Tramadol 50 mg
Tramadol is used to treat moderate to severe pain.
The extended-release form of tramadol is for around-the-clock treatment of pain. This form of tramadol is not for use on an as-needed basis for pain.
Tramadol may also be used for purposes not listed in this medication guide.
You should not take tramadol if you have used alcohol, sedatives, tranquilizers, or narcotic medications within the past few hours.
Tramadol can slow or stop your breathing, especially when you start using this medicine or whenever your dose is changed. Never take tramadol in larger amounts, or for longer than prescribed. Do not crush, break, or open an extended-release pill. Swallow it whole to avoid exposure to a potentially fatal dose.
ULTRAM® (tramadol hydrochloride) tablets is a centrally acting analgesic. The chemical name for tramadol hydrochloride is (±)cis-2-[(dimethylamino)methyl]-1-(3methoxyphenyl) cyclohexanol hydrochloride. Its structural formula is:
Chronic Pain Relief: Medicines - Treatments
Chronic Pain - Treatment Overview
What Is Pain?
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The onset of pain is a symptom of illness or injury in the part of the body that is experiencing the pain. The sudden onset of pain is calledacute pain. Acute pain gets a person's attention and prompts him or her to take action to prevent further worsening of the condition causing the pain. This could be a simple action such as the reflex that makes a person jerk their hand off a hot stove, or it could be more complex such as cooling, resting, or elevating an injured ankle. Moreover, the pain could prompt the person to see a doctor. Chronic pain is pain that persists over time (6 months or longer) and typically results from long-standing (chronic) medical conditions or damage to the body.
Pain interrupts our work, our recreation, and our relationships with our families. Comfort, that is, not being in pain, is one of the goals if a person becomes sick, and treatment by a health care professional for an illness associated with chronic pain is another goal.
Once the cause of the pain is found and proper treatment is started, the pain may serve the useful function of keeping the affected individual at rest so that the injury or illness can heal. But if the pain is from an illness that is incurable and will never heal, the pain loses its usefulness and becomes harmful. This type of pain keeps a person from normal activity, and inactivity decreases strength.
Treating chronic pain can be challenging. And it may take several types or combinations of treatments before you find relief.
Be sure to seek treatment if your pain lasts longer than 2 to 3 months. Early treatment may prevent the pain from getting worse.
The goals of treatment are to reduce your pain and increase your ability to function. This includes improving your sleep and your coping skills and reducing stress so you can return to your regular activities.
It's important to build a clear treatment plan with your doctor. Part of this plan includes identifying ways for you to manage your pain. Only you know the severity of your pain and how it affects your life. Be sure to ask your doctor if you are not clear about what steps you can take when pain occurs or gets worse.
Chronic pain treatments
You may be able to control your pain at home by using pain relievers and practicing healthy habits. For more information, see Home Treatment.
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When home treatment isn't enough, other treatments may include:
Pain medicines or medicines to treat problems that are linked to chronic pain. For more information, see Medications.
Treatments such as counseling, physical therapy, and complementary therapies. For more information, see Other Treatment.
Surgery, such as intrathecal drug delivery and spinal cord stimulation. For more information, see Surgery.
If your chronic pain is not relieved after you have tried numerous treatments, you may want to think about going to a pain management clinic. Treatment is provided by a team of doctors who work together to address all the things that may cause your chronic pain.
Chronic Pain - Symptoms
Chronic Pain Guide
What Increases Your Risk
When To Call a Doctor
Exams and Tests
Other Places To Get Help
The symptoms of chronic pain include:
Pain that does not go away as expected after an illness or injury.
Pain that may be described as shooting, burning, aching, or electrical.
Discomfort, soreness, tightness, or stiffness.
Pain can lead to other problems, such as:
Fatigue, which can cause impatience and a loss of motivation.
Sleeplessness, often because the pain keeps you awake during the night.
Withdrawal from activity and an increased need to rest.
A weakened immune system, leading to frequent infections or illness.
Depression, which is common and can make your pain worse.
Other mood changes, such as hopelessness, fear, irritability, anxiety, and stress.
Disability, which may include not being able to go to work or school or perform other daily activities.
Chronic Pain - Medications
Medicines can often help control chronic pain. In some cases, it may take several weeks for the medicine to work.
Medicine may work best when it's used along with other types of treatment, such as physical therapy and counseling, to address the different causes of chronic pain.
