Tramadol vs Oxycodone for Pain: How Do They Differ?

Tramadol and oxycodone are both opioid pain medications. They are used to control moderate to severe pain and carry some of the same risks, such as dependence (drug abuse and opioid addiction) and life-threatening respiratory depression, especially when combined with other sedative medications. However, there are some significant differences between oxycodone and tramadol, such as the way they work and their potency. Please continue reading to find out how tramadol and oxycodone are different in terms of uses, efficacy, and side effects.

What Are The Main Differences Between Tramadol And Oxycodone?

Potency

Although both tramadol and oxycodone are opioid pain relievers, their potency differs significantly. Oxycodone is a more potent opioid compared to tramadol. This high potency is the reason why the Drug Enforcement Administration (DEA) classifies oxycodone as a Schedule II (2) controlled substance under the Controlled Substances Act (CSA). This classification is due to oxycodone's high potential for abuse, which can result in both physical and psychological dependence.

Tramadol is classified as a Schedule IV (4) controlled substance under the Controlled Substances Act. This classification indicates that tramadol is a weaker opioid, which carries a lower risk for physical and psychological dependence.

Mechanism of action

Oxycodone and tramadol are both opioids, meaning they work by binding to opioid receptors in the body to relieve pain, thus blocking the pain signal and reducing the pain intensity. Even though they share this similarity, there are differences in how they work.

Besides binding to the opioid receptors, tramadol also affects the levels of two natural brain chemicals: serotonin and norepinephrine. Serotonin and norepinephrine are neurotransmitters (natural brain chemicals) that play various crucial bodily functions, such as mood regulation, sleep, memory, and learning. Increasing the levels of serotonin and norepinephrine may also help improve painful symptoms.

So, even though tramadol is a less potent opioid than oxycodone, it is still a good pain reliever, helpful for moderate to severe pain.

Brand names

Tramadol is available as a generic medication, but it’s also available under these brand names: Ultram, Ultram ER, Rybix ODT, Ryzolt, Conzip, and Qdolo. It is also available in generic form. Combination products containing tramadol include Ultracet (tramadol and acetaminophen) and Seglentis (tramadol and celecoxib).

In addition to the generic version, oxycodone is sold under brand names OxyContin, Oxaydo, and Xtampza ER. Combination products containing oxycodone include Percodan (oxycodone and aspirin) and Xartemis XR, Roxicet, Oxycet, and Percocet (oxycodone and acetaminophen).

Note: The brand names Ryzolt, Rybix ODT, and Ultram have been discontinued in the U.S., and generic tramadol products are available.

Uses

Both oxycodone and tramadol are used to treat moderate to severe pain in people who require pain relief around the clock. They are used to relieve pain that cannot be treated with other non-opioid drugs, such as acute pain (sudden onset pain), post-operative pain, pain from injury or trauma, cancer pain, and pain from other chronic illnesses.

Both oxycodone and tramadol relieve pain by binding to opioid receptors in the central nervous system to block pain signals. Additionally, tramadol can increase amounts of serotonin and norepinephrine, which are chemicals that help control pain and mood.

Your doctor can discuss different medications and how to safely use them, along with oxycodone or tramadol, for optimal pain relief.

Both tramadol and oxycodone are opioids, with a chemical structure similar to morphine. You will need a prescription from your healthcare provider for both medications. As controlled substances, they carry a risk of misuse and dependence. Therefore, there are stricter regulations regarding their uses and refills.

Depending on your medical history and the type of pain, your healthcare provider may recommend you use oxycodone or tramadol in addition to other kinds of pain relievers. These may include acetaminophen (Tylenol), which is effective for mild to moderate pain and fever, and aspirin or ibuprofen (Advil, Motrin), which is a nonsteroidal anti-inflammatory drug (NSAID) that can help with inflammatory pain and fever.

Age Range

Tramadol

Tramadol is approved for use in adults and children 12 years of age and older. Tramadol should be used with caution in those older than 75 years.

Tramadol may not be safe or recommended in the following cases:

In children younger than 18 years old with breathing problems (such as lung disease and obstructive sleep apnea);
As postoperative pain management in anyone younger than 18 years following surgery to remove tonsils (tonsillectomy) or adenoids (adenoidectomy).
Extended-release tramadol (Ultram ER) should not be used by anyone younger than 18 years old.

Oxycodone

Oxycodone is approved for use in adults and opioid-tolerant children 11 years of age and older (pediatric patients who are already receiving and tolerating opioid medications).

Dosage Forms and Doses

Tramadol comes as a tablet, extended-release tablet, extended-release capsule, and liquid. The usual dose of the tablets is 50 milligrams (mg) to 100 mg every 4-6 hours as needed for pain relief, with a maximum daily dose of 400 mg.

Oxycodone comes as a tablet, capsule, extended-release tablet, extended-release capsule, liquid solution, and concentrated solution. The usual dose of oxycodone tablets is 5 mg to 15 mg every 4-6 hours as needed for pain relief.

For both tramadol and oxycodone, the lowest effective dose is used for the shortest time possible to manage postoperative pain or severe pain due to trauma and injury.

Onset of Action and Duration of Effect

Tramadol and oxycodone both start working within an hour. Their effects last for 4-6 hours (regular formulations) and 12-24 hours (extended-release formulations).

