Pain Is Personal: Unexpected Gabapentin & Tramadol Side Effects

Pain is highly subjective. An event that causes excruciating agony for one person might be perceived by another as distressing but bearable. Even the same individual may experience pain differently from one day to the next. That helps explain why finding the “right” pain medicine can be so challenging. Some people get excellent relief from a pain medication such as tramadol, while others experience little benefit or troubling tramadol side effects.

There is no perfect pain reliever that works for everyone. Unfortunately, two commonly prescribed drugs, gabapentin and tramadol, illustrate just how unpredictable pain treatment can be.

Pain Is Personal…and So Is Pain Treatment

Doctors and nurses routinely ask patients to rate their pain because there is no laboratory test or imaging technology that can measure it. Researchers studying pain must rely largely on patients’ descriptions.

Perhaps you have had a nurse or a doctor ask you to rate your pain level on a scale of 1 to 10. When my mother, Helen Graedon, had a bad bellyache it was almost always a crisis. For her, digestive distress was unbearable. A physician friend had a bleeding ulcer that almost killed him and yet he barely realized that his digestive tract was in dire straits.

Pain Meds Work Differently for Each Person

The variability in response to pain medications makes treatment incredibly challenging. What works well for one person is a nightmare for someone else. Helen Graedon, for example, could not tolerate opioids. They gave her horrific nausea and stomach cramps. The gastrointestinal side effects were far worse than any other pain she might have had.

Others, however, find that opioids such as codeine, oxycodone, hydrocodone or fentanyl are the only way to cope with excruciating pain.

R. shared this story about a powerful opioid:

“I took oxycodone for nearly thirty years exactly as prescribed, without incident. Because of the war on opioids I have gone from a fairly well-functioning person to being nearly bedridden for the last six years, with nothing to take but aspirin. A trip to the supermarket can put me in bed for several days in agonizing pain. When I read statements that doctors need to stop writing prescriptions for opioids to stop the opioid epidemic, I see red.

“How are people in agonizing pain supposed to get the help we need? I have become more and more depressed as time goes by without any pain relief. I am NOT AN ADDICT! I just need pain relief.”

Opioids work well for acute pain. Surgeons frequently prescribe drugs such as hydrocodone or oxycodone after major surgery…for a few days.

But some people, like R., with severe chronic pain, only get relief with opioids. Sadly, the tragic epidemic of opioid-related deaths in the United States has made many prescribers reluctant to use such medications for anyone with chronic pain. The CDC and the FDA have made it clear that they do not approve of opioid use for people suffering this kind of severe lasting pain.

But millions of patients are suffering and still seeking relief. As a result, doctors frequently turn to other medications that are perceived to be safer alternatives. Two of the most common are gabapentin (Neurontin) and tramadol (Ultram, Ultracet).

Gabapentin Side Effects vs. Tramadol Side Effects:

Gabapentin is now the No. 1 medicine for pain in America. It is among the top ten most prescribed drugs in the US.

According to its official prescribing information, gabapentin is approved for only two conditions:

• Post-herpetic neuralgia (persistent pain after shingles)
• Certain seizure disorders

Despite that limited approval, gabapentin is widely prescribed for many types of chronic pain.

One reason may be that gabapentin is not a controlled substance, so prescribers do not face the same regulatory scrutiny associated with opioids.

But new concerns have emerged.

An investigation published in the Wall Street Journal (“The Hidden Risks of America’s Most Popular Prescription Painkiller,” Dec. 24, 2025) suggests that many doctors do not appreciate the drug’s downsides:

“A growing body of research shows it isn’t as safe or effective as doctors have long thought. Gabapentin has been associated in studies with greater risk of dementia, suicidal behavior, severe breathing problems for people who have lung disease, and edema, in addition to well-known side effects like dizziness.”

One disturbing side effect that most would not expect is cognitive dysfunction. An analysis of patient records covering 20 years included 26,416 adults with chronic low back pain (Regional Anesthesia & Pain Medicine, July 10, 2025). Those who filled at least six prescriptions for gabapentin were more likely to develop mild cognitive impairment or even dementia.

That chance was higher with 12 or more prescriptions. The risk was most pronounced among younger people, those under 65, who were twice as likely to have cognitive problems as those who got fewer than six gabapentin prescriptions. With so many gabapentin prescriptions dispensed, we could be looking at a serious public health problem.