Sometimes a medicine loses some or all of its ability to work when it is used daily over a long period of time. This is because your body develops a tolerance to it. If this happens, you may need to take more of the medicine, change medicines, or add another medicine. Your doctor can work with you to do this.
Pills for pain
You will likely start with medicines that cause the fewest side effects (such as acetaminophen). The dose will be increased or the medicines will be changed as needed. Be safe with medicines. Read and follow all instructions on the label.
AcetaminophenAcetaminophen, such as Tylenol.
Nonsteroidal anti-inflammatory drugs (NSAIDs)Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, for example), and naproxen (Aleve, for example).
Tricyclic antidepressantsTricyclic antidepressants, such as amitriptyline.
Serotonin and norepinephrine reuptake inhibitors (SNRIs)Serotonin and norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta).
CorticosteroidsCorticosteroids, such as prednisone.
AnticonvulsantsAnticonvulsants, such as gabapentin (Neurontin) and pregabalin (Lyrica).
Opiate pain relieversOpiate pain relievers, such as hydrocodone (for example, Vicodin). These may be used when other medicines do not help.
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Medicines you put on your skin
A variety of creams, gels, sprays, and patches may be used to relieve chronic pain, including:
Topical analgesics. These are pain relievers that are applied directly to the skin, such as EMLA cream or a lidocaine patch (Lidoderm). Some creams or gels can be made at the pharmacy according to your doctor's directions. Some may contain capsaicin, a naturally occurring substance found in chili peppers.
Cooling spray. This involves using a cooling spray (such as Biofreeze) directly on the skin. This may be repeated several times.
Injected medicines—shots—may be used to treat chronic pain, including:
Epidural steroid injections (injecting steroids around the spine). Although these injections have been used for many years and may provide relief for low back or neck pain caused by disc disease or pinched nerves, they may not work for everyone.
Joint block injections. A corticosteroid is injected into the painful joint or joints.
Nerve block injections. An anesthetic is injected into the affected nerve to relieve pain. The anesthetic may relieve pain for several days, but the pain often returns. Although nerve blocks do not normally cure chronic pain, they may allow you to begin physical therapy and improve your range of motion.
Trigger point injections. These may relieve pain by injecting a local anesthetic into trigger points (or specific tender areas) linked to chronic myofascial pain or fibromyalgia. These injections do not relieve chronic pain in everyone.
Chronic pain is often defined as any pain lasting more than 12 weeks. Whereas acute pain is a normal sensation that alerts us to possible injury, chronic pain is very different. Chronic pain persists—often for months or even longer.
Chronic pain may arise from an initial injury, such as a back sprain, or there may be an ongoing cause, such as illness. However, there may also be no clear cause. Other health problems, such as fatigue, sleep disturbance, decreased appetite, and mood changes, often accompany chronic pain. Chronic pain may limit a person’s movements, which can reduce flexibility, strength, and stamina. This difficulty in carrying out important and enjoyable activities can lead to disability and despair.
Pain is a very personal and subjective experience. There is no test that can measure and locate pain with precision. So, health professionals rely on the patient’s own description of the type, timing, and location of pain. Defining pain as sharp or dull, constant or on-and-off, or burning or aching may give the best clues to the cause of the pain. These descriptions are part of what is called the pain history, taken during the start of the evaluation of a patient with pain.
Since chronic pain may occur in a variety of locations in the body and for many different reasons, patients and their health professionals need to work together to identify the causes and symptoms of that pain and how it can be relieved.
Although technology can help health professionals form a diagnosis, the best treatment plans are tailored to the person, with input from healthcare team members, who each have different training backgrounds and understand chronic pain. The person with pain and his or her loved ones also must be actively involved in the treatment.
With chronic pain, the goal of treatment is to reduce pain and improve function, so the person can resume day-to-day activities. Patients and their healthcare providers have a number of options for the treatment of pain. Some are more effective than others. Whatever the treatment plan, it is important to remember that chronic pain usually cannot be cured, but it can be managed. The following treatments are among the most common ways to manage pain.
Medications, acupuncture, electrical stimulation, nerve blocks, or surgery are some treatments used for chronic pain. Less invasive psychotherapy, relaxation therapies, biofeedback, and behavior modification may also be used to treat chronic pain. These methods can be powerful and effective in some people. When it comes to chronic pain treatment, many people find adding complementary or alternative medicine (CAM) approaches can provide additional relief. These may include tai chi, acupuncture, meditation, massage therapies, and similar treatments.
