Tramadol (Ultram) is an atypical opioid drug that is primarily utilized to help people manage moderate or severe pain. It is considered an “atypical” opioid due to the fact that it also prevents the reuptake of the neurotransmitters serotonin and norepinephrine. It also has a very minor effect as a mu-opioid receptor agonist. This is a drug that works very well to help individuals ongoing moderate pain.
For chronic severe pain this drug is less effective than morphine, but in cases of moderate pain, it is considered equally effective. Individuals who take Tramadol will likely notice that it provides significant relief from pain sensations within an hour of ingestion. The drug itself doesn’t really have a purpose other than to provide people with relief from pain. It is used by people struggling with pain associated with fibromyalgia if that pain becomes severe enough to warrant an opioid.
When compared to morphine, the dosing of Tramadol is approximately 10% of the potency, therefore it also works well to help manage acute opioid withdrawal symptoms. There are people who use this drug recreationally to “get high,” but most people who use it are doing so because it helps with pain management. It is currently being investigated as to whether it helps treat depression, diabetic neuropathy, obsessive-compulsive disorder, post-traumatic stress disorder (PTSD), and premature ejaculation.
Factors that influence Tramadol withdrawal
There are many factors that play a role in determining the severity of opiate withdrawal symptoms. Things that will influence the intensity of your withdrawal include: time span over which you took the drug, your dosage, whether you have become dependent on the drug, how quickly you taper, as well as other individual factors.
1. Time Span
How long were you on Tramadol? If you were on this drug daily for many years and are looking to quit, you are likely going to have much more severe withdrawal symptoms compared to someone who took this drug for a couple months and/or shorter duration. Additionally if you took the drug “off and on” as opposed to every day, you should have an easier time with the withdrawal because you have given your body “breaks” from being under the influence of the drug. In general, the longer the span of time over which you took this drug, the tougher the withdrawal process.
2. Dosage (50 mg to 100 mg)
What dosage did you take? If you were on a high dosage, the process of withdrawing takes much longer than someone on a lower dose. Higher doses taken over an extended period of time result in your body building up a greater tolerance to the drug. The recommended daily dose of Tramadol is between 50 mg and 100 mg.
However, many people end up building up tolerance to the 100 mg and/or require a greater dose to treat their pain. The maximum recommended daily dose is 400 mg, however some people end up taking more with doctor supervision. There have been reported cases of people taking between 1000 mg and 2000 mg as a result of long term use and tolerance.
3. Tolerance / Dependency / Addiction
People that have been taking Tramadol for an extended period of time may develop tolerance to the drug. When tolerance develops, people usually increase the amount of the drug that they take so that they receive the same relief for pain management. Some people end up developing a major tolerance and actually become dependent on the drug for functioning.
Those who become dependent may have a very difficult time withdrawing from the drug or even decreasing the dosage. The fact that this drug does provide pain relief and individuals can develop a tolerance, it is possible to become addicted to Tramadol. Fortunately the addiction potential of Tramadol is significantly less than that of other opioids.
4. Cold turkey vs. Tapering
How did you quit taking Tramadol? Did you come off of the drug “cold turkey” or did you conduct a gradual taper? In most cases, it is highly recommended to taper off of any opiate due to the fact that cold turkey withdrawal can be dangerous. Many people have had success quitting cold turkey, but the symptoms may be significantly more severe than if a gradual taper is conducted.
Most people that have experienced Tramadol withdrawal “cold turkey” advise to conduct a taper. The rule of thumb that many users live by is that the tapering period should last 1/4 the total duration of the time you took the drug. So if you took the drug for 4 years, your tapering period should last one full year. You should also work with a professional to determine the increments by which you decrease your dosing.
5. Individual Factors
It is also important to understand that since everyone is unique, individual factors can influence withdrawal time and severity of symptoms. Certain people barely experience any sort of withdrawal when they come off of Tramadol, while others may experience very difficult symptoms that persist for weeks following their last dose.
Individual factors include things like: physiology, environment, social support, whether you are taking other drugs and/or supplements, etc. Keep in mind that some people are also more sensitive and/or aware to the physical and mental sensations that they experience during withdrawal.
Tramadol Withdrawal Symptoms: List of Possibilities
Below is a list of possible symptoms that you may experience when you discontinue Tramadol. Understand that not everyone will experience every last symptom on the list. You may experience one or two symptoms or an array of them. Realize that your withdrawal symptoms will be unique to you and may not necessarily echo what others experience.
- Abdominal cramps: One of the most common symptoms associated with Tramadol withdrawal is abdominal cramping. If you feel abdominal pain and as if you have an eternal stomach ache, it is just your body reacting to no longer receiving the drug.
- Anxiety: Most opioid drugs tend to help people stay calm and reduce anxiety. This drug can further reduce anxiety with its affect on serotonin levels. When a person withdraws, the individual is no longer getting the endorphin stimulation from the drug and the same effect on serotonin levels. The withdrawal can make people feel significantly more anxious than before they started the drug.
- Brain zaps: When withdrawing from higher doses and/or when withdrawing “cold turkey” many people experience electrical-shock sensations throughout their brain. These are most commonly experienced during antidepressant withdrawal. Since Tramadol affects serotonin, it is thought that serotonin levels readjusting leads to “zapping” sensations.
- Cravings: Some people have a very difficult time quitting this particular drug. Although it is less addicting than other opiates, many people still end up having cravings during their withdrawal. As time continues to pass and you stay sober, these cravings tend to gradually subside.
- Dilated pupils: Opiates tend to result in pupil constriction. When you come off of these drugs, your pupils will likely dilate and look pretty huge. This is merely something that you may notice when you look in the mirror.
