Tramadol addiction is the uncontrollable and harmful use of tramadol, an opioid analgesic prescribed for pain relief, despite the physical and emotional consequences that it brings. The prolonged use of tramadol leads to tolerance, physical dependence, and lasting changes in brain function.
According to Reines, S. A.’s 2020 study, ‘Misuse of Tramadol in the United States: An Analysis of the National Survey of Drug Use and Health 2002-2017.’, between 2015 and 2017, around 4% of oral tramadol prescriptions were misused in the past year—lower than the 7% to 8% seen with comparators when adjusted for drug availability. From 2002 to 2014, lifetime misuse of oral tramadol remained at 1.5% or less, significantly lower than misuse rates for hydrocodone (6%) and oxycodone (4%), and even lower than that of alprazolam.
Symptoms of Tramadol addiction present various behavioral and physiological changes. Individuals display increased impulsivity, engaging in risky behaviors without considering the consequences. Physiological signs include dilated pupils, increased heart rate, and significant weight loss.
The causes of Tramadol addiction encompass a combination of genetic predispositions and environmental influences. Genetic factors predispose individuals to addiction, while ecological stressors such as trauma or peer pressure exacerbates vulnerability. Additionally, tramadol’s impact on the brain’s reward system contributes to the development and perpetuation of addiction.
The effects of tramadol addiction are severe, impacting both physical and mental health. Physically, drug abuse leads to chronic conditions like respiratory issues, heart rhythm abnormalities, and decreased fertility. Mentally, tramadol addiction results in cognitive impairment, mood disorders, and an increased risk of psychosis. Prolonged use also elevates the risk of overdose and sudden death.
Effective substance abuse treatment for tramadol addiction typically involves a comprehensive approach, including medical interventions and psychotherapy. Medications such as methadone, buprenorphine, and naltrexone are found helpful in managing cravings and tramadol withdrawal symptoms. Psychotherapeutic approaches like cognitive-behavioral therapy (CBT) assist individuals in identifying triggers and developing coping mechanisms to support recovery.
Preventing tramadol addiction requires a multifaceted approach, encompassing public health initiatives, education, and regulatory measures. Raising awareness about the risks of tramadol misuse, promoting responsible prescribing practices, and implementing strategies to limit access to tramadol are crucial steps in prevention.
What is Tramadol Addiction?
Tramadol addiction is a chronic substance use disorder characterized by compulsive use of the synthetic opioid pain medication tramadol despite negative consequences. It is marked by physical dependence, requiring increasing doses to achieve the same effect (tolerance), withdrawal symptoms when stopping use, continued use despite awareness of physical or psychological problems caused by the drug, unsuccessful attempts to quit, and interference with daily responsibilities and social functioning.
According to Khodayari S. et al. 2019, “Acute Tramadol-Induced Cellular Tolerance and Dependence of Ventral Tegmental Area Dopaminergic Neurons: An In Vivo Electrophysiological Study,” over time, individuals develop a tolerance to tramadol necessitating higher doses to achieve the desired effects and ultimately resulting in addiction. Reference
Tramadol is addictive because it interacts with the brain’s reward system, triggering a craving response and reinforcing drug-seeking behavior. Similar to other opioids, it also alters serotonin and norepinephrine activity, which affects mood and further enhances its addictive potential. These combined effects contribute to the complexity and potency of tramadol addiction.
What are the Signs and Symptoms of Tramadol Addiction?
The signs and symptoms of tramadol addiction are behavioral, physical, and psychological. These include developing secretive behaviors, experiencing persistent drowsiness, showing declining physical health, and demonstrating compulsive drug-seeking patterns.
Here are the key signs and symptoms of tramadol addiction:
Behavioral Changes
Behavioral changes of Tramadol addiction include becoming secretive about activities, avoiding responsibilities, engaging in deceptive practices, withdrawing from social connections, and prioritizing drug use over relationships. These behavioral shifts manifest through concealment of drug-seeking activities, neglect of work or family obligations, manipulation of medical providers, self-isolation from support systems, and deterioration of meaningful relationships.
Here are the key behavioral changes of tramadol addiction in detail:
- Increased Secrecy: Individuals with tramadol addiction hide their drug use and activities due to shame or guilt, leading to a lack of transparency with loved ones.
- Evasion of Responsibilities: Tramadol impairs focus and motivation, causing individuals to neglect work, school, or home obligations as they prioritize their drug use.