Self-management of chronic pain holds great promise as a treatment approach. In self-management programs, the individual patient becomes an active participant in his or her pain treatment—engaging in problem-solving, pacing, decision-making, and taking actions to manage their pain. Although self-management programs can differ, they have some common features. Their approach is that the person living with pain needs help learning to think, feel, and do better, despite the persistence of pain. Improving communication with the healthcare provider is part of that empowerment.
Through NIH-supported research, starting successful self-management programs has reduced many barriers to effective pain management, regardless of the underlying conditions. Individuals who participate in these programs have significantly increased their ability to cope with pain. They improve their ability to be active, healthy, and involved members of their communities. In fact, new research suggests that the best self-management programs teach people different ways of thinking about and responding to pain, making their actions to relieve it more effective.
Common sources of chronic pain include injuries, headaches, backaches, joint pains due to an arthritis condition, sinus pain, tendinitis, or overuse injuries such as carpal tunnel syndrome. Chronic pain is also a feature of many types of advanced cancers.A number of symptoms can accompany chronic pain and can even arise as a direct result of the pain. These can include insomnia or poor quality sleep, irritability, depression and mood changes, anxiety, fatigue, and loss of interest in daily activities. Pain can trigger muscle spasms that can lead to soreness or stiffness.
Why pain can become worse: There is a "wind-up phenomenon" that causes untreated pain to get worse. Nerve fibers transmitting the painful impulses to the brain become "trained" to deliver pain signals better. Just like muscles become stronger for sports with training, the nerves become more effective at sending pain signals to the brain. The intensity of the signals increases over and above what is needed to get the affected person's attention. To make matters even worse, the brain becomes more sensitive to the pain. So the pain feels much worse even though the injury or illness is not worsening. At this point, pain may be termed chronic pain. And it is no longer helpful as a signal of illness.
The goal in treating pain: When a doctor is consulted, the goal for both patient and the doctor is to no longer have chronic pain. The patient wants the cause of their pain to be found and cured so that he or she can resume normal life without needing medication or further visits to health care professionals.
Treating lifelong pain: Unfortunately, many illnesses do not have known cures. The treatment of illnesses such as diabetes and high blood pressure is often lifelong. In these chronic illnesses, as in the treatment of chronic pain, the person's goal is to live as normally as possible. Sometimes medication is needed for the rest of a person's life in order to achieve that goal.
A sensible view of addiction: Chronic pain is no different from diabetes or high blood pressure. If a person needs to be on pain medicine for the rest of his or her life, they should not be said to be "addicted" to pain medicine any more than a person with diabetes who needs to be on insulin for the rest of his or her life should be said to be "addicted" to insulin.
Nonsteroidal Anti-inflammatory Drugs
The most common nonsteroidal anti-inflammatory drug (NSAID) for pain is ibuprofen. Three NSAIDs are available without a prescription in drug and grocery stores:
Bayer Buffered Aspirin
Bayer Low Adult Strength
St Joseph Adult Chewable Aspirin
Essentially, aspirin and ibuprofen are short-acting, while the effects of naproxen last longer. This difference means sometimes it takes three to four doses of naproxen before an effect is noted. Because of this difference, it may be better to use ibuprofen for more immediate relief from pain and to use naproxen for long-lasting relief.
Many NSAID medications are available only with a prescription. These include:
diclofenac sodium (Voltaren, Voltaren-XR, Cataflam)
indomethacin (Indocin, Indocin-SR)
mefenamic acid (Ponstel)
This class of drugs is one of the most marketed types of medications by drug companies. No clear evidence exists that the prescribed medicines cost more are any better than those that cost less.
Different NSAIDs also are marketed as being better for certain conditions. An example is indomethacin (Indocin) as a recommended treatment for gout. There is no proof this is true, but some evidence shows that different families of NSAIDs may have a selective effect on a person-to-person basis.
The main side effect of these types of medicines is that they can cause bleeding and irritation in the stomach. This bleeding usually occurs after long-term use but can also occur with short-term use. Long-term use can also affect the kidneys, (for these reasons, acetaminophen is probably safer for long-term use, although taking too much acetaminophen can cause liver damage).
NSAIDs have both a pain-relieving and inflammation-stopping effect. Generally, the pain-relieving effect does not increase with higher doses; thus, 400 mg of Motrin has just as much pain relief as 800 mg of Motrin. A person is more likely to suffer a significant stomach problem with the higher dose.
Consult a doctor if a person taking NSAIDs experiences pain in the stomach, has black stools, or has blood in the stool.