These are often used early in the course of the pain, frequently self-administered by patients in therapeutic to toxic doses. They are a rational choice when pain is mediated by an inflammatory process. In chronic nonmalignant pain they are best used on an occasional basis only. It also has properties of serotonin and norepinephrine reuptake inhibition like amitriptyline. It remains an unscheduled drug even though there are limited reports of abuse.
Analgesic potency is similar to that of other weak opioids.
The most common side effects are gastrointestinal symptoms, dizziness, dry mouth, drowsiness and constipation. Seizures have been reported, so Ultram is generally avoided when other factors are present that lower seizure threshold. Tricyclic antidepressants are effective adjuvant analgesics in a wide range of painful conditions. Their analgesic effect is distinct from their effect on mood. Unless contraindicated, they should be considered in most chronic pain patients, especially in cases of neuropathic pain with continuous dysesthesias.