- Use of Deceptive Practices to Obtain Tramadol Prescriptions: To sustain their addiction, individuals lie to healthcare providers or visit multiple doctors, engaging in unethical behavior to secure prescriptions.
- Withdrawal from Friends and Family Members: Addiction leads to social isolation, as individuals prioritize drug use over relationships and fear judgment from loved ones.
- Prioritization of Tramadol Use Over Meaningful Connections: Those addicted to tramadol frequently place their drug use above personal relationships, resulting in weakened social support and emotional well-being.
Physical Symptoms
Physical effects of tramadol addiction are observed through symptoms such as drowsiness, nausea, and impaired coordination. Additionally, individuals experience changes in appetite, fluctuations in weight, and deteriorating physical appearance.
- Dizziness: Dizziness is a sensation of lightheadedness or unsteadiness. Tramadol addiction induces dizziness by affecting the brain’s balance centers and altering blood flow, which disrupts coordination and spatial awareness.
- Insomnia: Insomnia is the difficulty in falling or staying asleep. Tramadol addiction leads to insomnia by interfering with normal sleep patterns and disrupting the brain’s ability to regulate sleep cycles. According to Bhoora, U.’s 2022 study, ‘Managing acute opioid withdrawal with tramadol during COVID-19 lockdown in a peri-urban setting.’, a majority of participants (n = 47, 81%) reported experiencing at least one side effect related to tramadol use, with 37 individuals (64%) encountering two or more side effects. The most frequently reported side effect was insomnia, affecting 45% of participants, followed by dizziness at 41%, nausea at 31%, and sweating at 29%.
- Nausea: Nausea is the sensation of needing to vomit. Tramadol disrupts gastrointestinal function and affects the brain’s nausea centers, resulting in feelings of sickness.
- Impaired coordination: Impaired coordination involves difficulty controlling body movements. Tramadol affects neurotransmitters in the brain, hindering motor skills and balance.
According to Mahdi, S.’s 2018 study, ‘Cognitive Profile in Tramadol Addicts.’, tramadol usage significantly impairs cognitive function, with 53.33% of active users and 46.67% of abstinent users showing impairment, compared to just 10% in the control group. The main cognitive domains affected are memory (delayed recall) and verbal fluency, with these impairments persisting even after 3-6 months of abstinence.
- Changes in appetite: Changes in appetite involve fluctuations in the desire to eat. Tramadol alters brain chemistry and hormonal balance, impacting hunger signals and leading to increased or decreased appetite.
- Fluctuations in weight: Fluctuations in weight refer to significant changes in body mass. These changes occur due to altered eating habits and metabolism from tramadol’s effects on appetite and energy levels.
- Deteriorating physical appearance: Deteriorating physical appearance includes visible signs of neglect or health decline. Tramadol addiction leads to poor self-care, nutritional deficiencies, and overall health deterioration, contributing to a decline in physical appearance.
Intense Cravings and Loss of Control
Tramadol addiction develops intense cravings for the drug, accompanied by a compelling urge to use it despite negative consequences. As addiction progresses, individuals lose control over tramadol usage, resulting in unsuccessful attempts to reduce dosage or discontinue medication.
Seeking Multiple Prescriptions (Doctor Shopping)
As tramadol addiction escalates, individuals mostly resort to deceptive practices to obtain multiple tramadol prescriptions from different healthcare providers. This behavior, known as “doctor shopping,” is a clear indication of addiction.
According to Chenaf, C.’s 2016 study, ‘Incidence of tramadol shopping behavior in a retrospective cohort of chronic non-cancer pain patients in France.’, among 3,505 chronic non-cancer pain patients (66.4% women, mean age 66.4 years) who were treated with tramadol for a median duration of 260 days, the 1-year incidence rate of tramadol shopping behavior was 1.0%. The behavior, defined as having overlapping prescriptions from multiple prescribers filled at three or more pharmacies, was more prevalent among patients under 40 years of age, those with low-income status, and individuals who had previously used strong opioids.
How is Tramadol Addiction Caused?
The causes of Tramadol addiction are multifaceted, influenced by various factors, including genetic predisposition, environmental influences, and psychological elements.
