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Tramadol, a synthetic opioid analgesic with a central action and SNRI (serotonin/norepinephrine reuptake inhibitor), is structurally similar to morphine and codeine. Tramadol is typically regarded as a lower-risk opioid alternative for the treatment of moderate to severe pain due to its favorable tolerability profile and multimodal mechanism of action. It has around 1/10th the potency of morphine and is a Step 2 choice on the World Health Organization's pain ladder.
In addition to acting as a -opioid agonist, tramadol also affects monoamines by modifying the effects of neurotransmitters involved in pain modulation, such as serotonin and norepinephrine, which activate descending pain inhibitory pathways. This is how tramadol differs from other conventional opioid medications.