First 10EM - By Justin Morgenstern - May 13, 2019
...I came to New Zealand to learn; to see how medicine was practiced in a different country. I was hoping see different practices, which could open my eyes to dogma that may have found its way into the way that I practice medicine. These differences will probably prompt a number of blog posts over the coming year. However, after reviewing the literature around tramadol, I have to say that my initial teaching was correct. Tramadol is a horrible drug that I will probably never prescribe...
Conclusion
There is really no logical reason to prescribe tramadol. It is an unpredictable medication. Some patients will get no pain relief at all. Others will get much higher opioid concentrations than you expect. It results in dependence, addiction, and abuse like all opioids, but seems to cause more adverse events that other opioids because of its SNRI actions.
If your patient needs an opioid, there is no reason to choose tramadol over morphine.