Tramadol Addiction: Understanding the Symptoms, Causes, Effects, and Treatment Options

Tramadol addiction is a chronic condition caused by prolonged use of the medication. Tramadol is a synthetic opioid pain reliever used to treat severe and persistent chronic pain. Individuals take high doses when they develop tolerance to get the same effect, resulting in tramadol abuse.

The signs of tramadol addiction are behavioral symptoms, such as drug-seeking behavior, neglecting responsibilities, loss of interest, and social isolation, physical symptoms such as dizziness, nausea or vomiting, seizures, and tremors, and emotional symptoms such as mood swings, frustration, and anxiety.

The causes of Tramadol addiction include genetic factors, brain chemistry, pre-existing mental health conditions, stress, accessibility, and prescription misuse.

The effects of Tramadol addiction are euphoria, drowsiness, coordination problems, organ damage, cognitive decline, and increased tolerance.

The treatment options for Tramadol addiction include cognitive behavioral therapy (CBT), motivational enhancement theory (MET), medications, detoxification, support groups, and inpatient treatment.

What is Tramadol?

Tramadol is an opioid medication used to treat moderate to severe pain and works by interacting with the specific receptors in the brain and reducing pain sensation. People use it in the form of oral tablets or capsules. In certain cases, it is used as a liquid or an injectable form.

Tramadol is a weak mu-opioid receptor analgesic that works in the central nervous system. It is a mixture of (+)-tramadol and (−)-tramadol and is used worldwide for managing pain. The (+)-tramadol strongly binds to the opioid receptor, which reduces pain and prevents the reabsorption of serotonin that affects mood. In contrast, (−)-tramadol blocks the reabsorption of noradrenaline hormone which contributes to improving cognitive function and emotional regulation, according to the study “An overview of tramadol and its usage in pain management and future perspective” (Biomedicine & Pharmacotherapy, 2019).

Tramadol addiction is a condition that occurs when an individual uses medication in a larger amount or for an extended period. Many individuals experience cravings for the drug and difficulty to control their usage. This ongoing consumption leads to problems such as a lack of interest in activities, fulfilling responsibilities, and conflicts, as defined by DSM-5 through the opioid use disorder criteria.

How Tramadol Affects the Brain?

Tramadol affects the brain by interacting with mu-opioid receptors and changing chemical balances. Tramadol activates natural pain-relieving chemicals, like enkephalins and endorphins which modulate pain signals and reduce pain. Tramadol blocks the reuptake of serotonin and norepinephrine which enhances their effects by staying longer between neurons, resulting in improved mood and high energy levels. Tramadol helps individuals to feel relaxed and calm, but its prolonged use leads to dependence. Individuals experience withdrawal symptoms, such as anxiety, sweating, or nausea when they reduce or stop taking Tramadol.

Is Tramadol Addictive?

Yes, tramadol is addictive due to its pharmacological impact and interaction with the central nervous system. Tramadol, as an opioid, engages with the opioid receptors and prevents neurotransmitters which alleviates pain and improves mood but increases the risk of habit formation. Tramadol produces a sense of euphoria in some individuals which encourages misuse. Addicted individuals need higher than prescribed doses over time to reduce the same level of pain which increases the likelihood of addiction.

How does Tramadol Addiction Develop?

Tramadol addiction develops when an individual's brain becomes used to its pleasurable effects. People start relying on tramadol to feel relaxed and good. With time, the brain's reward system produces less dopamine which leads to tolerance. Addicted people find it hard to experience the same level of effect, therefore, increasing its doses. This continuous cycle of needing medication to maintain relief leads to addiction.

What is the Prevalence of Tramadol Addiction?

Tramadol was prescribed approximately 15.5 million times in 2021 as per the data published on Statista on Tramadol prescriptions from 2004-2021 in the U.S. by Matej Mikulic.

The misuse of oral tramadol was 4%, less than the 7% to 8% of other opioids. In 2022 to 2014, the misuse rate of tramadol remained at 1.5%. The data shows that its misuse rate is comparatively lower than other prescribed benzodiazepines and opioids, according to the article “Misuse of Tramadol in the United States” by Reines et al. (NIH, 2020).

