Tramadol (Ultram) versus ...

Compared with NSAIDs, Tramadol does not aggravate hypertension or congestive heart failure, nor does it have the potential to cause peptic ulcers.

Compared with opioid analgesics, Tramadol does not induce significant respiratory depression, cardiac side effects, constipation, or have significant abuse potential.


Tramadol vs. Buprenorphine (Subutex®)

Buprenorphine is a very potent, but partial, mu agonist with an analgesic potency between 25- and 40-fold that of morphine.

Postoperative analgesia

Buprenorphine appears to produce more potent and longer acting analgesic effect compared to tramadol, although slightly delayed 14.

Buprenorphine provides a longer postoperative analgesia than tramadol 2.

Tramadol vs. Pentazocine (Talwin®)

Pentazocine, a benzomorphan derivative, is a mixed agonist-antagonist opioid analgesic, and acts as an agonist on kappa receptors and is a weak antagonist at mu and delta receptors. Pentazocine is one-sixth to one-third as potent as morphine. Oral pentazocine is closer in analgesic efficacy to aspirin and acetaminophen than to the weak opioid analgesics such as codeine 1.

Postoperative pain

In clinical trial the first dose of tramadol was significantly more effective than pentazocine after the first hour and throughout the subsequent 5 h. Final judgments on efficacy and acceptability were in favor of tramadol 4.

Postoperative pain following prolapsed intervertebral disc repair

Results of the comparative study showed both treatments provide equivalent analgesia for the six hours observation period. The global assessment of analgesia by patient and observer was not significantly different, although less additional analgesic was required in the pentazocine group. Side effects were quite common in both groups, and occurred more frequently in the pentazocine group 3.

Acute pain

Tramadol (50 mg) has shown to have an analgesic effect about equal to that of the pentazocine (50 mg). The incidence of side effects with tramadol appears to be less than that with the pentazocine 3.

Tramadol vs. Diclofenac sodium

Acute migraine attacks

The randomised, double-blind study compared the efficacy of intramuscular tramadol 100 mg with intramuscular diclofenac sodium 75 mg in acute migraine attacks 15.

Two-hour pain response rate was 80% for both tramadol and diclofenac groups. There were no statistically significant differences among groups in terms of 48-h pain response, rescue treatment, associated symptoms' response, headache recurrence and adverse event rates. Fifteen (75%) patients in the tramadol group and 16 (80%) patients in the diclofenac group stated that they may prefer the same drug for future admissions 15.

Posttonsillectomy analgesia

Oral tramadol provides the same analgesic efficacy as oral diclofenac for posttonsillectomy pain relief. Tramadol is beneficial for patients in whom NSAIDs are contraindicated 11.

Osteoarthritis chronic pain
Tramadol controlled-release is as effective as diclofenac sustained-release in the treatment of pain due to knee or hip osteoarthritis12.

Tramadol has been associated with a higher incidence of nausea, whereas diclofenac has been associated with a high rate of abdominal pain.

Side effects and tolerability

Unlike diclofenac, tramadol does not irritate the gastrointestinal mucosa. On the other hand, tramadol may produce physical dependence during chronic use.

Tramadol vs. Lornoxicam

Post-tonsillectomy pain

Preoperatively administered intravenously lornoxicam is more effective than tramadol with respect to early postoperative tonsillectomy pain in adult patients19.

Postoperative pain

Results of randomized double-blind study comparing lornoxicam versus tramadol in postoperative pain 16. Tramadol Lornoxicam
100 mg intramuscularly
16 mg intramuscularly
Pain relief the following 8 hours after injection
significantly greater
Analgesic efficacy in patients with moderate baseline pain
Analgesic efficacy in patients with severe/unbearable baseline pain
Rescue medication requirement
Conclusion: Patients' global impression of efficacy favored lornoxicam. Intramuscular lornoxicam is an effective alternative to tramadol for the treatment of moderate to severe postoperative pain.

Tramadol vs. Metamizole

A randomized double-blind design on 10 volunteers compared tramadol (50 and 100 mg orally) and metamizole (500 and 1,000 mg orally).

Constant painful stimuli were applied by controlled electrical stimulation of tooth pulp. Analgesia was monitored by verbal pain rating, by measurement of the current necessary to evoke sensation in a tooth and with the aid of the amplitude of somatosensory evoked potential. All 3 algesimetric methods showed in complete agreement higher analgesia by tramadol 100 mg. The mean relative potencies of metamizole and tramadol were found to be 1:23 in agreement with clinical studies 5.


Further reading

  • 1. Hoskin PJ, Hanks GW. Drugs. 1991 Mar;41(3):326-44.
  • 2. Alemanno F, Westermann B, Bettoni A, Candiani A, Cesana BM. Buprenorphine versus tramadol as perineural adjuvants for postoperative analgesia in patients undergoing arthroscopic rotator cuff repair under middle interscalene block. Minerva Anestesiol. 2014 Feb 25. PubMed
  • 3. Richter W, von Arnim B, Giertz H. Double-blind clinical trial of tramadol. Comparison with pentazocine and placebo. MMW Munch Med Wochenschr. 1981 Mar 27;123(13):517-20. PubMed
  • 4. Magrini M, Rivolta G, Bolis C, Furiosi D. Analgesic activity of tramadol and pentazocine in postoperative pain. Int J Clin Pharmacol Res. 1998;18(2):87-92. PubMed
  • 5. Rohdewald P, Granitzki HW, Neddermann E. Comparison of the analgesic efficacy of metamizole and tramadol in experimental pain. Pharmacology. 1988;37(4):209-17. PubMed
  • 11. Courtney MJ, Cabraal D. Tramadol vs. diclofenac for posttonsillectomy analgesia. Arch Otolaryngol Head Neck Surg. 2001 Apr;127(4):385-8. PubMed
  • 12. Beaulieu AD, Peloso PM, Haraoui B, Bensen W, Thomson G, Wade J, Quigley P, Eisenhoffer J, Harsanyi Z, Darke AC. Once-daily, controlled-release tramadol and sustained-release diclofenac relieve chronic pain due to osteoarthritis: a randomized controlled trial. Pain Res Manag. 2008 Mar-Apr;13(2):103-10. PubMed
  • 14. Alon E, Schulthess G, Axhausen C, Hossli G. A doubleblind comparison of tramadol and buprenorphine in the control of postoperative pain. Anaesthesist. 1981 Dec;30(12):623-6. PubMed
  • 15. Engindeniz Z, Demircan C, Karli N, Armagan E, Bulut M, Aydin T, Zarifoglu M. Intramuscular tramadol vs. diclofenac sodium for acute migraine attacks in emergency department: a prospective, randomised, double-blind study. J Headache Pain. 2005 Jun;6(3):143-8. PubMed
  • 16. Staunstrup H, Ovesen J, Larsen UT, Elbaek K, Larsen U, Kroner K. Efficacy and tolerability of lornoxicam versus tramadol in postoperative pain. J Clin Pharmacol. 1999 Aug;39(8):834-41. PubMed
  • 19. Işik B, Arslan M, Ozsoylar O, Akçabay M. Effects of preoperative lornoxicam versus tramadol on postoperative pain and adverse effects in adult tonsillectomy patients. Agri. 2009 Jul;21(3):113-20. PubMed

Published: March 31, 2008
Last updated: March 24, 2016


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