It is definitely a text book case of a drug where the "risk" outweighs the "reward" big time.
It works for many obviously, but it is a dirty medication.
I have pasted a section from the Martindale below just for extra info.
And I have known many cases of non recreational users who got prescribed this drug and so many sad stories.
Effects on the CNS. The UK CSM1 commented in February1995 that since June 1994 they had received reports of 15 patients who had experienced confusion and/or hallucinations while taking tramadol. The majority of the reactions developed 1to 7 days after starting treatment and in most patients resolved rapidly on withdrawal. It was noted that psychiatric reactions comprised about 10% of all reactions reported with tramadol. In a later comment2 in October 1996, the CSM noted that 27 reports of convulsions and one of worsening epilepsy had been received, which corresponded to a reporting rate of about 1 in 7000. Of the 5 patients receiving intravenous tramadol, 2 had been given doses equivalent to 1.45 and 4 g daily, well in excess of those recommended (see also Overdosage, below). Of the patients receiving oral tramadol, the majority were taking other drugs known to cause convulsions, including tricyclic antidepressants and SSRIs. A similar pattern has been reported in the USA 3 and Australia.4-6 A debilitating CNS-mediated reaction to an initial dose of tramadol has been described in a patient.7 Symptoms, which lasted about 4 hours, included ataxia, dilatation of the pupils, numbness in all limbs, tremulousness, and dysphoria. Although the exact mechanism of the reaction was not known, it was suggested that since the patient was an extensive metabolizer with very high activity of the cytochrome P450 isoenzyme CYP2D6, high concentrations of the active O-dimethyl metabolite were the cause. The patient recovered with no sequelae. It is possible that this represents a case of the serotonin syndrome, since tramadol is known to be associated with this condition, particularly at high doses or when given with other drugs that raise serotonin concentrations.
References:
41. CSM/MCA. Tramadol (Zydol)—psychiatric reactions. Current Problems 1995; 21: 2. Also available at:
http://www.mhra.gov.uk/home/idcplg?...015618&RevisionSelectionMethod=LatestReleased (accessed 26/06/08) 2. CSM/MCA. Tramadol—(Zydol, Tramake and Zamadol). Current Problems 1996; 22: 11. Also available at:
http://www.mhra.gov.uk/home/idcplg?...023218&RevisionSelectionMethod=LatestReleased (accessed 26/06/08) 3. Kahn LH, et al. Seizures reported with tramadol. JAMA 1997;278: 1661. 4. Adverse Drug Reactions Advisory Committee (ADRAC). Tramadol—four years experience. Aust Adverse Drug React Bull2003; 22: 1–2. Also available at:
http://www.tga.health.gov.au/adr/aadrb/aadr0302.pdf (accessed 26/06/08) 5. Labate A, et al. Tramadol and new-onset seizures. Med J Aust2005; 182: 42–3. 6. Boyd IW. Tramadol and seizures. Med J Aust 2005; 182: 595–6. 7. Gleason PP, et al. Debilitating reaction following the initial doseof tramadol. Ann Pharmacother 1997; 31: 1150–2.