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Tramadol differs from other traditional opioid medications in that it doesn’t just act as a μ-opioid agonist, but also affects mono-amines by modulating the effects of neurotransmitters involved in the modulation of pain such as serotonin and epinephrine which activate descending pain inhibitory pathways.13 Tramadol’s effects on serotonin and nor-epinephrine mimic the effects of other SNRI antidepressants such as fluoxetine and waxiness.
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