The causes of tramadol addiction are detailed below:
Opioid Receptor Agonism
Tramadol is structurally similar to opioids and acts as an agonist at the mu-opioid receptors in the brain. This mechanism is responsible for its pain-relieving effects but also contributes to its potential for addiction. The activation of these receptors leads to feelings of euphoria, which encourages misuse.
According to Gong, L.’s 2014 study, ‘PharmGKB summary: tramadol pathway.’, tramadol exerts its analgesic effects by binding to μ-opioid receptors in the brain and inhibiting the reuptake of serotonin and norepinephrine. Its metabolism produces O‑desmethyltramadol, which exhibits high receptor affinity and alters neural pain transmission. Genetic variations in metabolizing enzymes determine plasma levels of tramadol and its metabolites, influencing its efficacy and safety.
Dosage and Duration of Use
Higher doses and prolonged use significantly increase the risk of developing dependence. Individuals who misuse tramadol do so at elevated doses over extended periods. According to El-Hadidy, M. A.,’s 2015 study, ‘Medical and Psychiatric Effects of Long-Term Dependence on High Dose of tramadol’, tramadol dependence was examined at doses exceeding 675 mg/day (taken as 3+ tablets of 225 mg) for a minimum duration of 5 years, with follow-up assessments conducted 3 months post-treatment.
Genetic Predisposition
Research suggests that genetic variations amplify susceptibility to the addictive properties of tramadol. Certain individuals inherit genetic traits that increase their vulnerability to opioid dependence, including tramadol addiction. A study by Mistry, Chetna J. et al. 2014, “Genetics of Opioid Dependence: A Review of the Genetic Contribution to Opioid Dependence,” has identified specific genetic variants associated with an elevated risk of opioid dependence, underscoring the role of genetic factors in tramadol addiction.
Environmental Influences
Environmental factors also contribute significantly to the development of tramadol addiction. Access to tramadol, peer pressure, and societal norms regarding drug use influence individuals’ initiation and continued use of tramadol, potentially leading to addiction.
Psychological Factors
Psychological factors, such as stress, trauma, or co-occurring mental health disorders, increase the risk of developing tramadol addiction. A twin study by Meyers, Jacquelyn L. et al. 2013, “Genetic and Environmental Risk Factors for Adolescent-Onset Substance Use Disorders,” has indicated that both genetic and environmental factors play a role in drug abuse behavior, with psychological factors contributing to the complexity of addiction development.
What are the Effects of Tramadol Abuse?
The effects of tramadol abuse include both acute and long-term effects. Acute effects include respiratory depression, seizures, central nervous system suppression, and potential cardiopulmonary arrest. Long-term effects involve neurological disorders, liver damage, gastrointestinal issues, and psychiatric symptoms including hallucinations.
Here are the effects of tramadol abuse in detail below:
Acute Overdose Symptoms
An acute overdose of tramadol leads to life-threatening symptoms, including seizures, central nervous system suppression, coma, and respiratory depression. In the most severe cases, tramadol overdose results in cardiopulmonary arrest, which is the leading cause of death in overdose cases. The risk of lethality increases significantly when tramadol is combined with other substances.
Here are the key overdose symptoms of Tramadol abuse:
- Respiratory Depression: Tramadol triggers respiratory depression by dampening the brain signals that control breathing, potentially reducing oxygen levels critically. According to Park, S.’s 2024 study, ‘Risk Factors for Respiratory Depression Associated with Tramadol Based on the Global Pharmacovigilance Database (VigiBase).’, tramadol generated 140,721 reports with 1126 cases (0.8%) of acute central respiratory depression, 81.3% of which were classified as serious. Concomitant use of CYP2D6 inhibitors, opioids, benzodiazepines, and antidepressants increased the risk by 4.4 to 7 times, and pediatric patients showed a higher proportion of cases with an 8.6-fold higher mortality rate compared to non-acute central respiratory depression cases.
- Seizures: An overdose leads to seizures as tramadol disrupts normal neurotransmitter activity, increasing neural excitability. According to Mirakbari, S. M.’s 2024 study, ‘Pattern of Traumatic Injuries in Patients with Tramadol Poisoning: A Cross-Sectional Study in a Tertiary Care Hospital.’, seizures occurred in 66% of tramadol poisoning patients, with men showing significantly higher incidence (69.6% vs 46.8%). In a sample predominantly male (84.3%) with an average age of 24.66 years, trauma was reported in 23% of all cases, representing 35.4% of those who had seizures. The head and neck were the most common injury sites (55.1%), typically presenting as abrasions (55.9%). Notably, all trauma patients had experienced seizures, and these cases required longer hospital stays averaging 1.73 days.