Side Effects

The most common side effects of tramadol include headache, drowsiness, nervousness, mood changes, uncontrolled shaking, dry mouth, indigestion, heartburn, and constipation.

The most common side effects of oxycodone include headache, drowsiness, mood changes, dry mouth, stomach pain, constipation, and flushing.

Risks and Warnings

Risks associated with the use of tramadol and oxycodone include:

Serious allergic reactions
Life-threatening respiratory depression, especially when used with other central nervous system depressants
Fatal overdose
Serotonin syndrome (a potentially life-threatening condition when there’s too much serotonin in the body)
Withdrawal symptoms if the medicine is discontinued suddenly
Opioid abuse and addiction leading to psychological and physical dependence
Neonatal opioid withdrawal syndrome if the opioid drug is used by a pregnant woman
Impaired physical and mental abilities due to drowsiness and reduced concentration with risks while driving or doing other hazardous activities

In addition, taking tramadol and oxycodone can increase seizure risk, especially when these medications are used in combination with certain antidepressants and other opioids.

Oxycodone can cause severe hypotension (low blood pressure), including postural hypotension or orthostatic hypotension (fainting when going from a lying or sitting position to standing).

Opioids should be used with caution in people with increased intracranial pressure or head injury and gastrointestinal conditions such as paralytic ileus.

Find Savings On Your Pain Medications

What Provides Better Pain Control: Tramadol or Oxycodone?

Tramadol and oxycodone are strong pain relievers used for managing severe acute pain resulting from surgery, trauma, or injury, as well as chronic pain associated with cancer and other long-term conditions when non-opioid pain medications are ineffective in providing sufficient relief.

Oxycodone is more potent than tramadol. Due to its potency, oxycodone is used for fast and significant relief from severe pain. Even though tramadol is not as powerful as oxycodone as an opioid, due to its ability to increase the levels of serotonin and norepinephrine, tramadol is still very helpful to treat moderate to severe pain.

Different people may react differently to the same medications, and your doctor can help you determine which pain reliever is the best option for you. Typically, your doctor will evaluate your health history and current medications to choose a medication that is effective and safe for you.

Find out: How Long Does Oxycodone Stay in Your System?

Is There Anything Else I Should Know About Oxycodone And Tramadol?

For safe and effective pain relief, oxycodone and tramadol can be combined with other non-opioid pain medications. Your doctor can guide you on the best options and how to use them safely, ensuring the best pain management for you.

It's important to note that tramadol and oxycodone may be available in combination products. For instance, Percocet is a combination of oxycodone and acetaminophen. Knowing the total amount of acetaminophen (or other active ingredients) is crucial to avoid harmful health complications.

Additionally, non-drug approaches such as physical therapy, massage, and exercise play a vital role, especially if you are recovering from surgery, injury, or trauma. In addition to medications, physical activities such as exercise, yoga, pilates, low-impact workouts, and stretching are essential for a successful recovery. You should talk to your care team (surgeon, physical therapist, primary care physician) to design an individualized exercise plan that is safe and helpful for your recovery.

Are Oxycodone and Tramadol Good for Chronic Pain?

Pain can significantly impact your quality of life, but with effective pain management, you may be able to regain your productivity at school and work, resume your favorite hobbies, and spend quality time with your loved ones.

If you suffer from severe, constant pain from cancer or other chronic illnesses, you may have to take oxycodone, tramadol, or other strong pain medications long-term. Your active involvement is crucial for effective pain management. It's important to work closely with your pain specialist (physicians and other healthcare providers specializing in pain management) to determine the best treatment regimen for you, which may include both opioids and non-opioid medications.

Open communication about your pain levels, medication effectiveness, and any side effects is key to successful pain management. Your pain management team can also advise or refer you for physical therapy, occupational therapy, and mental health counseling for the most holistic treatment approach.

Frequently Asked Questions

What Painkiller is the Same As Tramadol?

Oxycodone, hydrocodone, and tramadol are all opioid pain medications. While oxycodone and hydrocodone are more potent than tramadol, all three opioid analgesics can be used to treat moderate to severe symptoms of pain.

Can Tramadol Provide Pain Relief from Severe Pain?

Tramadol can provide adequate analgesia (pain relief) from severe pain. It is typically used for short-term relief of severe pain, such as postoperatively. Except for those with severe chronic pain due to cancer or other chronic illnesses, patients are not usually given tramadol for long-term (chronic) pain conditions due to the risks associated with this medicine.

Is Tramadol Stronger Than Hydrocodone?

No, hydrocodone is a more potent opioid than tramadol. However, due to tramadol’s ability to increase the levels of serotonin and norepinephrine, it is still very effective at relieving moderate to severe pain from injury, trauma, or pain from certain chronic health conditions.

Your doctor can help you choose tramadol versus hydrocodone or other drugs (non-opioids like acetaminophen or diclofenac sodium) based on your medical history and pain score.

Learn more: Hydrocodone vs Oxycodone: What’s the Difference?

Is Tramadol Stronger Than Codeine?

Both tramadol and codeine are opioid analgesics and are considered to be roughly equal in controlling pain There is no evidence that one has a favorable potency compared to the other or a significant difference in analgesic efficacy.