The Post-Opioid Pain Problem: Gabapentin and Tramadol Under Scrutiny

Americans are suffering! That’s because 60 million people—nearly 1 out of 4—must deal with chronic pain. One of the country’s leading pain experts, Sean Mackey, MD, PhD, goes even farther. He estimates 1 out of 3 people suffers chronic pain sometime during their lives. The FDA, CDC and DEA have made it much harder for doctors to prescribe opioids for such individuals. Instead, physicians have turned to medications like gabapentin and tramadol to treat a patient’s pain problem. How safe and effective are these pain pills?

America’s Opioid Pain Problem 15 Years Ago:

In 2010 the most prescribed drug in America was hydrocodone (123,000,000 prescriptions dispensed). You may recognize brand names such as Vicodin, Norco and Lortab. “Only” 29,000,000 oxycodone prescriptions were dispensed that year. That doesn’t include nearly 7,000,ooo OxyContin prescriptions also dispensed that year. OxyContin is the brand name for oxycodone.

If you add up hydrocodone and oxycodone prescriptions, you get 159 million opioid prescriptions dispensed in 2010 and that does not include 5 million fentanyl patches. Clearly, there were way too many opioids being prescribed/dispensed in 2010. And far too many people died from opioid overdoses.

Once America woke up to the opioid problem, though, the pendulum started swinging in the other direction. Opioid prescriptions dropped dramatically over the last 15 years. The most recent annual data reveal that hydrocodone prescriptions were dispensed around 24 million times, down from 123 million times in 2010. What are doctors prescribing in its place?

Gabapentin for a Pain Problem?

Today, the most frequently prescribed medicine for pain is gabapentin. An article in the Annals of Internal Medicine (Sept. 30, 2025) describes the rapid increase in gabapentin prescriptions. Last year it was the number 5 most prescribed medicine in America.

In 2010 5.8 million people were taking 24,186,175 gabapentin prescriptions. Last year that number had jumped to 15.5 million obtaining 58,868,142 gabapentin prescriptions.

Most of those prescriptions were “off label.” That’s because gabapentin has only been approved by the FDA for treating partial seizures and the lingering pain after a shingles episode.

The authors of the article in the Annals of Internal Medicine (Sept. 30, 2025) offer this observation:

“Although the rate of increase in gabapentin prescribing slowed after 2016, gabapentin prescribing is still increasing. Gabapentin dispensing was highest and continues to increase among older adults, which may reflect increases in off-label prescribing for pain syndromes and other comorbidities common among older adults. As gabapentin dispensing continues to increase, many prescriptions may be filled for off-label indications with limited evidence of effectiveness. Although clinicians may be prescribing gabapentin as an alternative to opioids for pain, potential adverse effects of gabapentin—including dizziness, somnolence, gait disturbance, and potential for misuse—should be carefully considered.”

“As gabapentin dispensing continues to increase, particularly among older populations, prescribing physicians and advanced practitioners should be alert to the potential adverse effects of gabapentin.”

Older people are clearly getting more gabapentin prescriptions. That could increase their risk for falls since this drug can cause dizziness, drowsiness and trouble walking.

You can read more about gabapentin side effects at this link:

Surprising and Scary Gabapentin Side Effects

and

New Concerns About Gabapentin and Pregabalin (Lyrica) for Nerve Pain

What About Tramadol for a Pain Problem?

Another medication that doctors have turned to is tramadol (Ultram, Ultracet).

New research published in BMJ Evidence-Based Medicine (Oct. 7, 2025) describes the trend this way:

“Tramadol use has surged in recent years and is now among the most commonly prescribed opioids in the US. This increase is likely driven by its perceived benefits, including what physicians may view as a favourable adverse effects profile and the widespread belief that it is safer and less addictive than other short-acting opioids. However, evidence indicates that tramadol carries a comparable or even greater risk of transitioning from acute to prolonged use compared with other short-acting opioids.”

The authors of this study describe tramadol as a “dual-action analgesic opioid with monoaminergic properties.” That is a mouthful of medicalese. It means that tramadol has some opioid-like pain relieving properties. It also has some antidepressant-like activity because it affects neurotransmitters such as serotonin and norepinephrine.

The drug manufacturer originally suggested that it would be a good alternative to traditional narcotics. But there is now a realization that stopping tramadol suddenly can produce a “discontinuation syndrome.” That “withdrawal” can be challenging because it combines both the opioid aspect of the drug and the neurotransmitter discontinuation problem.

The investigators carrying out the latest tramadol study describe their findings this way:

“The objective of this review was to systematically evaluate the beneficial and harmful effects of tramadol compared with placebo for any type of chronic pain. Nineteen randomised placebo-controlled clinical trials randomising 6506 participants were included. All outcome results were at high risk of bias. Tramadol may slightly reduce chronic pain levels, but the effect size was below our predefined MID [minimal important difference]. Tramadol appeared to increase the risks of serious adverse events, mainly driven by a higher proportion of cardiac events and neoplasms. ‘Neoplasms’ were defined as the emergence of newly diagnosed cancer disease during the follow-up period of the trial. Trials reporting on neoplasms did not exceed 12 weeks of follow-up. A causality between the use of tramadol and the risk of new cancer disease, based on our results, is questionable at this point. Tramadol increased the risks of several non-serious adverse events, including nausea, dizziness, constipation and somnolence.”

Conclusions about Tramadol for a Pain Problem:

“Tramadol may have a slight effect on reducing chronic pain (low certainty of evidence) while likely increasing the risk of both serious (moderate certainty of evidence) and non-serious adverse events (very low certainty of evidence). The potential harms associated with tramadol use for pain management likely outweigh its limited benefits.”

Final Words About Tramadol and Gabapentin to Relieve a Pain Problem:

In summarizing the tramadol research in BMJ Evidence-Based Medicine (Oct. 7, 2025) one has to conclude that this drug has “limited benefits” for chronic pain patients. And it has some worrisome side effects. What the investigators did not comment on was withdrawal effects. When people suddenly stop tramadol, they can experience an unpleasant “discontinuation syndrome.”

We have described the darker side of tramadol in these articles:

Tramadol Side Effects and Withdrawal are Daunting

How To Stop Tramadol Without Withdrawal Symptoms?


Tramadol and Hypoglycemia: Beware Symptoms of Low Blood Sugar!

I have painted a rather sobering assessment of both tramadol and gabapentin. We have also heard from many people that such drugs can be helpful against pain. Without one or the other medication, some people would be suffering terribly.

Pain is individual! What works for one person may be virtually ineffective for someone else. It is almost impossible to predict in advance who will benefit from a particular medicine and who will suffer.

We encourage you to take some time to listen to our recent interview with  Sean Mackey, MD, PhD. You can download the mp3 or listen to the streaming audio by clicking on the arrow inside the green circle under the photo. Dr. Mackey understands the pain problem better than most healthcare professionals.

Never stop any pain medicine suddenly! Always discuss your pain problem with a healthcare professional who truly understands how to treat chronic pain. Our podcast with Dr. Mackey will help you in that conversation. If you know someone in chronic pain, please share this article and our interview with Dr. Mackey. Thank you for supporting our work. Please share your own experience with tramadol or gabapentin in the comment section below.