TRAMADOL

Tramadol's analgesic potency is approximately 10% that of morphine via parenteral administration. A Cochrane review of 22 RCTs found moderate-quality evidence that tramadol alone or combined with acetaminophen probably has no important benefit on mean pain or function in osteoarthritis compared to placebo, though slightly more patients report a 20% improvement. Evidence supports use in postoperative, neuropathic, and chronic pain settings, though study quality is often limited by industry funding and attrition bias. Tramadol prescriptions in the USA increased 22.8% from 2012 to 2015, with associated deaths rising globally. The drug's unique monoaminergic activity introduces risks of serotonin syndrome and seizures not typical of conventional opioids, and abrupt cessation can trigger both opioid and SNRI-like withdrawal syndromes.