Things you should know about painkillers: Tramadol and its side effects

One of the most popular medications for more serious pain is tramadol. In fact prescriptions doubled between 2006 and 2012 from 5.9 million to 11.1 million.

At our clinic we see everything from minor musculoskeletal issues (where osteopathy is appropriate) to more profound spinal conditions in which case we offer a non-invasive alternative to surgery called IDD (spinal decompression). These presentations all vary and lie anywhere between chronic and acute soft tissue and joint injuries, through to serious degenerative or traumatic intervertebral disc issues in the spine. With this latter sub-set of patients, we utilise our IDD Therapy programme. Many of these patients will be on a profile of long term analgesics (painkillers) and often one of their reasons for treatment is a wish to avoid long term usage of analgesics.

One of the most popular medications for more serious pain is tramadol. In fact, prescriptions doubled between 2006 and 2012 from 5.9 million to 11.1 million. One of the reasons for its increased popularity is partly because it is cheap (as a non-branded generic drug it costs the NHS £1.99 per 100 tablets). It is a potent drug and it acts by influencing opioid receptors (in the same way as morphine). It also inhibits uptake of serotonin and norepinephrine (neurochemicals in the brain) and this gives it improved therapeutic efficacy when compared to morphine and codeine. However, there are also important side effects that are important to recognise.

Traditionally tramadol was regarded as much less potent and safer than other narcotics which are often abused. However, when tramadol is taken by mouth it is converted into another compound called O-desmethyltramadol, which is a much more potent activator of opioid receptors than tramadol itself. As a result, users may feel a euphoric effect on tramadol, even if that was not their intention. This in itself may give rise to dependency.

It is also becoming increasingly obvious that long-term usage of tramadol also has undesirable side-effects:

• There a risk of developing a tolerance and users can require larger doses to feel the analgesic effect. Therein lies a risk of overdose. Greater than recommended doses can cause slow breathing and slow irregular heartbeat.

• Physical dependence as a user’s body adapts to the presence of the drug and eventually the body may even require it to function properly

• Many opioids lead to cognitive impairment and slower reaction times

The short-term effects of tramadol can lead to dependency via:

• Lack of pain

• Elated mood due to increased levels of serotonin and norepinephrine

• Anxiety reduction

However, there can also be some fairly unpleasant other side effects (although they can be moderated by reducing the dosage). These include:

• Nausea

• Vomiting

• Dizziness

• Hallucinations

• Dry mouth

• Headaches

• Constipation

• Loss of appetite

• Sweating.

Mores serious issues can also occur such as rapid heartbeat, lack of coordination and difficulty breathing and swallowing.