Tramadol vs. Hydrocodone: Which Treatment Is More Effective In Treating Musculoskeletal Pain? 

Hydrocodone and Tramadol are both medications that are prescribed to treat any symptoms that are not easily relieved by a non-steroidal analgesic. These medications can be effective in treating acute pain, such as after surgery, or in treating chronic conditions such as cancer. However, it is usually best to try a non-opioid treatment option first. Both are available by brand name, in generic form, and in combination with Tylenol (acetaminophen). 

These substances help to reduce discomfort by binding to the opioid receptors in your brain and altering the way your body responds to the pain. They are only available by prescription from your treating healthcare professional, which means that these opiates are far more potent than an over-the-counter pain reliever. 

What’s the difference? 

Most doctors consider hydrocodone to be stronger than tramadol, so it is typically prescribed only for more severe levels of musculoskeletal pain. Typically, hydrocodone is only prescribed if other milder medications have not been effective. It can also be effective in treating severe cough, it does this by decreasing the activity in the brain that is responsible for causing coughing. Tramadol is not usually prescribed to treat cough, as it does not have the same effect. 


You may also know this medication by its brand names; Ultram, Ultram ER, and ConZip. It binds to the opioid receptors in your brain while also increasing the activity of other brain neurotransmitters like serotonin and norepinephrine. According to the Drug Enforcement Administration, it is a Schedule IV narcotic because of its potential for abuse. 


You may know this drug by its generic names; Zohydro ER and Hysingla ER. It may also be known as Lortab or Vicodin when it is combined with acetaminophen. Because of its higher risk of abuse, the DEA considers hydrocodone a Schedule II narcotic. 

The Proper Way to Take These Opioids

There are a few reasons that someone might take tramadol or hydrocodone. These may include post surgery, after an accident causing serious injury, or for any health condition that causes severe pain. 

You should only take these medications if you can successfully take them in their original pill/tablet form as prescribed. These substances should not be chewed, cut, or broken as this would lead to too much of the medication entering the body at once. Ultimately resulting in an overdose. 

These drugs should not be prescribed to anyone under the age of 12 years old, as this would put the child at an increased risk of respiratory issues, addiction, overdose, and even death in severe cases. This also means that any woman who is pregnant or plans to become pregnant should not be taking these medications. Taking them can lead to life-threatening health problems for the baby after birth. You should also avoid taking these opiates when breastfeeding as unsafe levels of these drugs can pass through the mother’s breast milk. 

One Study Researches the Efficacy of These Pain Medicines

Tramadol-Hydrochloride is a centrally-acting analgesic with minor opioid receptor agonist activity that makes it suitable for treating acute moderate to severe discomfort. Monoamines inhibit reuptake, so they’re useful for treating chronic pain. It has less potential for addiction than other opiates and doesn’t block prostaglandins. Comparative research shows that tramadol-hydrochlo­ride is effective for managing postoperative pain, similar to propoxyphene or pentazocine, and similar to codeine after dental extractions. Turturro and associates conducted a randomized, double-blind, prospective study to research the analgesic effect of oral tramadol-hydrochloride versus oral hydrocodone with acetaminophen in individuals with acute musculoskeletal discomfort after minor trauma.

In order to participate in this trial, patients could not be pregnant or lactating, they could not have known substance abuse issues or a history of hypersensitivity to any of the analgesics being used. Each of the participants was given a capsule that either contained 100 mg of tramadol-hydrochloride or 5 mg of hydrocodone combined with 500 mg of acetaminophen. They were then re-evaluated every 30 minutes for 180 minutes using a visual analog sale. 

Initially, the average scores were about the same. Throughout the trial, the difference in the pain scores between the two groups became more significant at each interval. Thirty minutes from the end of the trial, the average score was significantly lower among the group taking hydrocodone with acetaminophen. 

In conclusion, the outcome of this trial tells us that tramadol hydrochloride has proven to be less effective than hydrocodone-acetaminophen in managing patients with musculoskeletal pain after trauma. Researchers also noted that the tramadol hydrochloride had increased side effects such as dizziness, nausea, constipation, and headache. Its decreased analgesic effect and increased side effects, along with increased cost make this option the least desirable when treating mild to moderate acute discomfort. 

Risks & Common Side Effects of These Drugs

Both of these medications have a high risk of addiction, as well as potential for overdose. Due to this, health care providers should always prescribe any opioid in the lowest dose possible for the shortest period of time possible. 

Most minor side effects, such as dry mouth, will resolve within a few days. However, there are some more serious side effects that may require immediate medical attention. These may include: 

  • Seizures
  • Mood problems, confusion, and hallucinations
  • Rapid heartbeat or shallow breathing
  • Hypersensitivity reaction, swelling of the tongue or throat, difficulty breathing, and skin rash. 

These substances should be used with caution by anyone that has certain medical conditions. Such as depression, as there is an increased risk of suicide while taking tramadol in anyone that suffers from depression. Some opiates can make it difficult to urinate, especially in men that have benign prostatic hyperplasia.  You should also be carefully monitored while taking these substances if you have cardiovascular disease or a decrease in blood volume. 

Some of the most significant dangers of taking these prescription medications are developing a tolerance to the drug or becoming addicted. If you’re taking either of these opiates for a prolonged period of time there is an increased risk that you will develop a tolerance to them. Meaning that you will need to take a higher dose in order to achieve the same level of relief. 

This can also lead to dependency or addiction. Once you become addicted, it will become very difficult to stop taking the medication and it is likely that you will experience symptoms of withdrawal when you stop. Symptoms of withdrawal may include agitation, insomnia, loss of coordination, and anxiety. In order to avoid experiencing withdrawal symptoms, it is recommended that you seek assistance from a medical professional to taper your dosage down slowly. 

Frequently Asked Questions

Both are opioid narcotics, but they are not the same. The two substances have similar uses depending on your symptoms, but they come in different doses and have different drug interactions and side effects. 

Yes, tramadol is an opioid. It is a synthetic opioid narcotic and is in the same drug class as other opioids. It is a Schedule IV drug and has less potential for dependence and abuse when compared to other prescription painkillers. 

Yes, hydrocodone is an opioid. It is a semi-synthetic opioid that has similar effects to other natural opioids such as codeine or morphine.

Yes, hydrocodone and acetaminophen can be combined. This combination drug is typically available by the brand name Vicodin and Lortab. 

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