Here is how the investigators conclude their study:

“Gabapentin prescription in adults with chronic low back pain is associated with increased risk of dementia and cognitive impairment, particularly in non-elderly adults. Physicians should monitor cognitive outcomes in patients prescribed gabapentin.”

We suspect that this gabapentin complication will come as a surprise to many physicians who have made the drug their go-to pain reliever.

Tramadol Side Effects May Also Be Unexpected

Another commonly prescribed pain reliever is tramadol. When this medication was first introduced, many clinicians were told that it carried a low risk of addiction and was safer than traditional opioid drugs. As a result, doctors often prescribe tramadol when they feel uncomfortable using stronger opioids such as hydrocodone or oxycodone.

However, experience over the years has revealed that tramadol is far more complicated than originally believed.

A systematic review published in BMJ Evidence-Based Medicine (Oct. 7, 2025) concluded that tramadol may provide modest pain relief but probably increases the risk of both serious and non-serious side effects.

The authors conclude:

“The potential harms associated with tramadol use for pain management likely outweigh its limited benefits.”

In addition, many patients report that stopping tramadol can be extremely difficult.

Tramadol Side Effects and Withdrawal

Tramadol affects the body in two different ways. First, it binds to opioid receptors in the brain, which helps relieve pain.

But tramadol also affects important brain chemicals such as serotonin and norepinephrine, the same neurotransmitters targeted by many antidepressant medications. Because of this double action, stopping tramadol suddenly may disrupt multiple brain pathways at the same time.

Doctors sometimes refer to this as “discontinuation syndrome.” That clinical phrase does not begin to capture how distressing the experience can be for some people.

Common Tramadol Side Effects

People taking tramadol may experience side effects such as:

• Nausea or vomiting
• Constipation
• Headache
• Dizziness or fatigue
• Restless legs
• Sweating
• Difficulty sleeping
• Dry mouth
• Skin rash

Another rare but serious risk is serotonin syndrome, which can occur if tramadol is combined with certain antidepressants or migraine medications. This life-threatening situation could be triggered if tramadol is combined with other medications such as “triptans” prescribed for migraine headaches or antidepressants that affect serotonin.

ALWAYS check with a pharmacist about potential drug interactions before combining tramadol with any other medication. To learn more about serotonin syndrome, click here and here!

Tramadol Withdrawal Symptoms

Some people who try to stop tramadol report symptoms such as:

• Anxiety or irritability
• Brain “zaps” or electric shock sensations
• Sweating or chills
• Tremors
• Headaches
• Insomnia or vivid nightmares
• Nausea or diarrhea
• Depression
• Hallucinations or unusual thoughts
• Aggressiveness

These symptoms may resemble those experienced when people stop antidepressants suddenly.

Because reactions vary widely, there is no single tapering schedule that works for everyone. Many people must reduce the dose very gradually under medical supervision.

Reader Stories About Tramadol Side Effects and Withdrawal

Over the years, readers have shared hundreds of stories about tramadol side effects and withdrawal. Here are just a few examples.

Q. I have been taking Ultracet (tramadol) for several years for back pain. I was taking 100 mg three times a day as prescribed. The pain is better and I tried stopping the tramadol and had a terrible reaction.

I went to my internist who advised that I stop taking the tramadol over a period of time. I am now taking 50 mg three times a day but cannot get any lower than that without experiencing nerve twitches in my legs and intense jitteriness that interferes with my sleep.

Have you heard of similar problems and do you know of any way to alleviate the withdrawal symptoms without getting hooked on another medication?

A. Tramadol (Ultram, Ultracet, Rybix ODT, Ryzolt) is a strong pain reliever that was originally thought to have opioid-like activity without the same potential to cause addiction as morphine or similar narcotics. To quote the “experts,” tramadol was thought to have a “low potential for abuse.” In other words, it wasn’t supposed to cause physical dependence or produce a “withdrawal syndrome.”

It turns out the drug is a lot more complicated than many experts first believed. In addition to its analgesic action via opioid receptors in the brain, tramadol exerts a profound effect on other neurochemistry. That means that brain chemicals like serotonin and norepinephrine are profoundly impacted by tramadol.