- Central Nervous System Suppression: Overdosing on tramadol results in central nervous system suppression, where its depressant effects hinder brain function and responsiveness.
- Cardiopulmonary Arrest: In extreme cases, tramadol overdose causes cardiopulmonary arrest by critically impairing heart and lung function, marking the lethal outcome. According to Alizadeh Ghamsari, A.’s 2016 study, ‘Frequency of Electrocardiographic Abnormalities in Tramadol Poisoned Patients; a Brief Report.’, a study of 1402 tramadol-poisoned patients, tramadol toxicity produces multiple electrocardiographic abnormalities including sinus tachycardia in 33% of cases, prolonged QTc intervals in 18.4%, and right axis deviation in 24.2%. The study reports additional findings such as QRS widening, deep S waves in leads I and aVL, and rare presentations of Brugada patterns and sinus bradycardia. These results demonstrate that tramadol overdose affects cardiac conduction by blocking fast sodium and potassium channels.
- Increased Risk with Other Substances: When combined with other substances, tramadol’s depressive effects on the nervous and respiratory systems are amplified, significantly escalating the risk of fatal complications.
- Coma: An acute tramadol overdose causes coma by severely depressing the central nervous system, leading to a loss of consciousness.
Long-Term Neurological and Physiological Effects
Chronic abuse of tramadol is associated with severe symptoms of neurological disorders, such as central nervous system depression, seizures, serotonin syndrome, Alzheimer’s disease, and Parkinson’s disease. Prolonged usage of tramadol also causes liver damage, including acute liver failure, particularly in individuals with pre-existing liver conditions. Additionally, long-term tramadol use leads to a range of adverse effects, from gastrointestinal disturbances to psychiatric symptoms like hallucinations. It also exacerbates chronic pain conditions in some individuals.
Here are the key long-term neurological and physiological effects of tramadol abuse:
- Neurological Disorders: Chronic abuse of tramadol is linked to a variety of neurological issues. These include central nervous system depression, a heightened risk of seizures, and the potential development of serotonin syndrome. According to Raj, K.’s 2019 study, ‘Neurobehavioral Consequences Associated with Long Term Tramadol Utilization and Pathological Mechanisms.’, long-term tramadol use associated with neurobehavioral disorders including seizures, serotonin syndrome, Alzheimer’s disease, and Parkinson’s disease. Tramadol produces seizures by inhibiting nitric oxide and serotonin reuptake while interfering with GABA receptor activity, which elevates lipid peroxidation and free radical formation leading to neurotoxicity. Tramadol increases serotonin levels in a manner similar to SSRIs and inhibits GABAA receptors, thereby suppressing dopamine synthesis and release and contributing to motor abnormalities seen in Parkinson’s disease.
- Liver Damage: Prolonged tramadol usage impairs liver function and leads to acute liver failure, particularly in individuals with pre-existing liver conditions. According to Soleimanpour, H.’s 2016 study, ‘Opioid Drugs in Patients With Liver Disease: A Systematic Review.’, tramadol undergoes liver metabolism via CYP3A4 and CYP2D6; a 100 mg dose peaks in the blood within 2 hours, with 30% remaining unchanged and 60% excreted in urine as metabolites, and a half-life of 4 to 6 hours. In patients with liver failure, reduced enzyme activity leads to impaired conversion into active metabolites. A case report cites high doses causing acute fulminant liver necrosis in a 67-year-old male, while a dose of 50 mg every 12 hours proves effective and safe for patients with primary or metastatic liver cancer.
- Gastrointestinal Disturbances: Extended use of tramadol result in various gastrointestinal issues, including nausea, constipation, and other digestive disturbances.
- Psychiatric Symptoms: Long-term tramadol use is connected with psychiatric side effects, such as hallucinations and mood alterations, potentially exacerbating underlying mental health conditions. According to Sidana, A.’s 2019 study, ‘Tramadol withdrawal psychosis.’, tramadol withdrawal led to auditory hallucinations in a patient taking 250-500mg daily, with symptoms appearing within 48 hours of cessation and resolving completely after 2 weeks of abstinence without antipsychotic treatment.
- Exacerbation of Chronic Pain Conditions: In some cases, instead of providing relief, chronic tramadol use might worsen existing chronic pain conditions.
