Tramadol is not evil.

Morphix, Am not clued up about long term pain relief, I thought condition would have been sorted by now, but was treat for sciatica originally when it was foot injury causing extreme pain...awaiting MRI scan now. Never taken over 100mg 6hrly even if needed. Seems am too eager to reduce dose. Obviously some nerve problem but hope will be sorted in time...had to push for interest. ( 7mths so far ) Every bit of information helps me understand about medicine. No idea what PVNS is. At first I was told 50mg 3 times in 24hrs was a very very strong dose, as had never heared of Tramadol it worried me,when the pain was bad was told I was addicted. So had strain and worry when not needed. All the above information has given me a clear understanding

obsborne you're welcome. I have a lot of experience of Tramadol and pain treatments in general, and have also studied molecular drugs chemistry at university level so I'm happy to share if it helps people avoid problems.

You mentioned nerve pain.. often a better choice than an opiate painkiller is a medication called Pregablin for nerve-related pain. You might want to ask your GP about this. It's not a painkiller and is non-addictive or habit forming, although if taken long-term it can cause some brain chemistry changes (it acts on GABA-B receptors and works as a muscle relaxant/tranquilizer) and so needs to be tapered down gradually again, like a painkiller. Some people claim it works well for nerve injury and chronic nerve pain conditions. It can however, affect cognitive ability and it produces a slightly intoxicated feeling in some people at higher doses. That may be a problem if you drive or in certain professions, but you may find a lower dose works ok and doesn't affect you cognitively.

If you're staying with the opiate painkillers long-term, Tramadol is a safer choice with far less addiction potential than pro-drugs like Codeine or high potency opiate drugs like Oxycotin. A common strategy GP's use for long-term pain management as I mentioned is to rotate the drugs periodically every few weeks, to lessen the risk of dependency or addiction to one drug. They should monitor regularly patients for any sign of dependency or addiction and intervene early. I know many GP's don't, and are happy to just issue repeat prescriptions of addictive opiates like Codeine in large quantity to some patients and leave them unsupervised for months. This seems rather irresponsible and I know someone like that who exceeds the dose due to tolerance/liking the effects of being opiated on Codeine. The GP would soon realise this, by checking early repeat prescription requests, or just seeing the patient more often and asking them to bring their meds with them.

Many GP's also from what I've been hearing are not fully clued up on Tramadol, its side effects, and the risk of dependency from daily use over a prolonged period. This is mainly because manufacturers marketed it as a low risk addiction painkiller based on limited clinical trials with animals. No proper studies having been carried out to my knowledge, on patients using it long-term. That's not to say everyone who uses Tramadol over a longer period gets dependent or develops tolerance. That hasn't been my experience anyway, but I always kept the dose low (50mg once daily). It is a potent drug as you said, even at 50mg taken 1-3 times a day. Any higher dosing, and the risk of dependency and withdrawal problems definitely increases substantially.

Tramadol should definitely never be stopped abruptly though at any dose, if it's been taken daily for an extended period of months. Many Dr's are again not aware of this or the problems it can cause some patients due to its serotonin effects. If you want to come off it, you definitely need to taper down the dose gradually to allow your brains serotonin chemistry to adjust, else it can go into shock. Some people report "brain zaps" others report feeling extreme lethargy/depression-like symptoms if Tramadol is withdrawn too soon.

There is also a lot of potential for major drug interaction with Tramadol and other drugs (and even herbal supplements) with due to the serotonin affects Tramadol has.

Although fairly rare, some cross-interactions (particularly with SSRI anti-depressants (or supplements like St John's Wort/5-HTP) cause potentially life threatening condition causing "serotonin crisis" if taken inconjunction with Tramadol, particularly at higher doses. Taking other drugs like this that affect serotonin can also lower the seizure threshold ceiling of Tramadol (down from 600mg to 400mg-200mg in some people)

So it's best not to take any drugs or substances that are likely to alter serotonin levels without checking with your GP if on Tramadol.

Also you will need a "wash out" period after you stop taking Tramadol for it to be fully out of your system, before you begin any anti-depressants or other drugs that affect serotonin. Usually 3-4 days is sufficient, but GP's may recommend longer periods of weeks to be safe, for certain medications.

So far not used any other meds for foot problem, pleased now I didnt take higher dose. Gp said I could have patch but I refused, didnt ask what it would be. Advised ok to take paracetamo; also but that doesnt appear to help. Hospital sent heart test result today (8th April 24hr test ) about atrial ectopic and episodes paroxysmal AF. sinus rhythem with paroxysmal AF. Appointment Nov. Not a clue , hope if meds required will get correct details as will be reluctant to take and this will cause doctor patient friction. Five month wait so mustnt be serious. Doing charity help on till twice a week, can sit down at times, missed it when unable to get out.

megzie, going to see how I get on minus tramadol as nerve problems can be tolerated during day also bone ache. Not keen on requiring pain tabs for months on end. Am due for MRI scan in few days so hope for answer to injury.

