Tramal (Tramadol etc) is a form of manufactured opioid that has a supposedly smaller dependency effect with only a few cases of dependency so far reported on low doses, higher doses have higher incidence of addiction.
Tramadol hydrochloride is used for moderate to severe levels of pain but many other opioids are used to treat severe pain, it is not classified the same as Oxycontin, morphine etc which are Schedule 8 drugs. Tramadol is classified as a Sch 4 drug, it is about as effective as codeine but only about 1/10 as effective as morphine.
If someone is taking an SSRI/SNRI drug and also Tramadol, because it is also an effective SNRI, may be subject to Serotonin syndrome (SS). They may need to reduce or cease their SSRI/SNRI drug to avoid these issues and their medical professional should be aware of this issue and monitor for and advise the user of the symptoms of too high levels of Serotonin (symptoms include tremors, headaches, seizures, respiratory failure, death). Tramal on it’s own can cause SS to occur but it is unusual.
Those with kidney or liver issues should also be very concerned with tramadol as it is contraindicated in those circumstances. Side effects can be seen at the following link: