine and codeine that are potent painkillers carrying a degree of sedative (sleep-inducing) and antitussive (anti-cough) action. They are ideal as pain remedy during or after a surgical procedure.

Alternative pain medications

Over-the-counter painkillers include mild analgesics like acetaminophen (that is more like an anti-pyretic and effective against headaches) to more potent analgesic agents like ibuprofen and similar drugs that provide long-term relief. However, most of these are ineffective for long-term use.

Most NSAIDs function by decreasing the production of inflammatory pain mediators (by blocking the enzyme activity of COX – Cyclooxygenase enzyme) that is also responsible for the production of gastric coating that protects the inner gastric lining from acid-induced damage. With long term use, the risk of gastritis, gastric ulcer, acid reflux, heartburn and similar issues limit the efficacy of therapy.

Similarly, opioids are not usually a first choice due to the high risk of addiction and tolerance. If potent analgesic action is desired, tramadol is the safest and closest to opioids.

Why prescribe tramadol in the first place?

With increasing numbers of reported tramadol addiction cases, a lot of people wonder why not opt for other pain relief medications. There are several factors that come into play when advising tramadol to the patient. For example:

• Age of the patient: Aspirin is not a safe choice for pediatric-age children due to the high risk of Reye’s syndrome. Similarly, most opioids like morphine are contraindicated in elderly due to the high risk of respiratory depression.
• Duration of use: For acute pain relief, opioids are the best remedies (even morphine and codeine unless there is an absolute contraindication due to age or any other factor). For longer durations, opioids are not preferred due to addiction, tolerance and dependence risk.
• Systemic dysfunction: Another limiting factor in the choice of analgesic medications is the systemic or organ dysfunction. For example, NSAIDs are not preferred with renal dysfunction while acetaminophen is not preferred with liver dysfunction. For patients with bleeding tendencies, aspirin is generally avoided and pain relief options are minimal.
• Intensity of pain: Most OTC painkillers are mild in nature and ineffective for moderate to severe pain involving sensitive tissue structures like joints. Tramadol provides a long-term relief for intense pain without any toxic dosage due to its role in central pain controlling pathways. Pain involving the spinal region, bones, joints, abdominal viscera and neuropathic pain responds only to opioids due to its effect on pain perception by the brain and the nervous tissue.

What can be done to gain maximum benefits and minimal side effects?

It is always a safe method to use drug combinations (smaller dose of tramadol and NSAID analgesic) to obtain maximum analgesic effect with minimal dosage. This decreases the risk of systemic damage and dependence. Another advantage of administering NSAIDs with tramadol is it relieves inflammation and decreases the requirement of analgesia by decreasing tissue edema.

For most chronic musculoskeletal conditions, the recommended ibuprofen dosage is 600 mg. With tramadol, a smaller dosage is required to produce similar effects. However, it is always desirable to seek an expert’s advice before starting therapy.