What are the Strategies for Treating Tramadol Addiction?
The strategies for treating tramadol addiction encompass comprehensive medical intervention, therapeutic support, and community-based recovery programs. From supervised detoxification with medical oversight to evidence-based behavioral therapies like CBT, to engaging in peer support networks, these approaches work together to support sustainable recovery.
Here are the key strategies for treating tramadol addiction below:
Medical Detox and Withdrawal Management
Detoxification is a crucial initial step in tramadol addiction treatment to safely remove the substance from the body and manage withdrawal symptoms. Medical detox involves supervised tramadol withdrawal management to alleviate symptoms such as anxiety, sweating, and difficulty sleeping. Medications are used during detox to ease tramadol withdrawal symptoms and manage drug cravings, reducing the risk of early relapse.
According to Mukau, L.’s 2022 study, ‘Buprenorphine for High-dose Tramadol Dependence: A Case Report of Successful Outpatient Treatment.’, buprenorphine treatment successfully managed high-dose tramadol dependence (5000-6000 mg daily) in an outpatient setting. Tramadol poses unique challenges due to its dual opioid and serotonin-norepinephrine reuptake inhibitor properties, making buprenorphine a viable option for reducing withdrawal symptoms and dependence. Buprenorphine, a partial opioid agonist, mitigates the risk of atypical withdrawal syndromes associated with tramadol cessation, offering a safer and more effective treatment pathway.
Therapy and Counseling Approaches
Therapy plays a vital role in tramadol drug addiction recovery, with cognitive-behavioral therapy (CBT) being particularly effective in addressing maladaptive thinking and behavior. Group counseling offers mutual support and a platform for sharing experiences, while family therapy addresses the impact of addiction on relationships and facilitates healing within the family unit.
According to Pugatch, M.’s 2014 study, ‘A group therapy program for opioid-dependent adolescents and their parents.’, a 13-week group therapy program for opioid-dependent adolescents demonstrated promising outcomes, with 86% attending three or more sessions and 52% reporting sustained abstinence from all substances during the program. These results indicate the potential effectiveness of structured group therapy in supporting recovery for adolescents with opioid use disorders.
Support Groups and Peer Networks
Involvement in support groups provides valuable peer support and coping strategies for individuals recovering from tramadol addiction. These groups offer a supportive environment for sharing experiences and insights, helping to prevent relapse and sustain sobriety. Aftercare programs and ongoing support serve as essential resources for individuals navigating the challenges of recovery from tramadol addiction and opioid addiction.
How to Prevent Tramadol Addiction?
To prevent tramadol addiction, individuals must adopt proactive measures and maintain a strong commitment to sobriety. Essential prevention strategies include:
- Proper Aftercare Planning: Develop a concise plan for ongoing support after treatment. This includes therapy and clear strategies for managing real-world challenges to prevent relapse.
- Avoiding Triggers: Identify and steer clear of people, places, or situations linked to past tramadol use. Reducing exposure to these triggers lowers cravings and supports recovery.
- Seeking Support from a Therapist or Support Group: Work with mental health professionals or join support groups for guidance. This provides personalized strategies, shared experiences, and reinforcement to stay sober.
- Developing Healthy Coping Mechanisms: Adopt positive ways to handle stress and emotions, such as exercise or meditation. These alternatives reduce reliance on tramadol and build resilience.
- Staying Accountable to a Recovery Plan: Stick to your structured recovery goals with regular check-ins. Consistent monitoring and support help catch early relapse signs and maintain sobriety.
These preventive measures help individuals avoid tramadol addiction relapse and maintain long-term recovery.
Peer networks play a vital role in preventing addiction by offering practical advice for managing cravings and avoiding triggers. Support groups strengthen prevention efforts by providing community support and accountability, which help individuals remember the consequences of substance abuse and stay committed to their recovery journey.
What Happens if You Take Tramadol Every Day?
Taking tramadol every day will damage your liver and kidneys, cause breathing difficulties, and increase your risk of developing serotonin syndrome. Daily tramadol use triggers neurological problems, including seizures, and contributes to conditions like Alzheimer’s and Parkinson’s disease.