Tramadol use was more common in females as compared to males across both older age and younger age groups. The older females used 1.97% of the tramadol, higher than the rate of 1.14% among older males. The younger females on average used 0.88% of tramadol compared to 0.55% of younger males according to the study "Tramadol use in the U.S. Adults With Commercial Health Insurance, 2005–2021" (American Journal of Preventive Medicine, 2024).

What are the Signs & Symptoms of Tramadol Addiction?

The signs of tramadol addiction are a combination of behavioral, physical, and emotional symptoms.

The signs and symptoms of tramadol addiction are listed below:

Behavioral Symptoms

The behavioral symptoms of tramadol addiction are listed below:

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• Drug-Seeking Behavior: Drug-seeking behavior means that addicted individuals prioritize Tramadol over everything else. They frequently visit multiple doctors, ignore dosage instructions, exaggerate symptoms to get more medication, request early refills, and refuse less addictive alternatives. Drug-seeking behavior shows a loss of control and dependence on the drug for pleasure.

• Neglecting Responsibilities: People addicted to tramadol neglect their responsibilities because the excessive use of medication consumes their mental and physical energy and makes it difficult for them to focus on tasks. Over time this addiction results in ignoring tasks, missing deadlines, and poor performance.

• Loss of Interest: Individuals abusing tramadol quickly lose interest in activities, such as traveling, socializing, or sports no longer excite them. This change happens because their mind shifts totally to the drug for pleasurable effects.

• Social Isolation: Social isolation happens due to tramadol addiction as addicted individuals stop interacting with family and friends to avoid judgment or feelings of guilt. The drug affects their mood and causes frustration and irritability which push them to isolate themselves.

Physical Symptoms

The physical symptoms of tramadol addiction are listed below:

• Dizziness: Dizziness is a warning symptom associated with tramadol addiction, misuse, and withdrawal as the excessive amount or prolonged use of tramadol slows down brain activity and increases dizziness. Individuals experience it as a withdrawal symptom due to their body adjusting to function without tramadol. Tramadol and morphine both provide similar quality of analgesia, sedation, and patient satisfaction but tramadol use for post-operative patient-control analgesia (PCA) results in nausea and dizziness as compared to morphine, according to the study “Increased nausea and dizziness when using tramadol for post-operative patient-controlled analgesia (PCA) compared with morphine after intraoperative loading with morphine published in the European journal of anaesthesiology.

• Nausea or Vomiting: Nausea and vomiting are common symptoms of tramadol addiction and withdrawal as the drug influences the central nervous system and makes certain individuals experience these symptoms during use. When addicted individuals attempt to reduce or quit their intake, it regulates nausea and vomiting along with headache and sweating. This occurs due to the body's dependence on drugs and sudden changes in chemical balance.

• Seizures: Seizures are a symptom of tramadol use, especially when used for extended periods or taken in higher amounts. Tramadol interacts with mu-opioid receptors leading to abnormality. Individuals with a history of brain injury, head trauma, and seizure disorders are more likely to experience seizures. 84% of the patients who abused tramadol experienced seizures within 24 hours, according to data published in the Addiction Center in 2024.The history of seizures increases the risk of developing seizures in patients using tramadol. Taking higher doses was associated with a rise in seizure frequency, according to the study by Babahajian et al. in 2019 on “Seizure prevalence and its related factors in tramadol intoxication; a brief report.” 

• Tremors: Tremors occur due to tramadol’s influence on dopamine, serotonin, and norepinephrine. When medication alters brain chemistry it leads to changes in muscle function and motor control. This results in trembling movements and body shaking. A 75-year-old woman experienced tramadol-induced parkinsonism after using tramadol for chest pain after her breast cancer surgery. Tramadol is the cause of this reaction, and its long-term lead to tremors and affects dopamine functioning, as per the study "Tramadol-induced parkinsonism: a case report of a 75-year-old woman" (NIH, 2019).

Emotional Symptoms

The emotional symptoms of tramadol addiction are listed below:

• Mood Swings: Mood swings occur among tramadol users due to its impact on brain chemistry. This alters the neurotransmitter level which regulates emotions and mood. Initially, it produces the feeling of euphoria but long-term use or withdrawal leads to unpredictable mood swings.