Antidepressant Discontinuation Syndrome:

Many antidepressants also affect the reuptake of the neurotransmitters serotonin and norepinephrine. For years clinicians thought there would be no consequences after altering brain chemistry with drugs such as desvenlafaxine (Pristiq), duloxetine (Cymbalta) or venlafaxine (Effexor). Sudden discontinuation of such drugs can bring on a host of symptoms. Here is a link with over 1,300 comments regarding Cymbalta withdrawal:

Remember that tramadol not only affects neurotransmitters. It is a synthetic cousin of codeine and binds to opioid receptors. That means it is weaker than narcotics like hydrocodone or oxycodone. But it works in part to ease pain by binding to opioid receptors in the brain.

Tramadol Side Effect & Withdrawal Stories from Readers

Arika in Washington is going through prolonged withdrawal:

“I was on tramadol for about five years. By the end of that time I was only taking 50 mg per day. I’ve been off of it for about a month and I’ve had several nightmarish weeks. One week, the anxiety and panic was hellish.  The next week I had to deal with extreme fatigue and muscle pain.

“I think I’m past the worst but am still being plagued by anxiety, panic, muscle weakness and fatigue (which gets worse after eating and exercise). Then there’s tingling and numbness all over my body.”

“I’m not seeing a light at the end of my journey – just making it through a day feels like a battle.”

Sweety in Bangalore shared this story:

“My mother-in-law has osteoporosis, rheumatoid arthritis and spondylosis. Her rheumatologist started her on tramadol. She took this medicine for nearly a year.

“Then her doctor changed her pain medicine in one day. After stopping the tramadol she experienced withdrawal symptoms: extreme pain, seizures and electric shock-like sensations. She got no sleep because of the symptoms.

“She also received anti-anxiety drugs given by her doctor. The tramadol was not tapered.  She is going through bad withdrawal.”

Shae in the Cayman Islands reports:

“I took it [tramadol] for 6 weeks, 4 x per day at 50 mg per dose. I stopped cold turkey and I’m on my fourth day of withdrawal symptoms.

” I have blurred vision, severe abdominal cramps and pain breathing. I am disoriented, have body aches, swelling of my feet, electric shocks in my hands and feet, back pain, chills, depression and flu-like symptoms.”

Tramadol Success Stories

Remember, we started this article with the idea that pain is personal and highly subjective. While some people may not get much relief from tramadol, other find it helpful. Here is the other side of the coin.

Nancy found tramadol helpful with hardly any side effects:

“Tramadol was a life saver when I fractured my back and during a gallbladder attack. Aside from constipation, no problem.”

D’Lain echoes Nancy’s experience:

“I have taken tramadol for almost 20 years now. What a life saver! It has helped me with arthritis pain and now lower back pain. No one has to suffer with constipation with an opioid drug, just take something for it, duhhhh, like Miralax, or just eat more salad and fruit and grains.”

Lowell got great relief with tramadol:

“Tramadol has been a huge blessing for me these last 15+ years. I had constant pain in my left hamstring, and the only solution that has worked has been tramadol. I tried at least a dozen other solutions and tests before settling on tramadol. I do come off of it every five years or so, to see if the pain comes back, and it does. Withdrawal is bad. It takes 6+ weeks of cutting back before I can stop. During that time, sleep is terrible.”

Where Is the FDA?

The FDA has not provided physicians with clear guidelines on how to phase off such drugs. We frequently see recommendations like “gradual withdrawal,” but no one bothers to provide clear instructions about what that really means. We’re really sorry that we don’t have any great insight on this process either. Readers have shared their own solutions at this link.

Final Words

By now you know our mantra: Pain is Personal! 

The same drug that brings relief to one person may cause serious side effects in another. Some patients benefit from gabapentin or tramadol. Others find the risks outweigh the benefits.

Discovering the best strategy often requires patience, careful monitoring and sometimes the guidance of a dedicated pain-management team.

Pain treatment should never be “one-size-fits-all.” Patients deserve individualized care that balances pain relief with safety.

Your Experience

Have you taken gabapentin or tramadol for pain? How well did it work?

Did you experience unexpected side effects or withdrawal symptoms?

Share your story in the comment section below. Your experience may help others who are trying to navigate the complicated world of pain treatment.

If you found this article helpful, please share it with friends or family members who might receive a prescription for pain medicine. Thank you for your support.