Tramadol (Ultram, Ultracet) has been on the market in the U.S. for 30 years. When this pain reliever was first introduced, doctors were told that it had opioid-like pain-relieving activity without a risk for causing physical dependence.

That meant it had a “low potential for abuse.”

In those days, the Food and Drug Administration considered tramadol a “non-controlled” analgesic. That meant the experts believed the medication would not cause physical dependence or a “withdrawal syndrome.”

In 2014, the Drug Enforcement Administration reclassified tramadol into Schedule IV, meaning it is legally restricted and has the potential to cause physical dependence.

It is often perceived as much safer than traditional opioids such as hydrocodone or oxycodone, which are classified as Schedule II drugs.

Tramadol is unique because it has some opioid-like activity, in addition to an effect on other neurochemicals like serotonin and norepinephrine.

That means stopping tramadol can trigger a “discontinuation syndrome” that can be challenging. Here are some reports from readers.

“After a freak accident, which resulted in a spiral fracture of my humerus and a fractured shoulder, I was given an opioid, then switched to Percocet. I asked for something that was not addictive and got a prescription for tramadol. They told me it was not addictive.

“It seemed to reduce pain more than the others and I was on it for a while. I decided to stop taking it, and as soon as I stopped, I had symptoms like the flu: shaking, sweating, body aches, runny nose. I felt horrible, but I didn’t have a fever.

“When I told my son how achy I felt, he said, Why don’t you take that medicine? I took one, and all those symptoms were gone.

“I went to the pharmacist and told her that I was having withdrawals, so I must be addicted to the tramadol. Again, I was told it wasn’t addictive or something I could become dependent on. I told her I needed to know how to come off it. She implied my problems were just psychological!

“I tried two more times before I just went cold turkey. My humerus hurt more after coming off of the tramadol than it ever did before. On the internet, I found multiple stories from folks, some saying it is harder to quit than heroin! Everyone should know about this.”

A health professional offered this perspective: “As a pharmacist in the early 2000s, I would call doctors to advocate for patients having withdrawal from tramadol. Generally, the doctors did not believe the patient or me. Occasionally, I got a doctor to agree to a small taper prescription, for which I gave the patient directions.

“This same problem occurs with high-dose steroids. Too many doctors think it’s OK to stop abruptly, but that’s a nightmare for patients.

“Good pharmacists are advocates for patients. It does take time, and that isn’t always available. How many times have you been helped by a pharmacist through your mail-order pharmacy? Can you even get through to them directly for information?”

We wish more health professionals were aware of the difficulty some patients have when stopping tramadol suddenly.

The discontinuation syndrome can be brutal and can last longer than many prescribers appreciate. Patients should be warned of this potential withdrawal problem before starting on tramadol. They should be given guidelines for stopping if that becomes necessary.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 300 W. 57th Street, 41st Floor, New York, NY 10019, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”