• Frustration: Individuals are often frustrated due to tramadol use and withdrawal. The medication affects the brain's reward system and changes the levels of neurotransmitters which impair emotional regulation, and increase irritability and frustration. During use, the individual becomes dependent on the effect of the drug, and during withdrawal, they struggle to cope with stressors leading to less frustration tolerance.

• Anxiety: Anxiety is another occurring sign among tramadol users. The use of the drug initially provides a calming effect and relief but its prolonged use alters the chemical balances in the brain, making people more prone to anxiety. This anxiety during withdrawal is accompanied by various symptoms including, sweating, rapid heart rate, and agitation. Patients using tramadol exhibit aggression, hostility, and anger during the dependence period. In contrast, an increase in depression, comorbid anxiety, and obsessive-compulsive system was observed after treatment, according to the study titled "Medical and Psychiatric Effects of Long-Term Dependence on High Dose of tramadol."

What are the causes of Tramadol Addiction?

The causes of Tramadol addiction are genetic factors, brain chemistry, pre-existing mental health conditions, stress, accessibility, prescription misuse.

The above-mentioned causes are described below:

• Genetic Factors: Genetic factors are the main contributing factors to tramadol addiction as some individuals are born with genetic variations that make them more vulnerable to developing addiction. Genes associated with pain sensitivity influence how their body breaks down drugs, leading to dependence. If someone's family is addicted to tramadol, it increases their chance of becoming addicted.

• The gene variation OPRM 1 118A>G reduces the effectiveness of mu-opioid receptors in the body, leading to weaker opioid response over time. The genetic changes influence how the individual body responds to medication, which significantly develops the risk of dependence on opioid drugs, according to the study titled "Genetic–epigenetic interaction modulates µ-opioid receptor regulation."

• Brain Chemistry: Brain chemistry causes tramadol addiction as the drug alters how the brain processes pain, pleasure, and reward. It affects dopamine which is responsible for motivation and feelings of pleasure. When an individual uses tramadol, the brain increases the level of dopamine and creates euphoria. Dopamine reduces its ability to release the same pleasure. A person needs more doses to feel normal over time.

• Pre-existing Mental Health Conditions: Pre-existing mental health conditions, such as GAD, SAD, or PTSD in individuals contribute to tramadol addiction. Tramadol provides them temporary relief but reinforces its misuse and worsens mental health in the long run. Tramadol, an opioid analgesic, has a significant impact when used twice daily with 200-300 mg doses for treating PTSD symptoms in patients, according to the article titled "Tramadol treatment of combat-related posttraumatic stress disorder” by Geracioti (NIH, 2014). While it provides relief for PTSD, its ongoing use increases the risk of misuse and addiction.

• Stress: Stress is a significant cause of increasing tramadol use. When someone experiences high-stress levels, they turn to drugs like tramadol to reduce pain and create relaxation. This temporary use of the drug forms a habit that makes it hard to quit, leading to an increase in the risk of addiction.

• Accessibility: The easy availability of tramadol whether through over-the-counter sales, illegal sources, prescriptions, or within social circles and at home leads to its misuse. If someone obtains the medication for chronic pain without medical supervision increases their dosage level without realizing its harmful effects.

• Prescription Misuse: Individuals misuse their Tramadol medical prescription by consuming higher than recommended doses or taking it even after improved condition. This increased cycle of misuse creates dependence as the body develops tolerance and needs a higher amount to get the same effects.

What are the effects of Tramadol Addiction?

The effects of Tramadol addiction are euphoria, drowsiness, coordination problems, organ damage, cognitive decline, increased tolerance, and respiratory depression.

These effects are defined below:

• Euphoria: Euphoria results from Tramadol's stimulation of the brain's opioid receptors, causing intense pleasure. Repeated Tramadol use triggers dopamine release, driving Tramadol addiction and dependence, according to the study "Opioid-Induced Euphoria in Tramadol Dependence" by Joana Barbosa and Sandra Leal published in NIH.

• Drowsiness: Drowsiness arises as Tramadol slows brain activity, leading to sedation. Consistent use causes persistent drowsiness, affecting daily functioning and alertness in Tramadol users, according to "Sedative Effects of Tramadol on the Central Nervous System" by Manraj Dhesi and Kenia A. Maldonado.

