The main conditions for which tramadol is utilized include mild to severe acute and chronic pain. Although the FDA has not approved it for this usage, there is some evidence to support its use as a second-line treatment for fibromyalgia. The NHS has approved its usage as a supplemental painkiller for the treatment of fibromyalgia.
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When taken orally in an immediate-release formulation, the analgesic effects take about an hour to manifest, and it takes an additional two to four hours to reach its peak impact. Tramadol is nearly as strong as codeine and pethidine, with a dose-dependent potency of around one-tenth that of morphine (i.e., 100 mg is equivalent to 10 mg of morphine, though this can vary).24] Its efficacy for moderately severe pain is about the same as that of very high dosages of hydrocodone and modest doses of codeine. It is less effective than morphine for severe pain.
The effects of lowering pain remain for around six hours. Because it is genetically based, the strength of analgesia varies greatly. It's possible that those with particular CYP2D6 enzyme variations don't make enough desmetramadol, the active metabolite, to effectively manage pain.
For refractory restless legs syndrome (RLS), which is defined as RLS that does not adequately respond to treatment with first-line medications like dopamine agonists (like pramipexole) or alpha-2-delta ligands (gabapentinoids), often due to augmentation, sleep medicine physicians occasionally prescribe tramadol (or other opiate medications).