- Depression: Since Tramadol affects the neurotransmitters serotonin and norepinephrine, it may lead some people to feel happier. It is being investigated as an antidepressant and many people find that it works great at alleviating depression. When quitting this drug, not only are endorphin levels low, but serotonin and norepinephrine levels may also be low – leading people to feel depressed.
- Diarrhea: It is well known that taking opioid drugs can lead to significant constipation. When you quit taking the drug and your bowel functioning changes, most people first experience diarrhea. This may be somewhat difficult to deal with and especially uncomfortable. The best way to manage this is by taking some over-the-counter Imodium.
- Dizziness: Among the most common of all withdrawal symptoms is that of feeling dizzy. Some people report feeling so dizzy that they cannot do any sort of physical activity. If you feel especially dizzy at times, make sure that you take the time to get proper rest. Understand that this is a reaction you are having to the withdrawal.
- Fatigue: Many people feel intense fatigue when they quit this drug. It may be difficult to get out of bed in the morning and/or do much of anything. Your energy levels should gradually pick back up within a few weeks.
- Goose bumps: Another common thing to experience is “goose bumps” across your entire body. These are little bumps and tingling sensations that may be powerful during the initial couple weeks of withdrawal.
- Headaches: Some people report having very painful headaches during withdrawal. If you are experiencing intense headaches, consider some sort of headache relief. Make sure that you are drinking plenty of water, getting adequate sleep, and relaxing your facial muscles.
- Insomnia: Although you may feel excessively tired at some points during withdrawal, you may also struggle with insomnia. This can be a result of increases in anxiety and stress, but may also be due to the fact that your neurotransmitters are out of balance.
- Mood swings: During withdrawal your moods may be difficult to control. You may feel somewhat normal one minute, then super depressed the next.
- Muscle cramps: As mentioned earlier, it is very common to experience abdominal cramping. However, some people experience cramps throughout all of their muscles. If you find yourself cramping up easily, just know that its normal.
- Nausea: The nausea can be overwhelming at times when you initially quit the drug. It may lead you to vomit, but in most cases it will just be very uncomfortable. Try to weather the storm and realize that this will improve.
- Pain: If you were being treated for pain, you may notice that the pain reemerges when you stop taking Tramadol. This pain may be more severe than before you went on the drug. It should eventually improve as a result of your body building up its natural endorphin levels. With that said, be sure to work with a doctor to treat your pain if it is unbearable.
- Panic attacks: If you experience intense anxiety during withdrawal, this could lead to a panic attack. It is the adjustment in neurotransmitter levels that can take some time and make people prone to panic. To decrease feelings of panic, take the time to consciously relax when you feel stressed.
- Restlessness: You may notice that you feel increasingly restless in the weeks following your last dose. If you feel especially restless, try to do something productive like clean up around the house or go for a walk.
- Sleep problems: You may notice that your sleep changes significantly compared to when you took the drug. It may be difficult to stay relaxed and fall asleep or you may notice yourself sleeping too much. Most people end up sleeping heavily at times during withdrawal and at other times notice that they cannot fall asleep at all due to insomnia.
- Suicidal thoughts: During withdrawal it is very common to feel intense depression – especially in the first few weeks following your last dose. In some cases this leads people to experiencing suicidal thinking, which can be difficult to deal with. Take the time to realize that this is simply a result of withdrawal and things will improve as you heal. If you are unable to realize that these thoughts are merely a phase of withdrawal, be sure to seek professional help from a therapist.
- Sweating: If you sweat profusely during withdrawal, just know that you are not alone. Many people end up experiencing intense sweating throughout the day and during their sleep at night. If you feel like a walking puddle, just know that it’s a symptom of withdrawal that will improve in time.
- Tremors: Many people report that they shake uncontrollably when they initially quit this drug. These tremors may be more severe if you quit cold turkey from a substantial dosage, but they can occur even if you taper properly.
- Vomiting: In some cases people actually experience flu-like symptoms and get sick. This may lead a person to vomit within days after taking their last dose. Typically vomiting won’t last more than several days after discontinuation.
Note: Most evidence points to the fact that people experience seizures while on this drug. Although many people are curious about whether withdrawal can cause seizures, it should be noted that this is a pretty unlikely experience during withdrawal. It should also be noted that in rare cases, people can hallucinate during the withdrawal process as well.
Tramadol Withdrawal Duration: How long will it last?
Most individuals report that the bulk of their withdrawal from Tramadol lasts anywhere from 10 days to a few weeks. However, it is important to understand that many people also experience what is known as post acute withdrawal syndrome (PAWS). These “post-acute” symptoms occur long after the drug is out of the body and most of these effects are a result of the body trying to reset itself back to homeostatic functioning.
Understand that what you experience during withdrawal will be largely influenced by the factors listed above including: time span, dosage, dependency, individual physiology, as well as how quickly you tapered. If you do not conduct a gradual taper, you may experience very severe withdrawal symptoms compared to someone who tapered slowly over a long period of time. It is important to understand that Tramadol stays in your system for less than 2 days after stopping (on average), and most people feel better several weeks after cessation.
If your withdrawal symptoms are too severe to cope with, you may want to work with a professional. You may want to take the time to visit a therapist who specializes in drug withdrawal and/or consider consulting a doctor. A doctor may be able to prescribe a drug like Clonidine to help take the edge off and reduce your anxiety, insomnia, and unnecessary stress that you may be experiencing. During withdrawal, do your best to get plenty of rest, get proper vitamins and nutrients, eat a healthy diet, and consider some very light exercise (e.g. walking).
Tramadol affects opioid receptors that manage pain as well as neurotransmitters that affect mood. Some people swear that this is the toughest drug that they have ever withdrawn from. If you have successfully withdrawn from Tramadol or are in the process of withdrawing, feel free to share your experience in the comments section below.