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Strong painkiller tramadol is used to treat moderate to severe pain that is not being treated by other painkillers. A synthetic opioid, tramadol operates on the brain and spine (central nervous system) to lessen pain perception.Tramadol is available in an extended-release formulation for the continuous management of pain. Tramadol in this form should not be used to treat pain on and as-needed basis.Tramadol reduces uptake of two neurotransmitters, norepinephrine and serotonin, in addition to working at the opioid pain receptor, which may increase its pain-relieving benefits, however the precise process is unknown.