• Coordination Problems: Coordination problems emerge due to Tramadol’s suppression of the central nervous system. Long-term Tramadol use disrupts motor functions, increasing the risk of falls and injuriesThe study, "Neurobehavioral Consequences Associated with Long Term Tramadol Utilization and Pathological Mechanisms” by Khadga Raj published in NIH in 2019.

• Organ Damage: Organ damage particularly to the liver and kidneys, occurs with chronic Tramadol use. Liver enzyme elevation and renal strain are direct effects of prolonged tramadol addiction, as per the research, "Hepatotoxicity and Nephrotoxicity in Chronic Tramadol Abuse."

• Cognitive Decline: Cognitive decline includes memory loss and impaired decision-making. Ongoing tramadol addiction decreases cognitive performance as per the research titled, "Cognitive Impairment and Tramadol Dependence" by Medhat M Bassiony published in NIH.

• Increased Tolerance: Tolerance develops as the body adapts to Tramadol, requiring higher doses for the same effects. Escalating doses increase overdose risk according to the study, "Acute Tramadol-Induced Cellular Tolerance and Dependence."

• Respiratory Depression: Respiratory depression becomes evident with higher doses of Tramadol, as it slows down breathing, potentially leading to life-threatening situations. Severe respiratory depression is a critical effect of tramadol addiction usually in overdose cases, according to the research, "Respiratory Risks in High-Dose Tramadol Use" published in NIH.

How is Tramadol Addiction Diagnosed?

Tramadol addiction is diagnosed using the DSM-5 criteria, which includes signs like increased tolerance, cravings, continued use despite harm, and withdrawal symptoms. Doctors assess behavioral changes, physical dependence, and loss of control over Tramadol use.

Medical evaluations involve physical exams to detect withdrawal signs or toxicity. Urine screenings and blood tests confirm Tramadol's presence and misuse levels. Patient history and assessments are important for accurate diagnosis as per the study titled, "Clinical Approaches to Diagnosing Opioid Use Disorders", published in NIH.

What is Tramadol Addiction Withdrawal?

Tramadol withdrawal symptoms are the physical and psychological effects experienced when tramadol-addicted individuals quit or reduce their use. The common withdrawal symptoms include physical symptoms such as nausea, vomiting, sweating, headache, rapid heartbeat, tremors, muscle, and joint pain. Psychological symptoms include anxiety, depression, mood swings, insomnia, and cravings for tramadol.

Individuals experience symptoms like sweating, anxiety, insomnia, drug cravings, palpitation, and pins and needles sensation in the first 3 days of withdrawal. Craving for drugs continues along with disorientation, confusion, and insomnia From 4 to 7 days. The symptoms become milder, though anxiety, irritation, and depression thoughts persist, according to the Addiction Center on tramadol Withdrawal And Detox.

Tramadol withdrawal typically reaches the peak point within 36-72 hours after reducing or quitting use. The symptoms generally last for 5-8 days, as per the American Addiction Center on Tramadol Withdrawal Symptoms, Timeline & Detox Treatment.

What are the Treatment Options for Tramadol Addiction?

The treatment options for tramadol addiction include cognitive behavioral therapy (CBT), motivational enhancement therapy, medications, detoxification, support groups, inpatient and outpatient treatment, and aftercare.

• Cognitive Behavioral Therapy (CBT): Cognitive Behavior Theory (CBT) is a proven method to treat tramadol addiction. CBT helps individuals identify the behaviors and harmful thought patterns associated with tramadol use. It develops a healthy coping mechanism, reduces cravings, manages triggers, and prevents relapse. Motivational interviewing, solution-based therapy, and cognitive behavioral therapy (CBT) during tramadol rehabilitation proved successful addiction treatment. CBT focuses on understanding maladaptive thinking patterns that lead to addiction and increase chances of recovery, as per “Treatment for Tramadol Addiction” by Sumpter. The advantage of CBT includes lasting behavioral change and recovery. The disadvantages include consistent practice and the individual's commitment.