According to Oh, S. N.’s 2024 study, ‘Tramadol use and incident dementia in older adults with musculoskeletal pain: a population-based retrospective cohort study.’, prolonged use of tramadol increases the risk of dementia and Alzheimer’s disease. Tramadol’s impact on serotonin and norepinephrine reuptake, combined with its opioid effects, could contribute to neurodegenerative pathways. Chronic exposure to tramadol correlates with cognitive decline and memory impairment, highlighting its potential long-term neurological consequences.
What Should You Not Mix With Tramadol?
You should not mix tramadol with medications and substances that slow down the brain, MAO inhibitors, or other serotonergic drugs to avoid serious and potentially fatal interactions. It is important to avoid combining tramadol with these substances to prevent harmful effects.
According to Spies, P. E.’s 2017 study, ‘Interaction between tramadol and selective serotonin reuptake inhibitors: are doctors aware of potential risks in their prescription practice?.’, combining tramadol with serotonergic drugs (SSRIs/SNRIs) can result in serotonin syndrome, characterized by neuromuscular excitation, autonomic nervous system excitation, and altered mental state. While the incidence is low and symptoms are usually mild to moderate, this interaction can be potentially life-threatening. The condition occurs through an additive effect as both drugs decrease serotonin reuptake, and treatment options include sedation, active cooling, and serotonin antagonists.
Are There Alternative Pain Management Options for Those at Risk of Tramadol Addiction?
Yes, there are alternative pain management options available for individuals who are at risk of or have a prior substance abuse history or other opioid painkillers. Non-opioid pain medications, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, acupuncture, chiropractic care, and cognitive-behavioral therapy (CBT) techniques for pain management are some alternatives that healthcare providers recommend.
In What Ways Do The Mechanisms Of Tramadol Addiction Compare And Contrast With Those Of Methamphetamine Addiction?
The mechanisms of tramadol addiction both compare and contrast with methamphetamine addiction in several significant ways. While tramadol addiction involves opioid receptor activation and dependence, methamphetamine addiction operates through stimulant effects on the central nervous system. The key contrast lies in their neurochemical actions – tramadol binds as an opioid agonist to specific receptor sites, whereas methamphetamine triggers the release of multiple neurotransmitters including dopamine, norepinephrine, and serotonin. However, these mechanisms compare in how they both hijack the brain’s reward pathways and lead to physical and psychological dependence through chronic use.
How Does Tramadol Addiction Intersect With Amphetamine Addiction, And What Nuanced Distinctions Exist Between The Two Addictive Patterns?
Tramadol addiction intersects with amphetamine addiction through their shared classification as addictive substances, while maintaining distinct patterns in how they affect individuals. The nuanced distinctions between these addictive patterns emerge primarily in their pharmacological mechanisms and bodily effects. Tramadol, functioning as an opioid pain reliever, and amphetamine addiction being tied to central nervous system stimulation, create fundamentally different dependency profiles. These distinctions manifest in varying withdrawal experiences and substance-specific risks. The treatment approaches necessarily differ due to these unique pharmacological characteristics, reflecting the complex interplay between these two forms of addiction. Each substance’s distinct pattern of addiction requires tailored intervention strategies, despite their shared potential for causing dependence.
What Are The Differences Between Tramadol And Valium?
The key differences between Tramadol and Valium are their medical uses, mechanisms of action, and side effects. Tramadol, an opioid pain reliever, treats moderate to severe pain, while Valium (diazepam) is a benzodiazepine that treats anxiety, muscle spasms, and seizures. These medications differ in how they work: Tramadol alters pain perception in the brain, whereas Valium works by enhancing GABA neurotransmitter effects for relaxation. Comparing their side effects, Tramadol typically causes dizziness and nausea, while Valium causes sedation and leads to withdrawal symptoms. Both medications differ in their risk profiles but share the potential for dependence, requiring careful medical supervision and proper prescription. Medical consultation is essential to determine which medication is appropriate for specific conditions.
Can Tramadol Cause Insomnia?
Yes, Tramadol causes insomnia and sleep disturbances.
According to Walder, B.’s 2001 study, ‘The effects of two single doses of tramadol on sleep: a randomized, cross-over trial in healthy volunteers.’, tramadol significantly disturbs sleep patterns, with both 50mg and 100mg doses increasing stage 2 sleep while reducing slow-wave sleep (stage 4). The higher dose of 100mg showed more severe effects by additionally decreasing REM sleep and causing sleep disturbances that persisted into the following night, even after the drug was no longer being administered.
