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Tramadol is a unique compound with moderate mu-opioid activity (compared to traditional opioids) and moderate monoaminergic activity (compared to tricyclic antidepressants). Tramadol has a more acceptable side effect profile than tricyclic antidepressants and antiepileptic drugs. Although possible, tolerance and dependence are rare complications of treatment. Of the four main types of pain, the effect of tramadol is not limited to neuropathic pain, but also includes suppression of noxious (nociceptive) pain.

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Neuropathic pain occurs spontaneously or periodically from damaged nerves. The neural signals behind neuropathic pain are different from the signals that are carried from damaged tissue (which can result from a fall, cut, or burn) to healthy nerves. This type of pain requires special medications known as painkillers; not uncommon as a result of spinal cord injuries, amputated limbs (phantom pain) and postherpetic conditions.
Opioid pain relievers such as tramadol and morphine are often useful in neuropathic cases. The drugs above are equally effective for nociceptive pain, which is the normal response of an organ/tissue to an adverse injury. The latter type includes cases of musculoskeletal and visceral pain. Sometimes a noxious source of pain can be localized (eg, joint pain or skin injury); in other cases, the pain may be related to internal organs or tissues.

For recreational use, health experts strongly recommend against using this drug because of its performance-enhancing properties. Apart from unpleasant side effects like nausea and vomiting, there is also the problem of addiction. Athletes who choose tramadol have the habit of exerting themselves every day and then naturally becoming addicted - this scenario is typical for all opioids. While there are sports organizations such as the World Cycling Union (UCI) that have recognized this problem and defined tramadol as doping, most sports federations continue to address it. For example, tramadol has never been banned from football and FIFA believes that the use of tramadol among football players is very limited and therefore has not taken any official action against it.

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