• Motivational Enhancement Therapy: Motivational Enhancement Therapy (MET) is another helpful treatment option for tramadol addiction. MET uses a client-centered approach and encourages an individual's intrinsic motivation to change. This therapy helps individuals gain insight into how addiction impacts their lives, making it easier to recognize recovery benefits. The advantages of MET include self-reflection and exploration of personal values. Its disadvantages include active participation and individual willingness.

• Medications: Medications such as opioid antagonists and partial opioid agonists, effectively treat tramadol addiction. These medications ease withdrawal and block the effects of opioids to stop relapse. Combining these medications with behavioral therapies enhances treatment results and supports long-term recovery. Buprenorphine, naltrexone, and methadone are effective in treating opioid use disorder. These medications block the eutrophic effects, reduce cravings, and normalize brain chemistry and body functions as per SAMHSA in 2024. The advantages of medication include reducing cravings for drugs and alleviating withdrawal symptoms. The disadvantages include side effects and dependency on medication.

• Detoxification: Detoxification is the foremost treatment option for tramadol addiction. Detoxification safely removes the drug from the individual's system. This process stabilizes the body and mood and prepares individuals for subsequent counseling and therapies. The advantages of detoxification include immediate relief and long-term recovery. The disadvantages include a high relapse rate if not properly followed.

• Support groups: Support groups are a valuable treatment option for recovering from tramadol addiction. Support groups such as Narcotics Anonymous (NA)  provide a supportive community. Members share struggles, and experiences, and hope to overcome this challenge. The advantages of support groups include emotional support, practical advice, and coping strategies. The disadvantages include a lack of structure and professional guidance.

• Inpatient Treatment: The inpatient program offers 24/7 medical supervision to individuals with severe tramadol addiction in a residential setting. Inpatient programs treat individuals with severe addiction and co-occurring mental health disorders. These treatment programs usually last from 28 to 90 days. In some cases, it extends beyond 90 days and provides intense care and supervision without distractions, as per Addiction Center in 2024. The advantages of inpatient programs include intensive care and a distraction-free environment. The disadvantages include higher costs and disruption to work and family responsibilities.

• Outpatient Treatment: Outpatient treatment provides non-residential care to tramadol-addicted individuals through flexible and structured programs. The advantages of outpatient care include lower cost, flexibility, and convenience. The patient consumed 5000-6000 mg of tramadol daily, resulting in excessive sedation, memory impairment, and seizures. The patient was managed in an outpatient setting after initial treatment in the emergency, according to the study “Buprenorphine for high-dose tramadol dependence: a case report of successful outpatient treatment” Clinical Practice and Cases in Emergency Medicine, in 2022. The disadvantages include limited access to medical staff, longer duration, and risk of relapse.

How is Tramadol Addiction Different from Other Addictions?

Tramadol addiction is different from other addictions because it affects both the opioid receptors and serotonin levels. This dual mechanism makes tramadol dependency more complex as compared to other opioid drugs such as codeine or morphine.

Codeine addiction develops slowly with prolonged misuse, whereas tramadol addiction is more complex and develops quickly due to its dual effect on opioid receptors and neurotransmitters. Morphine addiction develops rapidly with intense physical dependence. In contrast, tramadol addiction occurs gradually but involves serious withdrawal symptoms like anxiety and seizures.

Are the mental and physical effects of tramadol and benzodiazepine addiction the same?

Yes, Tramadol and benzodiazepine addiction share similar mental and physical effects such as cognitive impairment, anxiety, and depression, but differ in physical effects. Both opioids lead to mood disturbances, such as irritability, cognitive impairment, anxiety, and depression. Tramadol affects pain pathways and causes physical effects like fatigue, nausea, and in some cases seizures.  Benzodiazepines act as sedatives, causing drowsiness and muscle relaxation, and eventually leading to benzodiazepine addiction. Their withdrawal symptoms are more risky such as insomnia, tremors, and seizures.

Are cravings for tramadol and Xanax addiction the same?

No, cravings for Tramadol and Xanax addiction are not the same. The cravings for both addictions differ due to how each interacts with the individual's brain. Tramadol addiction leads users to crave mood-stabilizing and euphoric effects. Users depend on these effects to control physical pain and emotional discomfort. On the other side, Xanax users crave for anxiety relief and sedation. Users develop a psychological dependence on Xanax to control panic attacks and manage stress, or insomnia.