Tramadol (Ultram) Pain Reliever for Back Pain

Tramadol is a type of narcotic pain reliever often prescribed for moderate or moderately severe pain in adults. It is a synthetic analog of codeine with less potential for abuse than other opioid agonists, and works in the brain to alter the body’s response to pain.

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Tramadol is available as a generic, but is often best known by its brand names, including Ultram, Ultram ER (extended release), ConZip, EnovaRX (tramadol), and Synapryn FusePaq. In addition to pain relief, tramadol can create a feeling of well-being. While it is classified as a narcotic (also called an opioid) by the U.S. Food and Drug Administration, it is often described as narcotic-like because it is a synthetic drug with a slightly different chemical structure than other narcotics.

Tramadol is generally advised for just one or two weeks’ use, to reduce the risk of dependency. Also, the body develops a tolerance for tramadol quickly, making the dose less effective over time. The doctor may suggest a longer interval between doses for those older than 75.

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Like all medications, tramadol has potential risks as well as benefits. This article discusses both the benefits and drawbacks of tramadol.

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How Tramadol Is Used

Tramadol is available in a variety of forms and strengths. Examples of tramadol formulations include:

    Immediate-release form of tramadol (Ultram). This form of tramadol is available as a tablet and typically is prescribed to be taken every 4 to 6 hours as needed. It is used for back pain, sciatica, and for postoperative pain following spine surgery. The immediate-release form works well for people who do not need 24-hour pain relief.

    See Getting Adequate Pain Control After Back Surgery

    Extended-release tramadol (Ultram ER, ConZip). Extended-release (ER) forms of tramadol are available as tablets and capsules that contain more medication than the regular dose. The medication is formulated to be released in the body gradually over a 24-hour period and should be taken once a day. (ConZip, however, also includes immediate-release medication.) These formulas are designed to help individuals with chronic pain, and can potentially help stay ahead of the pain (before it becomes too intense) and promote sounder sleep. The extended-release medication cannot be split or crushed, as that could cause a dangerously strong amount of medication to be taken all at once. While the maximum dose of the extended-release formulations is 300 mg per day, dosages may need to be decreased for those with renal or hepatic impairment.

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    Tramadol oral suspension (Synapryn FusePaq). Tramadol is available as an oral suspension, which can be helpful for adults who have difficulty swallowing. The medication is typically given 3 to 4 times a day.

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As a general rule, when prescribed for back pain, doctors will typically start with a low dose of tramadol, such 25 mg per day, and may increase the dose slowly and as needed for pain relief. For most adults, the maximum safe dose is 400 mg per day of the immediate-release tablets.

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As with all medications, there are several unique potential risks and complications associated with tramadol that are important to know about. These are detailed on the next page.