I occasionally take Tramadol with Advil for Osteoarthritis pain in my knees and it takes the "edge" off - but after a week or so, I become real itchy. Usually I only take a half of pill at a time as I'm real sensitive to most medications. Lately I've been taking a quarter of a pill - and after a few weeks I would wake up itchy & started getting hives all under my chin/neck - once I stopped taking it, a few days later I was fine. Very strange as I've taken it on/off for years. Also, I notice when i take this drug i feel better mentally, and it gives me a little boost, but then sometimes it can make me grouchy. Last year after taking for approx 6 weeks it would raise my blood pressure - i had to stop, then BP was normal again. Its never the same - frustrating because it works good - but these side effects are troublesome...Now Im afraid to take after hive incident...so just trying to live with the pain on advil & PT.

morphix. Do not fancy taking muscle relaxant/tranquilizer type meds....sounds a bit like valium. Now settled on Tramadol 100mg 12hrlyish. and may be Paracetamol tabs 2 if needed during day. Awaiting MRI scan results for restricted movement of foot plus nerve toe problem. At least have not had any obvious side effects. More concerned about annoying cardiologist when he no doubt will prescribe treatment after 6 day check and my relutance to take advice. At times side effects can be worse than condition. Thanks for all information it did help.

For the past couple of days I've been building up to another attack of shingles or PHN or whatever causes the pain. Been a good boy til now and have kept the Tramadol for bed time along with amitriptyline 10mg.

The pain got a bit much today so I took 2 Tramadol at 7oclock pm and went for a walk. The effect is quite unnerving, dizzy. and my head follows the rest of me about 3 seconds later. Why on earth would anybody use these for recreational purposes?.Its awful. But the pain is now bearable.

Hi Steve, although dizziness is a known side effect in some people, what you describe sounds quite unusual effect. I'm assuming you took 100mg but curious to know dosage you took, and how often, if you don't mind me asking?

Does this effect happen all the time, and is your blood pressure and pulse ok normally, and are you able to check if it changes after dosing Tramadol?

I went to see my GP recently about my PVNS condition as I have begun getting pain in my knee again and feeling depressed.

I informed the GP about my use of Tramadol (on private prescription outside the NHS) over a long period of 6 years for pain relief and how it might have masked or helped, symptoms of depression which the GP thinks I've presented (lethargy, lack of motivation/interest in doing things, low mood etc). I told GP I had just recently took a very low dose of Tramadol again out of desperation (10mg) and it fixed all the symptoms like magic. I was back to my old self, energised and able to do things and feeling a lot better.

I suggested to GP that Tramadol raises serotonin and is probably indicating I have depression. GP agreed and asked me if I wanted more Tramadol!!

I said no thanks, I've battled to get off it for so long, and it causes so many problems for now (increased anxiety, insomnia, weight loss, hair loss, acne), that I better not start it again.

Dunno, for the past year or so I've restricted their use to bed time so if there has been any side effects I've slept through them. I took 2 again last night at 11-30 and slept the sleep of the tired and just, but, I'm a bit spaced out this morning. A 64years old space cadet.

I will monitor pulse, bp etc. today and let you know the findings.

Steve I'm astonished you can sleep on Tramadol! I can't get any sleep AT ALL for 24 hours straight, even if I take a single 50mg dose. The effect is like drinking about 3 or 4 strong teas or coffee. Wired! It's interesting how Tramadol seems to effect people so differently.

Re my last comment, that only happens if I take Tramadol beyond 12pm.. I have to take it really early (7-8am) if I don't want my sleep affected. And if I re-dose in the afternoon, I can forget sleeping. If I took it before bed time, I would not sleep for 24 hours.

That sounds a lot like me Morphix - I feel quite drowsy when I take Tramadol but I can't actually sleep at all which is fine if I don't have to get up for work at ridiculous o'clock in the morning! Unfortunately I usually do so I end up feeling half dead by the middle of the morning and wondering how I'm going to get through the day! However, when in pain it's a very a useful drug for me so I'm prepared to put up with the downsides. Hope you are getting on OK.

My blood pressure has been in the region of 117 over 76 not going above 121 or 82 and the old ticker has been about 70ish when resting and went up to 95ish after a good walk so not a lot to worry about there.

The thing I don't understand is how people can not sleep after Tramadol, I find it very difficult to stay awake.

Thanks for replies Mollymops and steve..

Maybe Tramadol affects older people differently or just people in general depending on their physiology and hormone responses. This I find very interesting though, how it makes you both drowsy.

Tramadol affects noradrenaline as well as serotonin, the first is a chemical in the brain which regulates hormonal responses concerning concentration, heart rate and the classic "fight or flight" response to stress.

So if you have more of this chemical in the brain (as you should on Tramadol) you should feel more awake, like you've had caffeine. The metabolic rate should speed up, with elevated heart rate increase and blood pressure, and you may feel more physical stress on the body if you're sitting still and there's no outlet for that energy. I think this is what the manufacturers of Tramadol had in mind when they made this drug, that the noradrenaline and serotonin effects would help people feel better who are suffering with pain, as these have some role in pain response.

I suffer with anxiety and I think I may already have high levels of noradrenaline or be more sensitive to the "fight or flight" response which even a strong cup coffee or tea will trigger! I've heard though, quite a few people say they feel "amped up" or wired, after taking Tramadol. Cognitive function is speeded up and they feel more energetic. That's why some use Tramadol recreationally I think, particularly those into sports. They seem to like that effect and energetic boost. For me it's a negative effect though and why I had to stop taking it, despite it being a great painkiller and anti-depressant.

Perhaps an explanation for why Tramadol makes you both drowsy is that noradrenaline, serotonin or the hormonal responses are either downgraded or altered in some way with age, and so Tramadol either has less effect on that receptor sites, or is simply being countered in some way by other hormones.

What you describe almost seems like a completely inverse effect to the classic effect Tramadol younger people experience. It's like you're experiencing the side effect you would expect from an SSRI anti-depressant alone, which generally do make you feel drowsy and sluggish (at least for the first few weeks of treatment).