Ultram for Fibromyalgia Pain

Ultram (tramadol) is an analgesic (painkiller) prescribed for moderate to severe pain. It's an opiate (narcotic) and also a monoamine uptake inhibitor, which means that it makes more of certain neurotransmitters available to your brain.

Ultram is also used to treat most types of neuralgia (nerve pain.) It's sometimes used off-label for fibromyalgia, restless legs syndrome, migraines, and obsessive-compulsive disorder. Ultram ER (extended release) is available for controlling severe chronic pain 24 hours a day.

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How It Works

Ultram appears to work in a couple of ways:

  • It impacts certain opioid receptors in the brain (meaning it changes the way pain messages flow through brain cells).
  • It increases available amounts of the neurotransmitters serotonin and norepinephrine.

Those chemicals can be low in people with fibromyalgia. Serotonin is involved with pain processing and the sleep cycle. Norepinephrine helps your body deal with stress. Both are believed to play a role in many symptoms of this condition.

Use in Fibromyalgia Pain Treatment

Ultram is not FDA approved for treating fibromyalgia pain, but it is sometimes prescribed off-label for the condition.

We have a few studies demonstrating that it may be effective, including at least one that suggests it's the only narcotic painkiller demonstrated to help with the unique pain types of fibromyalgia.

An animal study published in June 2009 shows that it may be especially effective against the hyperalgesia (amplified pain) of fibromyalgia when combined with Savella (milnacipran), but these results have not yet been replicated in humans.

A 2015 study published in the Clinical Journal of Pain suggested that tramadol led to fewer healthcare provider's visits for people with fibromyalgia.

A 2015 review of literature on the drug concluded that there was fair evidence supporting its use as a second-line treatment for people who needed more pain relief than FDA-approved drugs provide.


To lessen the risk of side effects, Ultram is generally started at a dose of 25 mg a day and increased gradually to 100-200 mg a day.

Be sure to follow your healthcare provider and pharmacist's instructions on increasing your dosage. More than 400 mg per day is considered dangerous for most adults. The safety cut-off for those older than 75 is 300 mg per day.

Side Effects and Warnings

Like all medications, Ultram does carry a risk of unpleasant side effects. Side effects that you should report to your healthcare provider right away include:

  • Breathing difficulties or wheezing
  • Confusion
  • Itching
  • Lightheadedness or fainting
  • Red, blistering, peeling or loosening skin
  • Seizures

Side effects that usually don't require immediate medical attention include:

  • Constipation
  • Drowsiness
  • Headache
  • Nausea or vomiting

If these side effects continue or are a problem for you, talk to your healthcare provider about them.

If you have a history of drug or alcohol addiction, you shouldn't take Ultram. This drug has caused seizures in some people and can make it more likely that you'll have a seizure if you have a history of seizures, head injury, a metabolic disorder, or you're taking certain medications (antidepressants, muscle relaxers, drugs for nausea and vomiting).

You may need a special dosage or tests to safely take Ultram if you have:

  • Kidney disease
  • Liver disease
  • Stomach disorder
  • History of depression, mental illness, or suicide attempts

Also note: When planning to stop taking Ultram, you will need to discontinue dosages slowly to avoid withdrawal symptoms. Talk to your healthcare provider or pharmacist about how to safely wean off of it.

A Word From Verywell

If you'd like to try Ultram, talk to your practitioner. You should weight the possible pros and cons carefully before making a decision. If you start taking Ultram, be sure to watch for side effects and talk to your healthcare provider about any problems you have.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  • Huynh CN, Yanni LM, Morgan LA. Journal of Women's Health. Fibromyalgia: diagnosis and management for the primary healthcare provider. 2008;17(8):1379-87.

  • Kaneko K, et al. The analgesic effect of tramadol in animal models of neuropathic pain and fibromyalgia. Neuroscience letters. 2014;562:28-33.

  • Kim SH, et al. Effect of the combined use of tramadol and milnacipran on pain threshold in an animal model of fibromyalgia. Korean Journal of Internal Medicine. 2009;24(2):139-42.

  • MacLean AJ, Schwartz TL. Tramadol for the treatment of fibromyalgia. Expert review of neurotherapeutics. 2015;15(5):469-75.

  • Peng X, et al.Long-term evaluation of opioid treatment in fibromyalgia. Clinical journal of pain. 2015;31(1):7-13.

By Adrienne Dellwo
Adrienne Dellwo is an experienced journalist who was diagnosed with fibromyalgia and has written extensively on the topic.