Tramadol Detox Program to Manage Tramadol Withdrawal Symptoms

Dr. Saurabh Bhardwaj

Dr. Bhardwaj, Medical Director is a Board-Certified Addiction Psychiatrist (ABPN) and currently the Medical Director of Defining Wellness Center in Brandon MS. He is also an Associate Professor of Psychiatry and Medical Director of Center for Innovation & Discovery in Addictions (CIDA) at the University of Mississippi Medical Center. He has been in Mississippi since 2018, building Addiction services for the state's only medical center and joined Defining Wellness Center in 2022 to provide specialized dual diagnostic services. He is a recipient of Ruth Fox scholarship from AAAP and trailblazer teaching award from UMMC. He is also a Fellow of the American Society of Addiction Medicine.

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Tramadol Addiction, Detox & Withdrawal Management

Tramadol is prescribed by doctors to relieve pain. It is an opioid analgesic that helps those suffering from moderate to severe pain by acting on the central nervous system. Therefore, it is often used after surgery. Tramadol may also be prescribed for those suffering from chronic pain.

Unfortunately, as with many of the substances in this group of drugs, long-term tramadol use can lead to dependence. Those who suffer from pain should not avoid taking essential, doctor-prescribed medications for fear of forming an addiction; it is important to understand that as long as the person is under medical supervision and has a true need for pain relief, mental dependence is unlikely, and the symptoms of physical dependence can be managed. Typically, doctors will suggest a gradual reduction in dose over time to minimize or avoid withdrawal side effects.

However, because there is still a risk involved in taking this substance, and because taking it without guidance from a physician can lead to dependency, tramadol is only available under restricted distribution according to the Opioid Analgesic Risk Evaluation and Mitigation Strategy. It is also considered a Schedule IV controlled substance under Drug Enforcement Administration guidelines.

Tramadol can be found in an extended-release capsule or tablet, which is ideal for chronic pain situations, as well as in fast-acting tablets, injection form, and solution and suspension forms. In 2013, there were nearly 44 million prescriptions dispensed for tramadol in all of its forms in the United States.

How Does Tramadol Work?

Tramadol is considered a narcotic. It suppresses the sensation of pain by acting on the central nervous system’s pain receptors, monoamine reuptake systems, opioid receptors, and the brain. This helps the brain to no longer receive pain signals. Tramadol cannot prevent pain, but it can make it more bearable by reducing how much the person will feel the pain. The person using this medication will also typically feel calmer and more relaxed.

Because tramadol blocks the pain pathways and interferes with the normal operation of the chemical messengers present in the brain, regular use may create physiological changes in the brain. There is also the danger that the person will, over time, develop a tolerance for this drug. That can create the need for prescribing higher doses in order to achieve the same effects.

Side effects of tramadol usage include:

  • Dizziness
  • Feeling sick
  • Constipation
  • Dry mouth
  • Headaches
  • Sleepiness
  • Feelings of being hot and sweaty

It is rare for someone to experience serious side effects such as difficulty breathing; if this happens, the person should go immediately to an emergency room.

The Food and Drug Administration of the United States has warned that tramadol can create physiological dependence. This occurs as the medication causes changes in the brain. Over time, these changes can become more fixed. At that point, the brain no longer functions the way it used to.

This can occur even when tramadol is taken as prescribed. According to the World Health Organization, even a legitimate prescription, if taken for a long enough period, can create a dependence.

Additionally, according to the 2012 National Survey on Drug Use and Health, 3.2 million Americans have used the drug for non-medical purposes at some point. For those taking tramadol without medical supervision, the chances of becoming addicted may be higher.

For those who are dependent on tramadol and want to quit, withdrawal can be tough. Fortunately, the staff at Defining Wellness Centers can help those who are struggling with addiction. Our compassionate staff members are experienced and can truly help.

Symptoms of Tramadol Withdrawal

As with any opioid, tramadol can result in withdrawal symptoms when a user stops taking it. Unlike with other narcotics, however, tramadol withdrawal may also take an atypical form. This is because it not only activates the brain’s opioid receptors, but it can also block the reabsorption of neurotransmitters such as serotonin and norepinephrine. According to the DEA, about 10% of tramadol users will experience atypical withdrawal. Symptoms include severe confusion, paranoia, panic attacks, hallucinations, and feelings of numbness or tingling in the limbs. The potential range of symptoms makes it more critical to seek professional help.
There are generally two phases to opioid withdrawal.

Early Withdrawal Phase

Early withdrawal occurs as the drug leaves the user’s bloodstream. Because tramadol has a relatively short half-life, withdrawal symptoms may start within 12 hours once usage stops. There are several symptoms associated with this stage of the process. These include:

  • Flu-like symptoms such as a runny nose, muscle and body aches, chills or fever, and sweating
  • Frequent yawning
  • Insomnia
  • Irritability, anxiety, agitation, and restlessness
  • A racing heart
  • Hypertension
  • Rapid breath
  • Difficulty concentrating or thinking clearly

Late Withdrawal Phase

The symptoms of this phase include:

  • Digestive issues such as stomach pain, cramping, or diarrhea
  • Dilated pupils
  • Nausea and vomiting
  • Goosebumps
  • Loss of appetite
  • Depression
  • Cravings for the drug

Timeline for Tramadol Withdrawal

Many users describe the symptoms of tramadol withdrawal to be similar to those of a bad case of the flu. For people who are experiencing a physical dependence on the drug, it may be helpful to know that what they will experience in withdrawal will be akin to something that they most likely have already gone through when ill.

Of course, there is also a psychological component associated with opioid use. While the symptoms of physical withdrawal will peak in a few days and then taper off substantially, the psychological effects of withdrawal may continue longer. Having guidance through the process is helpful as recovering users may wonder why they continue to experience a desire for the drug even after they feel better physically.

Because people experience withdrawal in different ways, it’s important for any recovery program to provide a degree of flexibility to deal with individual needs. It’s also important to take into account the various factors that can influence the length of time that a client will have withdrawal issues as well as the severity of these particular symptoms.

One crucial element is how long a client has been taking tramadol and the dosage used. The larger the dosage and the longer the person has taken the drug, the greater the potential severity and duration of the symptoms experienced during withdrawal. When there are physiological changes to the brain that occur after long-term drug use, then it takes a period of time for the brain to return to normal. Those who have taken tramadol for a long time and/or who have taken particularly high doses need to be patient with themselves. It takes time to recover.

Another aspect to be aware of is that the manner of taking the drug will affect the severity of withdrawal symptoms. A person who takes tramadol in the manner prescribed by a physician is less likely to have a hard dependency. On the other hand, someone who took tramadol without a prescription and who snorted, smoked, or injected the drug will be more likely to become dependent and will probably have a worse withdrawal experience.

Other Factors Affecting Tramadol Withdrawal

There are several other factors that should be considered because they affect both the severity of withdrawal symptoms and the time required for detoxification. These include the following:

  • Taking other drugs or alcohol along with tramadol: This can increase the chances of creating a dependency as well as potential complications of withdrawal.
  • A user’s particular combination of genes, lifestyle choices, and physiology: These all play a role in potential drug dependency.
  • The age of the user as well as his or her history of trauma, abuse, neglect, and stress

person’s genetics can play a role in up to half of the cases of drug dependency, according to the National Council on Alcohol and Drug Dependence. Therefore, family history is something to consider in treatment. If a person’s relatives also struggle with addiction, then there may be a genetic component. Knowing this can help create an optimal treatment plan and also remove some of the feelings of guilt or shame that many users suffer.

Other factors that can play a role include underlying medical conditions, mental health considerations, past experiences of trauma or abuse, and ongoing or chronic stress. All of these affect a person in ways that may impact their ability to make decisions, control impulses, and deal with pain. This is particularly relevant for those who experienced these things prior to maturity. Data from 2013 shows that those who used drugs prior to age 14 would, in adulthood, be more likely to have a substance use disorder than those who were at least 18 when they first used drugs. This may be due to drugs having a more powerful impact on younger brains. For those who have experienced trauma or abuse, Defining Wellness Centers provides holistic options that can provide relief.

Treatment Options for Withdrawal

The process of withdrawal can be facilitated through medically supervised detoxification. As with any opioid, going “cold turkey” is not advised. This is one reason why when doctors prescribe this painkiller, they also instruct their clients to follow a gradual process to wean off the drug.

For those who have a substance use disorder, a medically supervised program provides the professional care required to safely cease use. Due to the way chronic tramadol use affects the brain’s physiology, a long-term user may feel a desire to continue to use it as it has affected both the parts of the brain that feel pleasure and control impulses. The result is that someone going through withdrawal may feel depressed and have drug cravings.

FDA-approved medications may help with this. These medications include the following:

  • Methadone: Substituting this long-acting substance for the short-acting tramadol may be a good choice to stave off withdrawal symptoms. The disadvantage is that methadone is also an opioid. It should be used with caution and never without medical supervision.
  • Buprenorphine: The advantages of this opioid agonist include its long half-life as well as that it doesn’t activate the brain’s receptors in ways that are similar to opioids. This means that the user will not experience the same “high” that he or she might have had when taking tramadol. Additionally, if someone attempts to take more than the prescribed dose, the drug may not provide any additional effect. This reduces the likelihood of abuse. When paired with naloxone, which is the case with FDA-approved products containing buprenorphine, the likelihood for relapse is further reduced.
  • Naltrexone: In later stages of withdrawal, once tramadol is no longer present in the client’s system, this drug is potentially useful to prevent relapse.

Other medications and supplements may also be provided to clients undergoing a medically supervised detoxification and withdrawal, depending on the symptoms that need to be alleviated. There are also holistic and therapeutic treatments to consider. Professionals have many tools available to help manage symptoms and support clients, including counseling, exercise, meditation, and group sessions.

Obviously, tramadol dependence can be a challenge to deal with, so the professionals at Defining Wellness Centers are here to help. We provide compassion as well as a professional, multi-faceted approach. Many people who are dependent on opioids suffer from unnecessary feelings of guilt or shame. Instead of blame, our caring staff members address clients’ needs and provide care as clients move toward freedom from dependency. For more information about the programs available, feel free to contact us.

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